This exhibit was prepared in conjunction with the Colloquium Antiqua Medicina: Aspects in Ancient Medicine held on February 27, 1997 in University of Virginia’s McLeod Hall.

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Although the Greeks created rational medicine, their work was not always scientific in the modern sense of the term. Like other Greek pioneers of science, doctors were prone to think that more could be discovered through reflection and argument than by practice and experiment. There was not yet a distinction between philosophy and science, including the science of medicine. Hippocrates was the first to separate medicine from philosophy and to disprove the idea that disease was a punishment for sin. Much of the traditional treatment for injuries and ailments stemmed from folk medicine, a practice which uses the knowledge of herbs and accessible drugs, collected piece by piece through the ages, to cure everything from toothaches to infertility.

Red Figure, Attic Vase, 490 BCE, Louvre, Paris. Philoctetes bitten by a snake on Lemnos. While en route to Troy with the Greek army, the hero Philoctetes was bitten by a snake as he participated in a sacrifice to Chryse, a minor deity. The wound was so malodorous and caused Philoctetes to utter such inauspicious cries that his comrades marooned him on the island of Lemnos for the duration of the war. Philoctetes treated his wound with unspecified herbs until he was finally rescued from Lemnos and cured by the military doctors at Troy.

Stray references in Greek literature give us a better understanding of folk medicine and magic in Greek society. In Sophocles’s tragedy Philoctetes, the hero Philoctetes treats a snakebite on his foot using an unspecified herb as a palliative. The practice of singing incantations over wounds is mentioned in Homer’s Odyssey. Odysseus, wounded in his youth at a boar hunt, is said to have been skillfully bandaged by the sons of Autolycus, who then stopped the bleeding with incantations (Odyssey XIX, 455-458).

One of Hippocrates’s predecessors was Alcmaeon of Croton. In operating on the eye, Alcmaeon discovered ‘passages’ linking the sense organs to the brain, which he recognized as the seat of thought and feeling (an idea adopted by Plato, but not Aristotle). Alcmaeon was probably the first physician to formulate the doctrine of health as a balance among the powers of the body, these powers being constituent fluids with definite qualities and causal properties.

Fragment of a grave stele, Ionian, 5th century BCE: East Greek Tombstone of a Doctor. This tombstone can be identified as belonging to a doctor by the two small cupping vessels at the top of the stele. Because the marker is damaged, we cannot know whether the figure standing at right was a patient or an assistant.

Health, or isonome (”equality before the law“) was a balance between these fluids. When one dominated over another, illness, or monarche, developed. These terms, in another context, refer to the struggle between opposing political factions. Among the many qualities that needed to be held in balance were heat and cold, moisture and dryness, and bitterness and sweetness. This doctrine was later parlayed by Hippocrates into the Theory of the Four Humors, which provided the basis for medical theory up until the time of the American Revolution.

The philosophers/physicians Empedocles and Anaxagoras were contemporaries of Alcmaeon. Like other scientists of their day, they inquired about such quasi-medical topics as the composition of matter (is the primary element earth, fire, or water?), the seat of the human soul (some believed it to be the heart, some the liver, and still others the diaphragm), and the procreative process of humans (most held that the male sperm was exclusively responsible for conception).

A cursory survey of medical thought and practice throughout antiquity makes two underlying themes apparent. Throughout antiquity and into the Middle Ages there was a nexus between medicine and philosophy. Scientists in the ancient world often were philosophers as well as physicians, and the distinction between the two fields was often blurred. At its inception in the sixth century BCE, ancient medicine was a mere branch of natural philosophy. Even in Late Antiquity, when the philosopher/physician Galen reigned supreme, philosophy was considered a necessary part of medical training.

Unlike philosophy and medicine, which worked in harmony, the tension between medicine and religious belief often stifled or impeded physiological research. Throughout antiquity, rational medicine and faith healing existed side by side, never fully divorcing themselves from one another. Roman medicine, especially, was an eclectic blend of rational Greek medicine, folk remedies, and religious cult practice. Like so many other aspects of antiquity, medicine was truly interdisciplinary, influencing and in turn being influenced by art, literature, philosophy, politics, and in no small way, religion.

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The common practice among professional generals of the Hellenistic world was to campaign in the company of a personal physician. Literary sources leave us with the distinct impression that the wounded treated by these physicians were of the higher ranks, and there is little indication that the common soldiers had access to medical care. Instead, some troops functioned as medical staff as the need arose.

Fragment of  the Trajan column, Rome, dedicated 113 CE. Soldiers aiding their wounded comrades

Trajan’s Column commemorates the emperor Trajan’s Dacian Wars, fought at the beginning of the second century CE. This scene illustrates the treatment of the wounded under battlefield conditions. The medici (doctors) treating the wounded are dressing superficial wounds and their uniforms are identical with that of the soldiers they are aiding. This leads us to believe that the medici were simply soldiers who had demonstrated their capabilities for wound dressing and primitive surgery, not trained physicians.

Before Hellenistic influence, the Roman legion did not offer any medical services. It is to the Romans’ credit that they recognized the need for such services, but their solution was not a corps of trained physicians. The Romans clearly distinguished between the treatment of the “sick” and the “wounded.” The wounded were cared for, as much as possible, by fellow soldiers on the fields, and the transportable sick were placed in valetudinaria (hospitals) along with the severely wounded.

The Roman poet Virgil (70-19 BCE) composed an epic poem, titled the Aeneid, about the events leading up to the foundation of Rome. It follows the adventures of the Trojan hero Aeneas who was forced to do battle with the native inhabitants of Italy upon immigrating there from Troy.

Detail from wall painting from Casa di Sirico, Pompeii, 1st Century BCE, Naples National Archaeological Museum. Aeneas receiving medical attention from Iapyx

In one of the climactic scenes at the poem’s conclusion (Aeneid XII.383-440), Aeneas is wounded in the thigh by an arrow shaft hurled from the enemy camp. After the wounded Aeneas is carried off the battlefield, the surgeon Iapyx attempts to remove the arrow with forceps. When he is unsuccessful, Venus, Aeneas’s divine mother, intervenes. From across the Mediterranean at Mt. Ida near Troy, she brings dittany, an unknown herb, to heal the wound. Cicero, in the philosophical treatise De Divinatione, says that dittany was supposed to make arrows fall out of goats’ bodies.

Although he was unable to help Aeneas, Iapyx was given his skill of practicing the “silent arts,” i.e., medicine, by Apollo himself. Of Apollo’s three realms— music, prophecy, and healing—it is only healing in which the voice is not used, hence medicine was known as the silent art. This phrase also invokes the idea of obscurity, as the profession of medicine was not thought to lead to great fame.

Drawing of Attic Black Figured Vase, 6th Century BCE, National Museum Athens. Sthenelos bandaging Diomedes’ index finger

The episode between Sthenelos and Diomedes portrayed here is not mentioned in any extant saga of the Trojan War. In the Hippocratic treatise, In the Surgery, the injuries of war figure prominently, and the author states bluntly that “he who desires to practice surgery must go to war.”

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In ancient Greek society, male dominance extended even to childbirth. Greek medicine cast man as the bringer of sanity and health to the biologically defective, subservient woman through intercourse, which was believed to relieve the buildup of menstrual blood around the heart. Men also received full credit for conception, since the womb was seen mainly as a receptacle for sperm. Abortion, if not condoned in the Hippocratic Oath, was permitted under Greek law, and infanticide, particularly of female newborns, was widely practiced.

Marble votive relief fragment of goddesses, mother, nurse, and infant, late 5th century BCE, New York, Metropolitan Museum of Art, 24.97.92

To the left is a stone sculpture showing a woman who has just given birth and presumably prepares to nurse, her right breast exposed. The mantle that is draped over the new mother’s head refers to the miasma, or state of pollution, that was believed to attend a woman following childbirth. The distress of the woman is clearly apparent as she slumps forward and grips the seat for support. A nurse stands behind her holding the newborn baby. The size of the figure in front of the mother indicates she is a goddess, most likely Eileithyia, goddess of childbirth, or Hygieia, goddess of good health, cleanliness, and sanitation. Thus the relief may be a votive dedication.

Birth Control

Women in the ancient world practiced birth control with little interference from religious or political authorities. A precise knowledge of plants which could either block conception or cause abortion was resident in the oral female culture of herbalists and midwives.

Arkesilas Cup, King Arkesilas of Cyrene overseeing workers, Laconian black figured cup, 600-550 BCE, Paris, Cabinet des Medailles, Wikimedia

One of the most common contraceptive agents used in the ancient Mediterranean world was silphium which grew exclusively in the area of Cyrene in North Africa. Since Cyrene was the sole exporter of the plant, it became the city’s official symbol on its coinage, and it remained the city’s primary source of income until the first century BCE. On the cup to the left, workers weigh and store packages of goods under the supervision of Arkesilas, King of Cyrene. Some scholars suggest the product is silphiun.

Other plants used in classical times as contraceptives or abortifacients included pennyroyal, artemisia, myrrh, and rue. In Aristophanes’s comedy Peace, first performed in 421 BCE, Hermes provides Trigaius with a female companion. Trigaius wonders if the woman might become pregnant. “Not if you add a dose of pennyroyal,” advises Hermes. Pennyroyal grows in the wild and would have been readily available to ancient women. Recent studies show that pennyroyal contains a substance called pulegone that terminates pregnancy in humans and animals.

Dioscorides, Galen, and other ancient medical writers believed that the pomegranate possessed antifertility properties. The best known literary reference to its contraceptive power is in the Greek myth of Persephone and Hades. For every pomegranate kernel that Persephone ate, that many months were allotted to the infertile fall and winter.

