How Greek Medicine Slowly Entered the Roman Republic
The role of politics in medical development.
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In his version of how the Greek god of healing Asclepius came to Rome, Ovid writes in Metamorphoses that a malevolent plague had struck the city and so desperate was the situation that “medical skill was useless”. The Roman senate responded by consulting the Oracle at Delphi, which then instructed them to seek the help of Asclepius who resided in his temple at Epidaurus. According to the Periochae, summaries of Livy’s History of Rome, the plague struck around 293 BCE, right in the middle of Rome’s republican period.
What sort of medicine was practiced at the time that was rendered so useless by the tide of sickness? For the vast majority of the republic’s span, medicine in Rome was the domestic office of the paterfamilias (pl. patresfamilias), the oldest male member of the family. Included in their practice was folk herblore which was also practiced by women.
Transmission of medical knowledge was, therefore, almost exclusive within the male family line. What fathers knew they passed on to their sons. This had the consequential effect of ensuring the continuation of a medical tradition that was very limited within a domestic range. Fathers don’t know everything, and the restricted chances to practice medicine—diseases and injuries didn’t happen everyday—vastly deprived them of needed experience to improve their skills. Another problem of this tradition is that it depended on familiarity; a novel affliction such as an uncommon infectious disease which had never been experienced by the family and immediate community will surely cause problems, for what could fathers do to deal with a disease that even their forefathers didn’t know about? Moreover, patresfamilias were burdened by other duties imposed on them by the state and other household responsibilities, drastically reducing opportunities to learn and try new medical techniques and ideas. If they fell within the age group for military service, they were liable to join the army if the republic needed them to. (For a brief discussion on Roman healthcare afforded to soldiers in the first half of the republican period, see my previous essay here.) So if a paterfamilias died in battle without having taught medicine to a male heir, so too did their unique family medical tradition.
Against the plague, the parochial medicine of Rome stood no chance, prompting the senators to seek divine intervention elsewhere. The prominence of practicing patriarchs instead of medical professionals may have been the foremost reason for the failure; in fact, there is a glaring absence of doctors in the accounts recorded in Metamorphoses and Pariochae. A few centuries forward, Galen, physician to emperor Marcus Aurelius, was among the medical frontliners in the outbreak of the Antonine Plague in 165 CE. Along with him were the many doctors practicing in the empire and enrolled in the military. This stands in stark contrast to the response in the 293 BCE plague. As there were no doctors mentioned, could it be that there were no doctors in Rome at the time of the republic?
A number of key texts may prove helpful in shedding light on the state of professional medicine in the republic. The 1st century BCE Greek rhetorician Dionysius of Halicarnassus reported a similar plague happening in Rome way before the adoption of Asclepius. He writes in Roman Antiquities that during the consulship of Sextus Quintilius and Publius Horatius (P. Curiatus in Livy) in 451 BCE, “Rome was afflicted with a pestilence more severe than any of those recorded from past time.” The scourge was so devastating that “[a]lmost all the slaves were carried off by it and about one half of the citizens”. However, unlike the later catastrophe in 293 BCE, Dionysius claims that there were active doctors in this earlier plague, although like the patresfamilias they also failed to halt its further spread.
Does Dionysius’ text confirm the existence of professional doctors in republican Rome? Well, no. Aside from the brief mention in Roman Antiquities, there is nothing that confirms their operation at such an early period in the republic. What is likely is that Dionysius used the term medicii to describe all healers during the said plague. Medicus (pl. medicii) is the Latin word for physician which was gaining more currency by Dionysius’ time as more Greek iatros (ancient Greek word for doctor) moved to and practiced medicine in Rome. In this wrongful application of a “modern” word, Dionysius most likely included the patresfamilias and other folk healers under the all-encompassing category of “physician”.
The clear distinction of the medicus from other healers is extremely crucial because the Romans regarded their brand of medicine as an import from Greece. And during the early centuries of the republic, Roman sentiments regarding the Greeks were particularly low, especially among conservative circles. Nowhere else was this negative view more evident than in the dismissive attitude the Romans held regarding Greek medicine. Cato the Elder, one of the chief apostles of conservatism, was especially vociferous. Pliny records in his Natural History a letter sent by Cato to his son Marcus containing his vitriolic remarks about the Greeks, ending with an instruction to stay away from their doctors:
“I shall speak about those Greek fellows in their proper place, son Marcus, and point out the result of my inquiries at Athens, and convince you what benefit comes from dipping into their literature and not making a close study of it. They are quite a worthless people, and an intractable one, and you must consider my words prophetic. When that race gives us its literature it will corrupt all things, and even all the more if it sends hither its physicians. They have conspired together to murder all foreigners with their physic, but this very thing they do for a fee, to gain credit and to destroy us easily. They are also always dubbing us foreigners, and to fling more filth on us than on others they give us the foul nickname of Opici. I have forbidden you to have dealings with physicians.”