Caesarean Section

The Caesarean section operation did not derive its name from the story that Julius Caesar was born in this manner. It was called Caesarean because the Roman, or Caesarean, law demanded that when a pregnant woman died, her body could not be buried until the child had been removed. The law also stipulated that a Caesarean section could not be performed on a living pregnant woman until the tenth month of gestation. Ancient physicians were unable to save the life of the mother in such cases, thus the procedure was rarely performed. We know from ancient sources that Julius Caesar could not have been born by Caesarean section, because his mother, Aurelia, lived to be an adviser to her grown son.

Hysteria and the Wandering Womb

The word “hysteria” is derived from the Greek word hystera, “womb.” Greco-Roman medical writers believed that hysteria was caused by violent movements of the womb and that it was, therefore, peculiar to women. As early as the sixth century BCE, medical writers believed that the womb was not a stationary object, but one that traveled throughout the body, often to the detriment of the woman’s health. Aretaeus of Cappadocia, a contemporary of Galen, included in his medical treatises a section describing the wandering womb.

In women, in the hollow of the body below the ribcage, lies the womb. It is very much like an independent animal within the body for it moves around of its own accord and is quite erratic. Furthermore, it likes fragrant smells and moves toward them, but it dislikes foul odors and moves away from them… When it suddenly moves upward [i.e., toward a fragrant smell] and remains there for a long time and presses on the intestines, the woman chokes, in the manner of an epileptic, but without any spasms. For the liver, the diaphragm, lungs and heart are suddenly confined in a narrow space. And therefore the woman seems unable to speak or to breathe. In addition, the carotid arteries, acting in sympathy with the heart, compress, and therefore heaviness of the head, loss of sense perception, and deep sleep occur… Disorders caused by the uterus are remedied by foul smells, and also by pleasant fragrances applied to the vagina…

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Portrait of Andreas Vesalius (1514-1564) from De Fabrica, second edition, 1555, preface page 9 verso, Historical Collections, Claude Moore Health Sciences Library, University of Virginia

Modern medicine began in 1543 with the publication of the first complete textbook of human anatomy, De Humanis Corporis Fabrica by Andreas Vesalius (1514-1564). Vesalius can only be compared with Hippocrates in stature and importance. The great anatomist was a classicist by education. He knew Greek and Latin to perfection. He zealously studied the ancient authors and extolled them. In this sense, Vesalius was a humanist.

De Fabrica is composed in Latin. Few scientists, if any, of the sixteenth century would have presented their findings in the vernacular. But Vesalius renounced the Latin that was spoken and written by scholars of his time. He purified the common stock of words; he abandoned the simple colloquial prose style, the logical sequence of thought characteristic of the scientific literature of that period. Instead, Vesalius reintroduced the terminology of a time long past. He adopted a stately rhythmical style, a rhetorical word order; in short, he was the first anatomist to imitate the periodic Latin Kunstprosa, or “artistic prose” of Cicero.

The Classical Latin style in which Vesalius formulated his findings made it rather difficult for the average physician of his day to understand De Fabrica. Many a contemporary reader have wondered why Vesalius veiled his empirical investigations in the garb of so artificial a language. Yet, Vesalius believed that by recovering true and correct speech, the road was paved for the recovery of true and correct knowledge. Thus, the resurrection of anatomy could only occur hand in hand with the rebirth of the Classics.

However revolutionary his achievements may seem to the modern historian, for Vesalius, it was only the revival of the work of ancient anatomists. Anatomy, according to Vesalius,

…should be recalled from the dead, so that if it did not achieve with us a greater perfection that at any other place or time among the old teachers of anatomy, it might at least reach such a point that one could with confidence assert that our modern science of anatomy was equal to that of old, and that in this age anatomy was unique both in the level to which it had sunk and in the completeness of its subsequent restoration.

–De Fabrica, praefatio, 3r, ll.22ff.

Humanists viewed the development of art and literature during the Renaissance as a rebirth of the truth and perfection once possessed by the Greeks in antiquity. Vesalius extended this humanism to include anatomy. He knew from reading Cicero and Celsus that the ancients had dissected human bodies; he learned from Galen that Alexandria had been the center of anatomical research. Modern anatomy was indeed the resurrection of ancient anatomy.

Detail of De Fabrica frontispiece, 1543 edition

The image shown here is a detail taken from the frontispiece of the 1543 edition of De Fabrica, in all probability designed by Johannes Stephan van Calcar, a pupil of Titian. The plate shows Vesalius at one of his lectures on anatomy. The bearded figure of Vesalius stands in the middle beside the dissecting table, performing an autopsy on the cadaver of a woman. The full frontispiece shows Vesalius surrounded by a crowd of about 70 students and spectators of all ages.

It is noteworthy that neither Asclepius nor his rod-and-serpent is depicted in the frontispiece of the De Fabrica. Although Vesalius believed modern anatomy was the resurrection of Classical anatomy, he considered himself a scientific “progressive” and was not particularly enamored of the magical, miraculous cures of Asclepius’s cult and felt no need of a medical symbol, the origin and meaning of which he must have considered dubious.

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Votive relief from Asklepieion of Piraeus, 4th century BCE. Archaeological Museum, Piraeus, Greece.

Hippocratic principles were directly opposed to magic and ritual. However, the continuing success of the cult of Asclepius throughout antiquity clearly shows that medicine was never fully divorced from religion. Beginning in the sixth century BCE, health resorts, or sanctuaries, known as Asklepia (because they were presided over by Asclepius, the god of healing) sprang up all over the Mediterranean. The cult of Asclepius was simultaneously a religion and a system of therapeutics. In the panel to the left, a temple physician massages a patient’s shoulder while a priestess, serving as a nurse, looks on.

Ex-voto tablet from Epidauros, 3rd Century BCE, National Archaeological  Museum, Athens. Note the large vein on the leg.

Although medical treatment was free at Asklepia, a recovered patient was expected to make a votive offering, which sometimes took the form of a replica of the afflicted organ or limb. A patient is shown dedicating a large votive leg to Asclepius in thanks for curing his varicose veins. In these Asklepia, special rites were observed. After purification baths, fasting, and sacrifices, the patient would spend the night in the god’s temple, a process called enkoimesis, incubatio (“sleeping in”). During the night Asclepius would appear to the sleeping patient in a dream and give him advice. In the morning priests would interpret the dream and explain the god’s precepts. Patients thanked Asclepius by tossing gold into the sacred fountain and by hanging ex-votos on the walls of the temple.

Silver tetradrachm, Epidauros, 350-330 BCE.

This coin was minted at Epidauros, the site of the great healing sanctuary of Asclepius. The god became a symbol of the city. He is shown on the reverse of the coin accompanied by a serpent. The letter E to the right of the figure is short for Epidauros.

The Healing of Archinus, ex-voto tablet, c. 370 BCE, National Archaeological Museum, Athens

This famous dedication was made by Archinus at the healing shrine of Amphiaraus at Oropus, on the borders of Boeotia and Attica. The cult at Oropus was one of incubation, and on the right, we see the patient asleep on a couch. In the left foreground, Amphiaraus, like a human doctor, is treating the patient’s right shoulder: this scene represents the supposed content of Archinus’s dream. But, in the same scene, a sacred snake, a healing animal, is shown licking or biting the same right shoulder of the sleeping patient: this is the cure as it would supposedly have appeared to a waking observer. Behind, on a pillar, a votive stele commemorates the god’s act of healing. The figure on the right might perhaps be yet a third representation of Archinus, in this case, gratefully dedicating his stele.

There are hundreds of extant inscriptions and votive reliefs recounting the individual cures of patients at the Asklepia. The following examples were found at the ruins of the Asklepion in Epidauros:

•     Ambrosia, a woman of Athens, was blind in one eye. After laughing at some of the cures by which the lame and the blind were healed, while dreaming, she sees Asclepius standing beside her. He tells her that he will cure her if she promises afterwards to dedicate a silver pig as a memorial of her ignorance. Then he cut the diseased eyeball and poured in a drug. When day came, she walked out sound.
•     Agestratus was cured of headaches so severe he was unable to sleep.
•     Gorgias, having a suppurating wound made by an arrow that had pierced his chest, slept beside an altar and awakened with a sound skin, holding the arrow point in his hand.
•     Euhippus had had a spear point fixed in his jaw for six years. As he was sleeping in the temple Asclepius pulled out the spearhead. When day came Euhippus departed cured and holding the spearhead in his hands.

Votive terra cotta offerings from Cerveteri, Etruria, now in Museo Gregoriano Etrusco, 3rd century. Foot.

Votive terra cotta offerings from Cerveteri, Etruria, now in Museo Gregoriano Etrusco, 3rd century. Hand.

Votive terra cotta offerings from Cerveteri, Etruria, now in Museo Gregoriano Etrusco, 3rd century. Digestive organs.

The hand (left) and foot (right) in this collection of votive terra cottas are both painted red. Therefore, they represent the limbs of a male; in ancient Mediterranean art, the flesh of men was painted red and the flesh of women, white or pink. The sculpture was made in a mold that had been reused a number of times; consequently, sculptured details like the fingernails are only faintly visible. The esophagus, stomach, intestine, and kidneys are visible in this curious representation of the digestive organs. It was offered as a gift to a divinity either in gratitude or as a plea for healing.

The cult of Asclepius also existed in Rome after 291 BCE. No trace of the sanctuary of Asclepius in Rome exists, but the cult was immensely popular as evidenced by the number of terra cottas. These offerings depicted parts of the human body, often at greater than life size, and were dedicated by the afflicted at healing sanctuaries. More than 100 sanctuaries in Italy are known, the majority in western-central Italy, and it is clear that the inspiration for these temples stemmed ultimately from the temple in Rome itself.