-Pliny, Natural History (XXIX. vii.)
Cato supported his indignant stand against Greek medicine by living up to 85 years old. Who could say he was jeopardising his health by dismissing medicine? On the contrary, Pliny says that Cato was an ardent compiler of folk medical knowledge. So it wasn’t medicine in general that he was skeptical of, but he was disdainful of the way Greek doctors conducted their practice. The Romans, according to Pliny, were against charging fees for medical help which was how an iatros made a living. Additionally, there were two major concerns: first, there was no accrediting body to standardise medical qualifications, so anybody who was sufficiently fluent in Greek and had a basic grasp of medicine was already admitted as a competent enough doctor; and second, there were no laws to punish medical practitioners for malpractice.
These two problems were no mere whims conjured from latent xenophobia as these stemmed from what Pliny claims was the first Roman experience with a Greek doctor. Archagathus, a Peloponnesian physician, came to Rome in 219 BCE and was feted with cheers by the citizens. He was granted a taberna by the senate, a public office supported by state funds. In the early days of his practice he was celebrated as a vulnerarius, a wound-healer, for his successful treatments of gashes and lacerations. But the Romans later came to despise his “bloody” practice, calling him carnifex for his surgical methods that resembled that of an executioner. He was later expelled from the city and public outcry against his practice only fueled the still glowing embers of anti-Greek sentiments.
Archagathus was certainly the “first” doctor in Rome, falsifying Dionysius’ claim. This is well supported by the fact that the Romans acknowledged his mode of healing as particularly Greek, thus, it is in him where the conceptual transition of the Greek iatros to the Latin medicus first occurred. Furthermore, Archagathus enjoyed what other healers before him didn’t, a state-sponsored office as a medicus.
Despite the disrepute Archagathus brought to the medical arts, Pliny says that the Romans gradually warmed up to Greek medicine, so much so that during the expulsion of foreigners from the city (either in 187 BCE or 177 BCE as reported by Livy; Pliny gives no exact date), physicians were spared and were allowed to remain. If a special provision to stay was granted to physicians, then that only means that Archagathus was immediately followed by other Greek (or Greek speaking) doctors who then offered their services in the city.
However, it took decades for Roman arms to fully embrace Greek medicine and doctors. And for good reason. Memories of Archagathus’ bloody procedures still haunted the Roman consciousness. If doctors wanted to escape Archagathus’ overarching scarlet shadow, they had to convince the city’s inhabitants that they were also capable of providing competent and effective medical care without shedding too much blood. Luckily for the doctors, there came one such person to persuade the Romans. After a failed bid as a tutor of rhetoric in Rome, Asclepiades of Prusa tried his hand at medicine. Fortune did favour the bold, for he soon found success in his new vocation, a personal triumph that far exceeded all that had been achieved by his medical predecessors.
What set Asclepiades’ apart from Archagathus was his reluctance to immediately resort to the blade. Sternly believing in the importance of keeping harmony and balance in the body, Asclepiades championed dietetics, exercise, and hygiene in his treatments and avoided drastic interventions whenever possible - although it is noted that he also bled his patients, which was a common practice at the time. Celsius also notes that Asclepiades was the first to make an opening on a patient’s windpipe to facilitate breathing. This was probably a rudimentary form of tracheotomy.
One of Asclepiades’ popular treatments was letting his patients drink various quantities of wine to relieve their symptoms and pain. Exposure to the Hippocratic theory of humours may have played a part in the formulation of this remedy, but upon further inspection it might be more in keeping with his belief in atomism, although both are quite complementary to each other. According to Celsius, Asclepiades put forward an atomistic theory of disease based on the constant motion of “corpuscles” within the body:
“Now, to begin with, he posits atoms as the first principles of the body, corpuscles apprehended only by the understanding, endowed with none of the customary qualities of things, always found in combinations, and endlessly moving about. When these corpuscles suffer collision in the course of their motion, they split up, under the mutual impact of the blow, into countless fragments differing in size and shape; again, as they move, they form through attachment or union all the perceptible bodies. These bodies have within themselves the capacity for change by reason of the size, number, shape, and order. . . Now out of the union of corpuscles passages varying in size and shape are formed, which may be apprehended only by reason. Through these passages the body's fluids are conducted with a regular motion. So long as this process is not checked by any impediment, the state of health continues; but if the flow is impeded by a blocking of the corpuscles, a state of disease results.”
-Celcius, Acutae pasiones I. xiv.