Other cult centers sprang up across Italy. Study of the terra cottas from these precincts reveals the emergence of some specialized centers in healing. At Ponte di Nona, e.g., a rural complex some 15 kilometers to the east of Rome, the collections are dominated by feet and hands– precisely the parts of the body which are likely to suffer damage in the course of agricultural work. In the town of Veii, on the other hand, the terra cottas from the Campetti sanctuary contain a huge proportion of male and female sexual organs. If not associated with some form of fertility cult, these may well hint at a high incidence of sexually transmitted diseases, of a sort that might well be picked up in an urban brothel.

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Stone relief of childbirth from Isola Dell’ Sacra, Ostia, 1st century CE

This relief of a scene in childbirth portrays a midwife in the midst of a delivery aided by an assistant who stands behind the birthing chair. The assistant grips the mother around the chest to steady her.

Agnodice is a figure often mentioned in the histories of the medical profession, but her story is largely unfamiliar to Classicists. She is credited with achieving the role of physician, although it was forbidden to her by law. It is highly unlikely that she was an veritable historical figure in third century Athens; more likely, she belongs to the realm of myth and folk tale. Her story comes to us through Hyginus, a Latin author of the first century CE:

A certain maiden named Agnodice desired to learn medicine and since she desired to learn she cut her hair, donned the clothes of a man and became a student of Herophilos. After she learned medicine, she heard a woman crying out in the throes of labor so she went to her assistance. The woman, thinking she was a man, refused her help; but Agnodice lifted up her clothes and revealed herself to be a woman and was thus able to treat her patient. When the male doctors found that their service were not wanted by the women, they began to accuse Agnodice, saying that she had seduced the women and they accused the women of feigning illness [to get visits from Agnodice]. When she was brought before the law court, the men began to condemn Agnodice. Agnodice once again lifted her tunic to show that she was indeed a woman. The male doctors began to accuse her all the more vehemently [for breaking the law forbidding women to study medicine]. At this point the wives of the leading men arrived saying “you men are not spouses but enemies since you are condemning her who discovered health for us.” Then the Athenians emended the law so that freeborn women could study medicine.

Midwives from the seventeenth century to the present day have used this tale to defend themselves against a male-dominated profession seeking to medicalize childbirth. Agnodice has been invoked as fact, and cited as a pioneering midwife, a precedent for women in medicine in general.

However, as much as traditional medical history focuses on pioneering individuals who struggle against the odds and win—and indeed Agnodice fits well into such a tradition—it is highly unlikely that Hyginus’s account is based upon fact. The act of lifting the skirts to reveal one’s sex is a common folk-tale motif found in other stories. Terra cotta figurines of women lifting their garments, which date to the fifth to third centuries BCE, are generally interpreted as apotropaic, driving evil forces away. The story of Agnodice may simply be an explanation for such a figure. Furthermore, the name Agnodice literally means “chaste before justice,” a coincidence which suggests her name stems from this tale—a not uncommon device in Greek literature.

Terra cotta statuette from Priene, c. 5th-3rd century BCE. Baubo

During the 1898 excavations at Priene, German archaeologists unearthed a number of figurines such as the one pictured at left. They have subsequently been identified as statuettes of the mythical woman Baubo. According to Greek myth, Baubo amused the goddess Demeter by painting a face on her belly, pulling up her dress over her head and dancing. Figurines of women pulling apart their skirts to expose their genitals have been found elsewhere in the Mediterranean and their existence may be connected in some way to the tale of Agnodice.

The story of Agnodice underlines one of the major problems in treating female patients. As the author of the Hippocratic treatise De morbis mulierum (1.62) explains, women were loathe to confide in doctors, and this often interfered with successful treatment. However, it is not surprising that women were less than cooperative when one considers they were brought up in seclusion and taught to be ashamed of their bodies.

Gynecology was not always the province of male physicians. Before the fifth century BCE and the advent of Hippocratic medicine, childbirth had been entrusted to the informal care of female kin and neighbors who had themselves given birth. Some of these women became known for their skills and were accorded the informal title of maia or “midwife.” As they worked, they accumulated lore about other aspects of women’s reproductive lives, such as fertility, abortion, contraception, and even (in imagination, if not in reality) sex determination.

But, by the time the Hippocratic treatises were composed in the late fifth century BCE, this traditional female monopoly in childbirth was breaking down; male doctors were increasingly involved in gynecological cases, as evidenced by the creation of treatises dealing with such problems.

The shift from female control to male involvement came about largely because men were suspicious of women’s reproductive autonomy. Female patients described in the Hippocratic treatises, and for that matter, in Greek literature in general, were often suspect by men. A wife’s potential to sabotage her husband’s lineage was a great source of anxiety for men. Thus, women’s struggle to control their own bodies was a volatile issue in antiquity, even as it is today.

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Recovered surgical instruments used during the Roman Empire indicate that the art of surgery progressed and proliferated greatly during this time. Both Galen and Celsus emphasized the importance of surgery in the training of the conscientious physician, although they came from divergent medical traditions (Celsus, prooemium VII; Galen, II, 272).

Technical competence in surgery became better as new medical tools were devised. New metals and alloys were found to provide sharper edges and cheaper equipment. Most instruments were made of bronze, or occasionally of silver. Iron was rarely used because, as in most ancient cultures, it was considered a religious taboo by both the Greeks and Romans. The full repertoire of Roman surgical equipment is still far from completely known.

Bas Relief Fragment, 4th Century CE, Athens, National Museum. This shows a doctor performing an operation on a patient’s head while Asclepius (identifiable by his superhuman size and the caduceus in his right hand) looks on.

Occasionally instruments not originally manufactured for surgical purposes were implemented. Galen and Celsus both mention that the strigil, a curved piece of metal with a handle used for scraping oil and sweat off the body after exercise, was often used to get into small openings. Galen instructs, “after having heated the fat of a squirrel in a strigil, insert it into the auditory canal” (Galen, XII, 623).

While a cursory reading of Celsus’s summaries on surgery indicate a sure knowledge of human anatomy, doctors still needed good tools and experience (and patients, courage) for surgery to go smoothly. The patient’s chances of recovery increased if the head and abdomen were not involved.

Archaeological remains of what appear to be surgeons’ “shops” are common enough to indicate that some physicians specialized in surgery. Particularly famous is the so-called House of the Surgeon at Pompeii, where most of the surgical tools now housed in Naples were found. Philological evidence seems to support the idea that there was at least some distinction, even if not a rigid one, between general practitioner and surgeon. Medieval texts distinguish the two positions with different terms: medicus for a doctor, and magister for a surgeon.

Detail of a Stele from Herculaneum, 1st Century BCE. Here, a surgeon excises an arrow from a wounded soldier. Both men are depicted nude, suggesting that the episode stems from a mythic tale.

Galen wrote detailed instructions on the use of surgical instruments, the variety of which proliferated under the Romans. Yet, the makers of these medical instruments are at best shadowy figures. It seems improbable that there would have been sufficient demand for craftsmen dealing exclusively in medical instruments, and there is no known inscription naming such a specialist. The well-known relief pictured to the left suggests that some medical instruments may have been manufactured by specialist blade makers rather than by craftsmen specializing in medical instruments.

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Pliny, in his Natural History, says that the first doctor (medicus) to come to Rome was Arcagathus. He arrived from the Greek Peloponnese in 219 BCE and was well received. Arcagathus was accorded the rights of citizenship and a medical shop was set up at state expense for his use. Prior to this time, Rome had no physicians and only home remedies were used.

Because Arcagathus was an expert wound surgeon (uulnerarius), he immediately became popular; however, his popularity did not last. His vigorous use of the knife and cautery soon earned him the title “Executioner”(Carnifex). Over 100 years lapsed before we hear that another Greek physician (Asclepiades of Bithynia, ca. 100 BCE) had taken up residence in Rome.

Reverse of a bronze medallion of Antoninus Pius, Emperor of the Roman Empire from 138 to 161 CE, Rome. Tiber welcomes Asclepius in the form of a snake.

In 295 BCE a plague ravaged Rome and the Romans decided to appeal to the Greek god of medicine. No doubt the Romans had heard of the success of the medical shrines in the Hellenistic world and hoped some of this power might be transferred to Rome. A temple to Asclepius was built on an island in the Tiber, not inside Rome, reflecting a suspicion of  foreign gods. The pestilence soon went away and the popularity of the new cult was assured. The introduction of Asclepius is the first event of “medical history”in Rome.

Before the arrival of Arcagathus, early Roman medicine was agriculturally based. Early authors of agricultural treatises, such as Cato the Elder and Columella, both from the early second century BCE, had as much to say about medicine, or home remedies, as they had to say about growing seasons, animal husbandry, and slave discipline. In Cato’s time, the pater familias, or head of the family, was the dispenser of remedies. His knowledge of the farm and its needs was thought to best qualified him to deal with matters of health.

Early Roman medicine characteristically relied on one or two remedies. According to Pliny, the “early Romans gave wool awesome powers,”confirming the religious-agricultural context of early remedies. Unwashed wool, dipped into a mixture of pounded rue and fat, was good for bruises and swellings, according to the early traditions. Rams’ wool, washed in cold water and soaked in oil, was used to soothe uterine inflammations. Wool dipped into a mixture of oil, sulphur, vinegar, pitch, and soda cured lumbago.

Yet, for all its uses, wool was not the cure-all that cabbage was, at least for Cato. Cato advocated not only the consumption of cabbage itself to fend off illness, but drinking the urine of a person who has eaten cabbage.

Some of Cato’s cures were applicable to humans as well as to the livestock on the farm:

If you have reason to fear sickness, give the patient/oxen before they get sick the following remedy: 3 grains of salt, 3 laurel leaves, 3 leek leaves, 3 spikes of leek, 3 of garlic, 3 grains of incense, 3 plants of Sabine herb, 3 leaves of rue, 3 stalks of bryony, 3 white beans, 3 live coals, and 3 pints of wine. You must gather, macerate, and administer all these things while standing, and he who administers the remedy must be fasting. Administer to each ox or to the patient for three days, and divide it in such a way that when you have administered three doses to each, you have used it all. See to it that the patient and the one who administers are both standing, and use a wooden vessel.

The repetition of the number three in this cure connotes a element of magic. The greater part of this remedy consists of foodstuffs from the pantry. Possibly the standing position is a remnant of psychological factors pointing to an earlier time of medicine man or shaman. The insistence upon a wooden bowl shows this recipe to be an ancient one.

The Romans inherited some of their ideas of anatomy and medicine from their Etruscan ancestors and adapted them to the practice of the official state religion. This is true for the practice of hepatoscopy, or reading the divine signals in animal livers. Model bronze livers, unearthed in Etruria, were used by priests to interpret omens within the liver. Hepatoscopy had its origins in Near Eastern practice and was only performed by state-appointed priests.

Thus Roman medicine can be divided into three distinct areas: (1) the agricultural home remedies of the pater familias; (2) the state religion as handed down from the Etruscans; and (3) the private practitioner using Greek medical principles.

Opposition to the introduction of Greek medicine in Rome by Arcagathus was the result of several factors: political strife in the Roman nobility, hostility against Greek culture, fear of Arcagathus’s surgical and pharmaceutical treatments, and loathing for the mercenary character of the medical profession, which was regarded as a sign of luxury. In the period following the Second Punic War, in the early second century BCE, sumptuary laws were passed to combat conspicuous consumption. The introduction of Greek doctors into the households of the Roman nobility was seen as a degenerative sign; the Romans were succumbing to Greek culture and practices.

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Bibliography:

• Bandinelli, Ranucci Bianchi , Rome: The Center of Power (New York, 1970).
• Boardman, John, The Oxford History of Classical Art (Oxford, 1993).
• —, The Cambridge Ancient History Plates to Vols. V & VI (Cambridge, 1994).
• Buranelli, Francesco, The Etruscans: Legacy of a Lost Civilization from the Vatican Museum’s Exhibition Catalog (Memphis, 1992).
• Cartelli, Giovanni Pugliese, et al., Megale Hellas (Milan, 1983).
• Constable, George, ed., Empires Ascendant: Time Frame 400 BC – AD 200 (Richmond, 1987).
• Enciclopedia dell’arte antica classica e orientale IV, (Rome, 1990).
• Feder, Theodor, Great Treasures of Pompeii and Herculaneum (New York, 1978).
• Kray, Colin M., Greek Coins (London, 1966). Lexicon Iconographicum Mythologiae Classicae (LIMC) VI.2 (Munich, 1981).
• Lyons, Albert S., and Petrucelli, Joseph, Medicine: An Illustrated History (New York, 1978).
• MacKinney, Loren, Medical Illustrations in Medieval Manuscripts (Los Angeles 1965).
• Neret, Gilles, David, la terreur et la vertu (Paris, 1989).
• Olender, Maurice, “Aspects of Baubo: Ancient Texts and Contexts,” in Before Sexuality: The Construction of Erotic Experience in the Ancient World, From Zeitlin, ed. (Princeton, 1990).
• Pope-Hennessey, John, Fra Angelico (London, 1974).
• Reeder, Ellen D., Pandora: Women in Classical Greece (Princeton, N.J., 1995).
• Riddle, John M., Contraception and Abortion from the Ancient World to the Renaissance (London, 1992).
• Rousselot, Jean, Medicine in Art: A Cultural History (New York, 1967).
• Rowland, Benjamin, Drawings of the Masters (New York, 1965).
• Scarborough, John, Aspects of Roman Medicine (London, 1969).
• Schoene, Herman, Illustrierter Kommentar zu der hippokratischen Schrift Peri Arthron (Leipzig, 1890).
• van der Meer, L. Bouke, The Bronze Liver of Piacenza: analysis of a polytheistic structure (Amsterdam, 1987).
• Vogt, Paul, Carstensen, Gert & Schaewaldt, Hans, Die Chirurgie in der Kunst (Vienna, 1983).

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If the work of Hippocrates represents the foundation of Greek medicine, then the work of Galen, who lived six centuries later, is the apex of that tradition. Galen crystallized the best work of the Greek medical schools which had preceded his time. It is essentially in the form of Galenism that Greek medicine was transmitted to the Renaissance scholars.

Woodcut illustration from a Venetian edition of Galen’s works, 1550. Collection Bertarelli, Milan. Medicatrina, Clinic Scene.

Galen hailed from Pergamon, an ancient center of civilization, containing, among other cultural institutions, a library second in importance only to Alexandria’s. Galen’s training was eclectic. Although his chief work was in biology and medicine, he was also known as a philosopher and philologist. Training in philosophy was, in Galen’s view, an essential part of the training of a doctor, not merely a pleasant addition. This illustration accompanying Galen’s work shows the surgical procedures described by Galen—on the head, eye, leg, mouth, bladder and genitals— still practiced in the 16th century.

His treatise entitled That the Best Doctor is Also a Philosopher provides a rather surprising ethical reason for the doctor to study philosophy. The profit motive, says Galen, is incompatible with a serious devotion to the art of healing. The doctor must learn to despise money. Galen frequently accused his colleagues of avarice.  In order to defend his profession against this charge, he downplayed the motive of financial gain associated with becoming a doctor.

For his first professional appointment, Galen served as surgeon to the gladiators in Pergamon. In this tenure, he undoubtedly gained much experience and practical anatomical knowledge from the combat wounds he treated. After four years, he emigrated to Rome where he earned a brilliant reputation as a practitioner and a public demonstrator of anatomy. The emperors Marcus Aurelius, Lucius Verus, Commodus, and Septimius Severus sought his care.

Galen on the Soul

Postage Stamp, 1977. People’s Democratic Republic of Yemen. The stamp is a testament to Galen’s lasting influence.

The fundamental principle of life, in Galenic physiology, was pneuma (air, breath). Pneuma took three forms and had three types of action: animal spirit (pneuma physicon) in the brain, center of sensory perceptions and movement; vital spirit (pneuma zoticon) in the heart, center of blood flow regulation and body temperature; and natural spirit (pneuma physicon) residing in the liver, center of nutrition and metabolism (both animal and natural spirit are known as pneuma physicon, or sometimes the animal spirit is known as pneuma psychicon).

Galen studied the anatomy of the respiratory system, and of the heart, arteries, and veins. But he did not discover the circulation of the blood in the body, and he believed that blood passed from one side of the heart to the other through invisible pores in the dividing wall. Galen was convinced that the venous and arterial systems were each sealed and separate from each other. William Harvey, discoverer of the circulation of the blood, wondered how Galen, having gotten so close to the answer, did not himself arrive at the concept of circulation.

Galen’s Physiology

Detail of a Manuscript Illustration of Hippocrates, Galen and Avicenna from an edition of the works of Galen, Lyons, 1528, National Library of Medicine, Bethesda. As Galen looked back to Hippocrates as his authority, so Avicenna looked to Galen.

Galen’s genius was evident in the physiological experiments he conducted on animals. The work On the Use of the Parts of the Human Body comprised seventeen books concerning this topic. To study the function of the kidneys in producing urine, he tied the ureters and observed the swelling of the kidneys. To study the function of the nerves he cut them, and thereby showed paralysis of the shoulder muscles after division of nerves in the neck and of voice loss after interruption of the recurrent laryngeal nerve.

Because his knowledge was derived for the most part from animal (principally the Barbary ape), rather than human, dissection, Galen made many mistakes, especially concerning the internal organs. For example, he incorrectly assumed that the rete mirabile, a plexus of blood vessels at the base of the brain in ungulate animals, was also present in humans. In spite of Galen’s mistakes and misconceptions, his writings reveal an astonishing wealth of accurate detail.

Galenism

Galen, for all his mistakes, remained an unchallenged authority in his lifetime, and his work established a legacy that continued for over a thousand years. In his day Galen said everything there was to be said on anatomy. According to reports he kept as many as 20 scribes on staff to write down his every dictum. When he died in 203 CE, serious anatomical and physiological research ground to a halt.

Although he was not a Christian, Galen’s writings reflect a belief in only one god, and he declared that the body was an instrument of the soul. This made him acceptable both to the fathers of the church and to Arab and Hebrew scholars. Galen’s mistakes perpetuated fundamental errors for nearly fifteen hundred years.  Later, Vesalius, the sixteenth century anatomist, began to dispel Galen’s authority, although he regarded his predecessor with esteem.

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Surgical Examination of a Fractured Cranium

MSS from North Italy, circa 1300, Rome. Biblioteca Casanatense, Rolandus Parmensis, Chirurgia, I, 5-6, Surgical examination of a fractured cranium

Broken heads were handled with care. Here the physician (magister), with hands on each side of the body, makes a careful examination, exploring the fracture with a finger. According to Rogerius (Chirurgia I, 4), “there is no better method of identifying a cranial fracture.” As indicated in the accompanying text, he will probably trephine, then cleanse the wound (note the cloth held by the assistant) and medicate (note the flask of medicine held by his assistant). A surgical ointment called apostolicon chirurgicum was much used in such cases. The text above the picture reads as follows:

Concerning cranial fracture in the shape of a fissure. Sometimes it chances that the cranium is fractured like a fissure and is split so that neither side seems higher than the other; also that it is uncertain whether the fracture extends inside the cranium. To find out, have the patient hold his mouth and nostrils shut, then blow vigorously; if any breath comes out of the cleft, you know that the cranium is fractured even into the cerebrum. Treat as follows. If the wound is narrow, enlarge it, and unless prevented by bleeding immediately trephine with an iron instrument, very cautiously on both sides of the fissure. Make as many holes as seems wise, then cut the cranium from one whole to another with a bistoury (spathumina), so that the incision extends to the edge of the fissure. Carefully remove pus oozing from above the cerebrum with a silk from a fine linen cloth introduced sideways between the cerebrum and cranium by means of a feather… [then medicate].