It is from this idea of constantly moving corpuscles where Asclepiades derived his many treatments. A sick patient could be brought back to good health when the internal motion of these corpuscles are restored to their natural tempo and direction. With this in mind, he devised a suspended sleeping contraption where he would let his patients lie down then gently rock them, believing that physical oscillation will subsequently influence the patient’s internal stirrings. This and his other treatments—like the consumption of wine, salted and cold water, and emetics—made him beloved not just in Rome but also abroad. He was supposedly approached by an embassy from Mithridates, king of Pontus, inviting him to serve in his court, an offer he politely declined by giving the king a dedicated treatise on pharmaceutical herbs instead of his service.
We can surmise the public’s mostly positive opinion of Asclepiades (the wine most likely helped) from the displeasure issued by a number of prominent critics who saw Asclepiades’ success as extremely unwarranted and even dangerous, because in their eyes the doctor was nothing but a charlatan. One of them was Pliny, who accused Asclepiades of using his training in rhetoric to attract and, as Pliny would have it, fool potential patients. He describes Asclepiades as “[h]aving never practised medicine, and being totally unacquainted with the nature of remedies—a knowledge only to be acquired by personal examination and actual experience—as a matter of course, he was obliged to renounce all previously-established theories, and to trust rather to his flowing periods and his well-studied discourses, for gaining an influence upon the minds of his audience.” He then emphatically charges the doctor of “[r]educing the whole art of medicine to an estimation solely of primary causes,” that is, “he made it nothing but a mere conjectural art”.
Galen, who aside from being a court physician was also regarded as a principal authority in medicine, likewise voiced similar irritation at Asclepiades’ brand of medicine, saying with characteristic scorn that Asclepiades did not understand “what was said by Hippocrates; and he attempts in stupid - I might say insane - language, to contradict what he knows nothing about.”
This tale of two physicians, one bedeviled by practicing surgery and another blessed by advocating self-styled treatments, is highly descriptive of the state of medicine in republican Rome. The sudden introduction of surgical operations by Archagathus was too radical for the Romans who were steeped in folk tradition. Asclepiades took advantage of this using his skills in rhetoric to amplify the promise of his treatments which often overlapped with folk local practices. According to Pliny, Asclepiades’ success
“was considerably promoted by many of the usages of ancient medicine, repulsive in their nature, and attended with far too much anxiety: thus, for instance, it was the practice to cover up the patient with vast numbers of clothes, and to adopt every possible method of promoting the perspiration; to order the body to be roasted before a fire; or to be continually sending the patient on a search for sunshine, a thing hardly to be found in a showery climate like that of this city of ours; or rather, so to say, of the whole of Italy, so prolific as it is of fogs and rain.”
But surgery and other related practices were eventually welcomed by the Romans as an integral part of medical practice, especially for severe medical conditions that topical ointments or dietary supplements could not relieve. According to Plutarch, when the general and seven-times consul Marius suffered from varicose veins in both his legs, he “resolved to put himself into the physician’s hand”. “Refusing to be bound,” Marius presented one of his legs to the unnamed physician to be operated “without a motion or a groan, but with a steadfast countenance and in silence”. He “endured incredible pain under the knife,” but didn’t want to undergo the same agony again by having his other leg cut open, “declaring that he saw the cure to be not worth the pain.”
Unfortunately, not even the most skilled surgeon could remove the septic tumour that had long been developing in Roman politics. The conservative circle in the senate, led by the likes of Cicero and Cato the Younger, formed a fierce resistance against every popular initiative that would have rescued the republic from further sinking into oblivion. They were all up in arms against one man, Julius Caesar, who they saw as a threat to the survival of the rotting Roman aristocracy. Their fears, of course, were justified, for Caesar was bent in introducing reforms that he saw were necessary for Rome and its citizens without much regard for the opinions of the nobility. When he had successfully wrested power, Suetonius writes that Caesar “made all those who practised physic in Rome. . . free of the city, in order to fix them in it, and induce others to settle there.” This granting of civil rights gave medical professionals the necessary political support to practice in the city, that despite their foreign origins they now found a home in Rome where their contributions to public health were much needed and appreciated. However, the medical talents Caesar invited could not heal the malice deeply rooted in the hearts of his enemies. They soon assassinated Caesar in one of the most deceitful displays of daftness in history. But irony shortly took vengeance, for in killing Caesar they further propelled the already speeding wheels that would eventually crush their beloved republic and deliver Caesar’s heir, Octavian, to the throne of power.
Politics intersected with all facets of Roman life. So it is no wonder that decisions pertaining to public health and medicine were placed at the hands of politicians. They had the power to decide what institutions to establish in Rome, though not necessarily for the benefit of the majority. Politics, as it was then and is still true now, was always about the interests of the ruling class. Had the pro-Hellenic section of Roman elites held a senatorial majority earlier, then it’s possible that Greek medicine and doctors would’ve been welcomed in Rome without having to wait for Caesar to initiate their radical introduction.
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