Celsan Operation for Bladder Stones

Manuscript from North Italy circa 1300, Rome. Biblioteca Casanatense, Rolandus Parmensis, Chirurgia III, 34, Celsan operation for bladder stones

Throughout the ancient and medieval times bladder stones were removed by a method called “Celsan” because of Celsus’ detailed description in his De Medicina (VII, 26). According to him, and also Rogerius (Chirurgia III, 41-43), after the patient dieted for several days the stone was worked down into the urinary tract. Manuscripts of John Arderne’s fourteenth century Chirurgia contain marginal sketches showing the stone worked out into the penis whence it was excised. In the traditional procedure, however, the physician inserted a finger in the anus to work the stone downward to the outlet of the bladder while he pressed externally to assist in controlling the movement. This is described in the text which follows the miniature. Once the stone was worked to the outlet of the bladder, it was removed by surgery. The operation (as today) was performed from the rear. This is shown in the miniature, with the patient in the traditional position, legs jack-knifed, held firmly by assistants (discipuli) while the surgeon extracts the stone through a bloody incision. The text below the picture, along with the preceding section of text, describes the operation and also pre- and post-operational treatment as follows:

If there is a stone in the bladder, make sure of it as follows: have a strong person sit on a bench, his feet on a stool; the patient sits on his lap, legs bound to his neck with a bandage, or steadied on the shoulders of the assistants. The physician stands before the patient and inserts two fingers of his right hand into the anus, pressing with his left fist above the patient’s pubes. With his fingers engaging the bladder from above, let him work over all of it. If he finds a hard, firm pellet it is a stone in the bladder, which is soft and fleshy; thus you find that it impedes urination; if you want to extract the stone, precede it with a light diet and fasting for two days beforehand, On the third day, having done everything beforehand, as we said, to find whether there is a stone in the bladder, locate the stone, bring it to the neck of the bladder; there, at the entrance, with two fingers above the anus, incise lengthwise with an instrument and extract the stone… [medication, morning and night for nine days]. –Rogerius, Chirurgia, III, 36

Vertebra Reduction by Jolting on a Ladder

Manuscript from Byzantium, c. 1100, Florence. Laurentian Library, MS 74.7, folio 200, Apollonius, Dislocations, 2, in Greek, Reduction by jolting on a ladder

In spinal reductions the merited reputation of the ancient Greeks for progressive medical methods has an exception, the brutal method of reducing the spinal dislocation by tying the patient (or victim) to a ladder which has dropped to the ground vertically so as to jolt the displaced vertebrae into proper alignment. This procedure was described in the fifth century BCE Hippocratic treatise On Joints (Peri Arthron) ch. 44, copied and illustrated four centuries later by Apollonius in Dislocations ch. 2, to be copied and recopied into two other Greek manuscripts. According to the Hippocratic tradition, a “humpback,” considered almost incurable, might be treated by jolting the patient while tied to a ladder. This procedure can be seen in our miniature and followed in detail in the accompanying text.

Cases where the curvature is low on the spine are best treated with the head downward… Pad the ladder… Lay the patient on it, on his back, using soft but strong bandages, tie his ankles to the ladder; bind his legs together below and above the knees and bandage to the hips. Bandage him loosely at the flanks and chest; tie the arms and hands, extended along his sides, to the body, but not to the ladder. Then raise the ladder against a high tower or house. The ground should be solid and the assistants well trained so that they will let the ladder fall smoothly and in a vertical position…It is best to drop it from a mast by a pulley… Jolting is best done with such an apparatus, but it is disagreeable to discuss in detail. Cases where the curvature is high up on the spine are better treated with the feet downward…Bind the patient firmly to the ladder at his chest, but loosely at his neck, merely enough to keep it straight. Bring his head to the ladder at the forehead. Bind the rest of the body loosely here and there, only to keep it vertical… Fasten the legs together, but not to the ladder, so they hang in line with the back.

In modern times, until the nineteenth century, such procedures were used in medicine, and also in corporal punishment under the name strappado.

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The father of medicine as envisioned by a Byzantine artist. Portraits of Hippocrates represent the physician with a noble face and impressive body to match his intellectual attributes. Various dignified ancient busts have been said to represent Hippocrates, yet no original Greek portraits have survived; hence, our evidence comes from Roman copies. Hippocrates, Greek Manuscript 2144, f 10v c. 1342, Bibliotheque Nationale, Paris

We pass from myth to the opening of history. The central historical figure in Greek medicine is Hippocrates. The events of his life are shrouded in uncertainty, yet tales of his ingenuity, patriotism, and compassion made him a legend. He provided an example of the ideal physician, after which others, centuries after, patterned their existence.

He was associated with the Asclepium of Cos, an island off the coast of Asia Minor, near Rhodes, and with a group of medical treatises known collectively as the Hippocratic Corpus. Hippocrates was the first to give the physician an independent standing, separate from the cosmological speculator, or nature philosopher. Hippocrates confined the medical man to medicine. At the same time that he assigned the physician his post, Hippocrates would not let him regard the post as sacrosanct. He set his face against any tendency toward sacerdotalism. He was also opposed to the spirit of trade-unionism in medicine. His concern was with the physician’s duties rather than his “rights.” Hence, the greatest legacy of Hippocrates: the Hippocratic Oath.

The Hippocratic Oath

The so-called Hippocratic Oath was unquestionably the exemplar for medical etiquette for centuries, and it endures in modified form to this day. Yet uncertainty still prevails concerning the date the oath was composed, the purpose for which it was intended, and the historical forces which shaped the document. The date of composition in modern debate varies from the sixth century BCE to the fourth century CE.

In antiquity, it was generally not considered a violation of medical ethics to do what the Oath forbade. An ancient doctor who took the Oath was by no means in agreement with the opinion of all his fellow physicians; on the contrary, he adhered to a dogma which was much stricter than that embraced by many, if not by most, of his colleagues.

I swear by Apollo the Physician and Asclepius and Hygeia 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:

To hold him who has taught me this art as equal to my parent and to live my life in partnership with him, and if he is in need of money to give him a share of mine, and to regard his offspring as equal to my brothers in male lineage and to teach them this art—if they desire to learn it—without fee and covenant; to give share of precepts and oral instruction and all other learning to my sons and to the sons of him who has instructed me and to pupils who have signed the covenant and have taken an oath according to the medical law, but to no one else.

I will apply dietetic measure for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice. I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect. Similarly I will not give a woman an abortive remedy. In purity and in holiness I will guard my life and my art.

I will not use the knife, not even on sufferers from stone, but will withdraw in favor of such men as are engaged in this work.

Whatever houses I may visit, I will come for the benefit of the sick, remaining free of all intentional injustice, of all mischief and in particular of sexual relations with both female and male persons, be they free or slaves.

What I may see or hear in the course of the treatment or even outside of the treatment in regard to the life of men, which on no account one must spread abroad, I will keep to myself holding such things shameful to be spoken about.

If I fulfill this oath and do not violate it, may it be granted to me to enjoy life and art, being honored with fame among all men for all time to come; if I transgress it and swear falsely, may the opposite be my lot.

—Translated by Ludwig Edelstein

The organization of the Hippocratic Oath is clearly bipartite. The first half specifies the duties of the pupil toward his teacher and his obligations in transmitting medical knowledge; the second half gives a short summary of medical ethics. Because the second half of the Oath is inconsistent with Hippocrates’s own principles and practices, we must assume he was not its sole contributor, if one at all.

One immediate inconsistency is the Oath’s prohibition against abortion. The Hippocratic Corpus contains a number of allusions to the methods of abortion and the use of pessaries. The Oath’s prohibitions did not echo the general feeling of the public either. Abortion was practiced in Greek times no less than in the Roman era, and it was resorted to without scruple. In a world in which it was held justifiable to expose children immediately after birth, it would hardly seem objectionable to destroy the embryo.

A second discrepancy between the Oath and general Hippocratic principles is the ban on suicide. Suicide was not censured in antiquity. Self-murder as a relief from illness was regarded as justifiable, so much so that in some states it was an institution duly legalized by the authorities. Nor did ancient religion proscribe suicide. It did not know of any eternal punishment for those who ended their own lives. Law and religion then left the physician free to do whatever his conscience allowed.

Pythagoreanism is the only dogma that can possibly account for the attitude advocated in the Hippocratic Oath. Among all the Greek philosophical schools, the Pythagoreans alone outlawed suicide and abortion and did so without qualification. The Oath also concurs with Pythagorean prohibitions against surgical procedures of all kinds and against the shedding of blood, in which the soul was thought to reside. Again, this interdiction against the knife is especially out of keeping with the several treatises in the Hippocratic Corpus that deal at length with surgical techniques and operating room procedures.

It is little wonder that this Oath, although incorrectly attributed to Hippocrates, has remained steadfastly the symbol of the physician’s pledge. The prohibition against abortion and suicide were (and remain) in consonance with the principles of the Christian Church. The earliest reference to the Oath is in the first century CE, and it may have been appropriated soon after to fit the religious ideals of the time. The substitution of God, Christ, and the saints for the names of Asclepius and his family was easy enough. It is ironic that the Hippocratic Oath, in its present form with its religious subtext, is associated with Hippocrates, the man who first separated medicine from religion and disease from supernatural explanations.

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In the fourth century BCE, the locus of medical thought and practice was not Cos, the island home of Hippocrates. Instead, it was the great center of Greek learning at Alexandria, founded in 331 BCE by Alexander the Great and governed by a dynasty stemming from his general Ptolemy. The Ptolemaic rulers gave lavish financial support to the library and museum at Alexandria, which consequently attracted researchers in all fields. Medical research in the Alexandrian museum became world renowned. Two of its most influential investigators were Herophilos of Chalcedon (fl. circa 280 BCE) and Erasistratos of Iulis (fl. 250 BCE). Most of our knowledge of their work is derived from later commentators in the Roman period, such as Celsus and Galen.

Herophilos

Herophilos is remembered primarily for his contributions to the study of human anatomy, on which he composed several treatises, including On Dissections. We know he made a careful study of the brain which, against the view of Aristotle, he recognized as the center of of the nervous system. A number of the terms he coined passed into anatomical vocabulary, either directly or via their Latin translations.

In dissecting the brain, Herophilos applied the epithet chorioeides, “like the chorion,”to the meninges, because he thought of them as like two membranes, chorion and amnion, which envelop the fetus in the womb. His line of thought survives in the Latin expressions which we still use. In his account of the blood vessels of the brain, Herophilos identified the confluence of the sinuses, which he called the “wine press”(lenos) and which anatomists after him called the tocular Herophili.

He dissected the eye and distinguished its principal membranes; he likened one of these membranes to a retiform, a Greek word meaning “net-like.” We still call this membrane the retina. Another term he successfully coined is duodenum, the Latin translation of the Greek dodekadaktylon, (“twelve fingers long”), supposedly representing the average length of this portion of the human intestine.

Herophilos’s most important contribution to clinical medicine was his theory of the diagnostic value of the pulse. Although the pulse is referred to occasionally by earlier writers (for example by Aristotle in his Inquiry Concerning Animals, 521a5f), it was Herophilos’s teacher, Praxagoras, who first restricted the pulse to a distinct group of vessels and held that it could be used as an indicator of disease.

Herophilos corrected his master’s teaching on several points. He maintained that the pulse is not an innate faculty of the arteries, but one they derive from the heart. He also distinguished the pulse not merely quantitatively, but also qualitatively, from palpitations, tremors and spasms, which are muscular in origin.

Roman wall fresco from a villa at Boscoreale near Pompeii, first century BCE, Metropolitan Museum of Art, New York. Seated cithara player with girl behind

Herophilos elaborated a far-reaching doctrine of the pulse. The essential phenomenon in the pulse, according to Herophilos, is rhythm, as in music. To understand the pulse, then, we must study the theory of music. Herophilos was chiefly guided by the musical theories of Aristoxenus of Tarentum, a Peripatetic philosopher and a musician, a pupil of Aristotle. Following this route, the doctrine of the pulse became so complicated that no one but a skilled musician could possibly understand it.

When we reflect that Herophilos had no accurate means of timing the pulse-rate, his attempt to develop a systemic theory of pulse is astonishing. As Galen (K IX 464) reports: “as the musicians establish their rhythms according to certain definite arrangements of time-periods, comparing arsis and thesis with one another, i.e. the upward and downward beat, so Herophilos supposed that the dilation of the artery corresponds to arsis and its contraction to thesis.”

This idea borrows elements of Pythagoreanism, a sect of philosophy which held that numbers rule the universe. Thus, the stars move through the firmament at fixed distances, and their harmony corresponds to the tonal intervals on a music scale. The human body is also arranged according to musico-mathematical rules. Herophilos attempted to discover these rules, to reduce the rhythm of the pulse to mathematically expressible relations analogous to musical theory. Although this project was doomed to failure, Herophilos’s insistence on the importance of the pulse in diagnosis was of lasting value.

Erasistratos

Erasistratos, Herophilos’s rival at Alexandria, made remarkable progress in anatomy, describing the brain even more accurately than Herophilos. He distinguished the cerebrum from the cerebellum, and determined that the brain was the origin for all nerves. He distinguished sensory from motor nerves and was the first to dispel the notion that nerves are hollow and filled with pneuma (air). Instead, he averred that they are solid, consisting of spinal marrow. In his account of the heart and its function, he distinguished between pulmonary and systemic circulation.

Jacques-Louis David, 1774 Erasistratus Discovering the Cause of Antiochus’ Disease, École nationale supérieure des beaux-arts, Paris

Antiochus, son of Seleucus I Nicator, King of Syria, was dangerously ill, and, when other physicians failed to help him, Erasistratos was called in. While he was examining the patient, Stratonice, one of the elderly king’s wives and a young woman, entered the room. From the quickening of the sick man’s pulse and from the flush which spread over his cheeks, the doctor recognized that the illness was mental rather than physical—that a passion for his inaccessible stepmother was at the root of the problem.

Dissection and Vivisection

In Alexandria the dissection of corpses was a regular practice, whereas before the fourth century BCE it had been condemned and outlawed on religious principle. Celsus had also publicized a rumor that the anatomists used living people, most likely condemned criminals, in vivisection.

We can credit the philosophical teachings of Aristotle for changing the minds of learned men regarding dissections. First, Plato had taught that the soul was an independent and immortal being, which carried the body as a mere envelope and instrument to be discarded at death. Aristotle declared that the soul constituted a higher value than the whole organism, implying that after death nothing remained but a physical frame, without feelings or rights. Therefore, one could justly claim a dead body for dissection and anatomical study.

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Detail of wild blackberry in Vienna Dioscurides, 512 CE, Austrian National Library. An edition of De Materia Medica by Dioscurides, prepared for Julia Anicia, daughter of Emperor Anicius Olybrius.

Dioscurides was a physician who resided in Rome during the first century. He composed a compendium of all the materia medica then known from Greek medicine and other sources. He may have learned his medicine by practical experience while in the legions, and he most certainly relied on an earlier work by the physician Crateuas. His work describes some 600 plants and their possible medical use. The manuscript also has Arabic annotations because it came into the hands of an Arabic owner. In the picture to the left, wild blackberry is described and illustrated.

Detail of the Frontispiece of Vienna Dioscurides, 512 CE, Collection Bertarelli, Milan. Seven Physicians, Galen, the most prominent, sits on the folding chair to the left.

The frontispiece of the Vienna Dioscurides shows seven famous pharmacologists; this detail highlights Galen. Byzantine science was essentially Classical science. The value of a book like the Vienna Dioscurides was determined by the veracity of its illustrations. Eventually, copies became so bad that a movement was initiated to “clean up” the texts. Periodically, there were “renaissances.” In the sixth century CE, when the copy was made, there was such a renaissance. Scientific illustration could only progress as fast as accurate illustrations could be made. Consequently, science progressed pari passu, i.e., in equal parts, with scientific illustration. It was only with mechanized type that this problem of lag-time could be overcome.

Detail from Manuscript from Byzantium, 15th century, in Greek, Bologna, University, MS 3632, folio 51 Theophilus Protospatharius, On Urines

This Byzantine manuscript is illustrated with techniques and divisions of uroscopy. Seated at the left is Theophilus Protospatharius, a famous seventh century Greek whose treatise, On Urines, was much used throughout the Greek East and the Latin West (in translation). Handing Theophilos a urine flask is his assistant, Posos, according to the Greek caption above him.

Detail of The Burial of Saints Cosmas and Damian, Fra Angelico, 1449, Museo di San Marco, Florence

Cosmas and Damian were reputedly twin brothers, physicians, and martyrs in the 3rd century under Diocletian. The camel in this detail enjoins that the bodies of saints Cosmas and Damian should be buried side by side; initially they were to be separated on account of a supposed disagreement. Cosmas and Damian are the patron saints of doctors.

The Introduction of Hospitals

Late antiquity witnessed a revolution in the medical scene: the birth of the hospital. Literary sources occasionally mention hospitals, but only documents from Egypt reveal how widespread they were at this time. These Egyptian testimonials record a multitude of hospitals founded by private individuals and independent of ecclesiastical institutions. The origin of the hospital as an independent institution for the care and treatment of the sick can be dated to the third quarter of the fourth century CE. The hospital resolved major tensions in the medical, ecclesiastical, and religious scenes of late antiquity.

Religion Interpolated

There have always been people who seek healing, even bodily healing, from the priest, as well as the physician. People often look to religion for a cure. In the early centuries of our own era, the old gods paled and new ones replaced them. Was Asclepius the true healer, the saviour, or was Jesus Christ? The Christian world decided in favor of Jesus. The old gods died.

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Frontispiece, 1555 edition of Hippocratis Coi Medicorum Omnium Longe Principis, a volume of the complete works of Hippocrates in Latin translation, Historical Collections, Claude Moore Health Sciences Library, University of Virginia

The Hippocratic Corpus is a library, or rather, the remains of a library. Although the dozens of books included in the Collection were originally attributed to Hippocrates himself, scholars now know that they were more likely composed between the sixth and fourth centuries BCE. Between the career of Hippocrates and the pre-Socratic philosophers, a special kind of prose for medical writings developed in Greece. Although Cos, the island home of Hippocrates, is located within what was a Doric-speaking region, the medical writers of Cos (believed to have written the Hippocratic treatises) appropriated the more refined Ionic dialect of philosophy. Later, during the Renaissance, scientists like Andreas Vesalius would similarly shun using the vernacular, instead penning their medical treatises in Latin.

One of the earliest specimens of the Corpus is On Ancient Medicine, a tract written by an anonymous physician from the fifth century BCE. We can infer this author was both familiar with contemporary theory, and devoted to traditional lore and technique. On Ancient Medicine is one of two polemical works in the Hippocratic corpus; the other is On the Sacred Disease which includes an early observation of epilepsy. Both works attack the concept of divine origin of disease and the intrusion of hypothetical philosophers into medicine.

The Humoral Theory

The ancient doctrine of the Four Humors, as illustrated in this fourteenth century manuscript (MS C. 54, Zentralbibliothek Zurich, The Four Humors), stated that there were four basic human temperaments: melancholic, sanguine, phlegmatic, and choleric.

The elaborate doctrine of the Four Humors endured through many centuries and is one of the central tenets of the Hippocratic Corpus. This theory was grounded on the Empedoclean principle of the four supposed elements: earth, air, fire, and water. Man’s four constituent elements, or humors, were identified analogously as black bile, blood, yellow bile, and phlegm, all of which had to be in correct proportion to one another. This fourfold pattern was infinitely adaptable: to the seasons, the winds, the elements, and even, in due course, to the Evangelists. It offered a kind of universal holdall, in which tastes, temperaments, and a surprising number of diseases could find loose accommodation. Though virtually worthless as a theory, it remained the fundamental prop of European medicine for over two millennia.

There is something subtly seductive about the doctrine of the Four Humors; its widespread and lasting impact on European medical thought has been greatly out of proportion to its medical value. The success of the humoral theory put a heavy brake on physiological research since there were few phenomena for which the humors could not be made to yield some sort of easy explanation.

Greek Orthopaedics

Detail of Manuscript from Byzantium, c. 1100, Florence, Laurentian Library, MS 74.7, Apollonius, Dislocations 2 in Greek,  Bone setting of jaw

Orthopaedics originally was the branch of ancient Greek surgery that concerned itself with reducing or realigning bodily distortions. It is thought that it was strongly influenced by the techniques of treating athletes in the gymnasia. As far as written sources are concerned, the basic information comes indirectly from three Hippocratic treatises: On Joints, On Fractures, and Surgery. These original works are no longer in existence. Their content was introduced to the Western world through Greek manuscripts, compiled by Apollonius of Citium in the first century BCE and by Soranus in the second century CE. Of all the subjects covered in the Hippocratic corpus, those volumes treating dislocations and fractures demonstrate the most affinity to modern technique and practice. In this Byzantine illustration, the doctor seizes the jaw between his fingers and puts it in place while an assistant holds the patient’s head.

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Forum Baths, Pompeii, first century BCE,  Caldarium

Giant bath houses, characteristic of Imperial Rome, could house not only bathing facilities but lecture halls, gymnasia, libraries and gardens. Hot (caudarium), tepid (tepidarium) and cold (frigidarium) baths were provided usually. The room pictured to the left was kept warm by hot air circulating through pipes in the walls and floor.

Authors as disparate as Celsus, Vitruvius, Pliny, Frontinus, Columella, Varro, and Vegetius, demonstrate the Roman concept of health interwoven with the normal life and ordinary process of government in the Roman Empire. Vitruvius, a practicing architect in the milieu of the Roman Empire, shows through his writing how important sanitary planning was for public buildings. His chapter on city planning begins with a discussion of the salubrity of sites. The influence of the Hippocratic tract On Airs, Waters, and Places is apparent:

In the case of the walls these will be the main points: First, the choice of the most healthy site. Now this will be high and free from clouds and frost, with an aspect neither hot nor cold but temperate. In this way a marshy neighborhood will be avoided. For when the morning breezes blow towards the town at sunrise, as they bring with them mists from the marshes and, mingled with the mist, the poisonous breath of the creatures of the marshes [i.e., microorganisms], to be wafted into the bodies of the inhabitants, they will make the site unhealthy. ~De Architectura I.2-5

Pont du Gard, Nimes, France, 14 CE

The aqueducts were the true triumph of Roman sanitary engineering and were used throughout their empire. Frontinus, the author of a treatise on Rome’s aqueducts, became water commissioner (curator aquarum) in 97 CE. He recognized the sanitary aspects of his position stating, “my office … concerns not only the usefulness of such a system, but also the very health and safety of Rome ….”

Public Latrines, Corinth, 4th century BCE

Latrines, either well drained or with the provision for semi-sanitary maintenance, became commonplace both in the houses of the wealthy and in bath complexes where there was a constant supply of running water. In lieu of toilet paper, Romans used a sponge tied to the end of a stick. After use it was returned to a bucket of saltwater.

Terra Cotta Statuette, 350-300 BCE, National Archaeological Museum of Taranto. Woman bathing. A woman, having removed her shoes, prepares to wash herself in a luterion.

Mosaic  from Pompeii, 1st century CE, Naples National Archaeological Museum. This particular mosaic was used as a tabletop.

The skull symbolizes man’s fate and reminds us of the frailty of human existence. There are many extant examples of cups and dining areas adorned with skeletal motifs. Rather than shrink from signs of death, the Romans seem to have employed them as reminders to “seize the day.“

In Petronius’s Satyricon, in the middle of a great banquet, a slave brings in a silver skeleton put together with flexible joints, and after it was flung on the table several times, the host Trimalchio recited:

Man’s life, alas, is but a span,
So let us live it while we can,
We’ll be like this when dead.

Despite the advanced state of sanitation engineering in the Roman world, the average life span was only 30-40 years.

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Introduction

The eruption of Mount Vesuvius in 79 CE buried the Roman cities of Pompeii and Herculaneum under feet of ash and pumice. Objects under the volcanic material were found to be well preserved when they were excavated centuries later. Among the artifacts recovered were surgical instruments from multiple sites, the best known being Pompeii’s House of the Surgeon, so named because of the nature of the items recovered there. In 1947, reproductions of these instruments were presented to the Claude Moore Health Sciences Library by the 8th Evacuation Medical Unit from the University of Virginia after its service in Italy during World War II. The collection is one of the best surviving examples of the tools at a surgeon’s disposal in the first century BCE. Since there was relatively little innovation in surgery and surgical tools from the time of Hippocrates (5th century BCE) and Galen (2nd century CE) this collection is typical of surgical practice for nearly a millenium. In fact, the technology of some tools, such as the vaginal speculum, did not change significantly until the 20th century.

The following display presents images and summaries of the known uses of each instrument. The extant comments of medical writers from antiquity–including Oribasius, Galen, Soranus, Aetius, and the Hippocratic corpus–have provided scholars with some clues about the use of some instruments. Some instruments, such as mixing instruments and tweezers, probably had other household such as the application of cosmetics and paints.

Vaginal Speculum. Greek: dioptra
Latin: speculum magnum matricis
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One of the most spectacular, if fearsome looking, Roman medical instruments is the vaginal dilator or speculum (dioptra). It comprises a priapiscus with 2 (or sometimes 3 or 4) dovetailing valves which are opened and closed by a handle with a screw mechanism, an arrangement that was still to be found in the specula of 18th-century Europe. Soranus is the first author who makes mention of the speculum specially made for the vagina. Graeco-Roman writers on gynecology and obstetrics frequently recommend its use in the diagnosis and treatment of vaginal and uterine disorders, yet it is one of the rarest surviving medical instruments. Specula are large and readily recognizable and should not have suffered the same degree of destruction as thin instruments, such as probes, scalpels and needles. As a source of bronze, however, they may have been more subject to recycling than the smaller instruments.

Rectal Speculum. Greek: hedrodiastoleus
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The earliest mention of the rectal speculum is to be found in the treatise on fistula by Hippocrates (iii.331): “…laying the patient on his back and examining the ulcerated part of the bowel by means of the rectal speculum…”

Bone Levers. Greek: mochliskos
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From what Galen says, these instruments were used for levering fractured bones into position and may have been used for levering out teeth.

Bone Forceps. Greek: ostagra
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Soranus (lxiv) says that in case of impaction of the foetal cranium, the head may be opened with a sharp instrument and the pieces of the skull removed with bone forceps. Paul Aigenita (VI.xc) says that in a depressed fracture of the skull “fractured bone is to be removed in fragments, with the fingers if possible, if not, with a bone forceps.”

Cupping Vessels for Bloodletting. Greek: sikua
Latin: cucurbitulae
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Cupping Vessels for Bloodletting. Greek: sikua
Latin: cucurbitulae
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The larger cupping vesssel would have been used for larger areas on the body, such as the back or thighs. The smaller vessel would have been applied to the arms.

Tubes to Prevent Contractions & Adhesions. Greek: motos molubous
Latin: plumbea fistula
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After operations on the nose, rectum, vagina, etc., it was usual to insert a tube of lead or bronze to prevent contraction or adhesion and also to convey medicaments.

Clyster for Administering Enemas. Greek: metregchutes
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Tile Cautery. Greek: kauterion
Latin: ferrum candens
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The cautery was employed to an almost incredible extent in ancient times, and surgeons expended much ingenuity in devising different forms of this instrument. The cautery was employed for almost every possible purpose: as a ‘counter-irritant’, as a haemostatic, as a bloodless knife, as a means of destroying tumours, etc.

Portable Probe Case. Greek: kauterion
Latin: ferrum candens
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This plain cylindrical case was used to store and protect the thin probes and curettes used by physicians. Hippocrates mentions a portable equipment case for use on housecalls.

Male Catheter.
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Obstetrical Hooks/Sharp Hooks. Greek: agkistron
Latin: hamus, acutus
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Hooks, blunt and sharp, are frequently mentioned in both Greek and Latin literature, and served the same possible purposes we use them for: the blunt for dissecting and raising blood-vessels like the modern aneurism needle; the sharp for seizing and raising small pieces of tissue for excision and for fixing and retracting the edges of wounds. In dissection, many of the manipulations which we perform with the dissecting forceps were performed by the ancients with sharp hooks.

Epilation Forceps. Greek: tricholabis
Latin: vulsella
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By far the largest number of forceps of this type are not surgical instruments, but household implements. Many were used for epilation (hair removal) or by artists.

Uvula Forceps. Greek: staphylagra
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In Aetius (II.iv.2), there is an interesting description of the amputation of the uvula by first crushing it in a forceps so as to prevent haemorrhage and then cutting it off. Hippocrates (I.63) mentions the uvula crusher as one of the instruments necessary for the outfit of the physician.

Scalpels.
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Surgical Scissors. Greek: psalis
Latin: forfex
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The surgical author Oribasius treats the cutting of hair as a regular medical procedure in a special chapter of his work. Celsus also frequently refers to cutting the hair as a therapeutic measure. Possibly the ancients found difficulty in putting an edge sufficiently smooth for surgical purposes on their shears. We have few references to the use of the shears for cutting tissues.

Spatula Probes. Greek: spathumele
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Almost every medical writer mentions the spathomele. It consists of a long shaft with an olivary point at one end and a spatula at the other. It was a pharmaceutical rather than a strictly surgical instrument. The olive end was used for stirring medicaments, the spatula for spreading them on the affected part. The spathomele was used by painters for preparing and mixing their colors. The very large numbers in which they are found would indicate that their use was not confined to medical men.

Probes/Curettes. Greek: cyathiscomele
Latin: cyathiscomele
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The scope of the cyathiscomele in medical art is evidently, like the flat spathomele, to act occasionally as a sound, but mainly to mix, measure and apply medicaments. Some are adapted for use as curettes. The large numbers in which this instrument occurs would itself indicate that it was used for lay as well as medical purposes.

We hope you enjoyed this exhibit. Thanks for your interest!

All images on this page are the property of the Claude Moore Health Sciences Library, University of Virginia.

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The “knotty tree limb” symbol appears frequently on surgical instruments, as well as being linked to representations of Asclepius and, in particular, Hercules. It can also be found on the handles of apotropaic instruments, which ward off evil forces. Some scholars claim that the motif is limited to instruments particularly liable to cause pain. Given the widespread worship of Hercules in the Roman world, this motif was probably adopted by Greek physicians to please their Roman clients.

Drinking cup of the Potter Sosias, Achilles binds Patroclus, Attic Red-figure, from Vulci, Italy, c. 490 BCE, Altes Museum Berlin

Illustrations of physicians at work are rare in Greek art. This scene, on the inside of a dish dating about 490 BCE, depicts Achilles binding a wound on Patroklos’s arm. It exemplifies the prevalent formality in patient treatment at that time: a prescribed kneeling position for particular tasks and an overall calmness of manner. Achilles was trained in medicine by Chiron, the centaur-sage. Although he was invincible in battle, Achilles is shown here as an inept medic. He is attempting to make a crisscross tourniquet, which should be at once comfortable and capable of staunching the wound. To judge from Patroklos’s wince, the tourniquet is painful and inexpertly applied because the two ends will not meet. His work will have to be unraveled and redone.

Tombstone of Jason, an Athenian physician, grave stele, Athens, 2nd century CE, British Museum, London

The bearded physician Jason is shown sitting on a cushioned stool while he palpates the swollen belly of a young boy. Note the stylized and proportionately oversized cupping vessel in front of them. Cupping vessels (cucurbitulae) were used in bloodletting, the handmaid of humoral pathology and one of the mainstays of medical practice throughout antiquity. The method of application was to ignite a piece of dry linen in the fundus of the cup. The cup was then applied to the skin. As the heated air within cooled, it contracted and sucked the skin into the neck of the cup. For the convenience of hanging, a ring was usually soldered to the cone-shaped apex of the cup.

The Origins of the Medical Caduceus

Detail, Pompeiian fresco, House of the Centenary, 1st century BCE, Museo Archeologico Nazionale, Naples, Italy

Snakes are familiar symbols of healing because of their presence on the medical caduceus, the symbol of the herald’s wand used by Hermes. The medical caduceus originated during WWII, when medics used it as a symbol for a truce. Its association with medicine goes back even further, to ancient Greece, where the snake entwined upon a walking staff was one of the accoutrements of the healer-god Asclepius.

Asclepius and Hygeia, Greco-Roman Marble Statue, 1st Century CE, Pio Clementino Museum

The Asclepian staff has often been confused with the caduceus. Both were probably symbols of truce in wartime, but the Asclepian staff entwined by only one snake is regarded by Classicists as the true symbol of the medical profession.

The snake has been a symbol of healing since prehistoric times. It was associated with regeneration, due to the easily observable phenomena of it shedding its skin. Because they were used in the healing rites at his temples, the god Asclepius (seated in the statue at left) often appears accompanied by one or more serpents. Snakes were also used in Italy as part of the private family worship. Each household contained a shrine, or lararium, where offerings to the familial ancestors were placed.

Detail, Pompeiian fresco, House of the Centenary, 1st century BCE, Museo Archeologico Nazionale, Naples, Italy

These ancestors, or Lares, were thought to assume the form of snakes, and they were credited for the family’s health and prosperity. The detail shown here is from a lararium uncovered in Pompeii. The god Bacchus is shown, morphed into a cluster of grapes.

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The earliest account of disease in Greek literature appears in the opening episode of Homer’s Iliad, which was composed in the eighth century BCE. When Agamemnon tries to ransom his captured daughter, he insults the priest Chryses. As punishment, the god Apollo sets a plague upon the Greek army. According to Homer, at the onset of the plague, Apollo only shot his arrows at mules and dogs in the camp and then later at the Greek soldiers themselves (Iliad I.9ff).

What Homer describes is a highly communicable disease with acute fever, sudden in onset and rapidly fatal, such as easily might attack an army. No symptoms are explicitly mentioned, nor are any recoveries. After the Greeks appeased Apollo with sacrifices and the return of Agamemnon’s daughter, they set about cleansing the camp by throwing “defilements” into the sea. This suggests that part of the disease was a severe dysentery exacerbated by battlefield conditions.

In mythology, the arrows of Apollo and his twin sister Artemis are often a symbol for the sudden onset of disease. The myth of Niobe illustrates this point. Niobe was a mortal woman who boasted that she was superior to Leto (the mother of Apollo and Artemis) because she had borne seven sons and seven daughters as opposed to Leto’s two children. As punishment for this insult to their mother, Apollo shot all seven sons with arrows and Artemis shot all seven daughters. Not only was Niobe robbed of the source of her pride, but she was forced to watch all fourteen of her children die in rapid succession, even as she tried to shield them, with her own body, from the deadly allegorical darts.

Arrows could not only cause disease, but heal it as well. In this capacity, Apollo was called Paean. He was also the father of Asclepius, the healing god whose cult was widespread in the Greek world.

In Homer’s Iliad, Apollo is addressed with his epithet Apollo Smintheus, or “Apollo the mouse god.” The Greeks associated Apollo with mice, which were believed to be vectors of disease, and so prayed to him under that name. They did not know it was the microorganisms on the fleas on the rodents, and not the rodents themselves, that were harmful. They simply recognized the correlation between rodent infestation and plague, and so prayed to the mouse god for relief.

A famous passage in Thucydides’s History of the Peloponnesian War describes the plague that gripped Periklean Athens during the Peloponnesian War (II.47.3-54.5). His vivid depiction of the plague and its aftermath inspired other authors in antiquity to treat similar topics, such as Sophocles’s Oedipos Tyrannos and Lucretius’s De rerum natura (Book V).

Greek myth is often an allegory for an historical event. One of the canonical Twelve Labors of Hercules involved ridding the swampy district of Lernea of a multi-headed serpent known as the Lernean Hydra. Every time Hercules cut off one of the serpent’s heads, two more grew in its place. Archaeologists believe this myth actually commemorates an infamous plague which devastated the population of ancient Lernea. The rapid spread of whatever sickness gripped the region corresponds to the duplicating heads of the serpent.

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As a profession, medicine was more highly regarded in Greece than in Rome. Physicians were basically craftsmen, probably enjoying some esteem among their customers, but not being part of the socio-political elite.

Roman doctors did not fare so well. Many doctors were freed Greek slaves, hence the social standing of doctors was quite low. Because recovery rates were so low, many people were skeptical or even scornful of doctors. Their skepticism is easily understood. Roman literature tells us much about the reactions of individuals to medicine and doctors. Listening to the Roman authors, we hear tales of quackery and chicanery at all levels of society:

Some doctors charge the most excessive prices for the most worthless medicines and drugs, and others in the craft attempt to deal with and treat diseases they obviously do not understand. ~Gargilius Martialis, Preface, 7

There were no licensing boards and no formal requirements for entrance to the profession. Anyone could call himself a doctor. If his methods were successful, he attracted more patients; if not, he found himself another profession.

Until recently, Diaulus was a doctor; now he is an undertaker. He is still doing as an undertaker, what he used to do as a doctor. ~Martial, Epigrams 1.47

You are now a gladiator, although until recently you were an ophthalmologist. You did the same thing as a doctor that you do now as a gladiator. ~Martial, Epigrams 8.74

Medical training consisted mostly of apprentice work. Men trained as doctors by following around another doctor.

I felt a little ill and called Dr. Symmachus. Well, you came, Symmachus, but you brought 100 medical students with you. One hundred ice cold hands poked and jabbed me. I didn’t have a fever, Symmachus, when I called you, but now I do. ~Martial, Epigrams 5.9

Plutarch grumbles that practitioners used all sorts of questionable methods to gain patients, ranging from escorting the prospective patient home from bars to sharing dirty jokes with him.

Evidence for the public mistrust of physicians is plentiful, including these epigrams from the Greek Anthology:

Socles, promising to set Diodorus’s crooked back straight, piled three solid stones, each four feet square, on the hunchback’s spine. He was crushed and died, but he became straighter than a ruler. ~Greek Anthology XI, 120

Alexis the physician purged by a clyster five patients at one time, and five other by drugs; he visited five, and again he rubbed five with ointment. And for all there was one night, one medicine, one coffin-maker, one tomb, one Hades, one lamentation. ~Greek Anthology XI, 122

Phidon did not purge me with a clyster or even feel me, but feeling feverish I remembered his name and died. ~Greek Anthology XI, 118

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