Where to Get the Best Medical Education in the Ancient World
How the Ptolemies made Alexandria the greatest medical "school" in antiquity.
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Alcohol and gambling usually don’t go well together. Your opponent(s) might take advantage of your intoxicated state and cheat in the process. That’s exactly what happened to Titus Pullo, an off-duty Roman legionary, in episode two of HBO’s Rome. He had been losing in every round of dice thanks to bad judgement and trickery. When he was about to lose all his coins, he checked his opponent’s hand to see if there was anything underhanded going on. And indeed there was - the trickster was palming another set of dice. Agitated and with blood and alcohol rushing up to his head, Pullo promptly drove a dagger through the cheater’s throat, ensuring that no other Roman citizen would be cheated by the charlatan. A drunken brawl ensued where Pullo was painfully hit with a club at the back of his head. The morning after, Pullo found himself strapped on a makeshift operating table and had a portion of his skull medically removed with a cranial drill. Operating on him was a doctor along with an understudy.
While the series is a fictionalised retelling of the events that had transpired during the death throes of the Roman republic, the scene of Pullo’s medical intervention depicts, to some accurate degree, what would've been typical in ancient medical operations. Yes, certain complaints of headaches entailed having your skull bored with a drill. But in this portrayal, the operation is of less importance to us than those who actually did the operation. Of particular interest in the scene is the doctor being assisted and followed by his student.
The student-master relationship was the dominant model of education at the time. As there were no formal institutions for medical training in the ancient world, those interested to learn had to look for mentors willing to take them in as students - oftentimes for a fee. This was particularly advantageous for interested students born and raised in flourishing cities where local and traveling scholars abounded, but it was especially challenging for those born on the fringes of civilisation where the only visitors were mostly men trained to communicate using weaponry. However daunting the circumstances may have been, dedicated students still traveled the hostile roads of the ancient world in search of tutors. Their anxiety of not knowing exactly where to go was assuaged by the (almost) certainty of finding scholars in bigger cities. So that’s where most of them went. And for aspiring doctors, they knew very well which place to go to get the best medical education in the ancient world.
It wasn’t in the original plan when development of the city began, but Alexander the Great’s humbly named Alexandria in Egypt became just that — the premiere medical destination in the ancient world. Medical scholars from all over the Mediterranean and beyond flocked to its busy streets in the hopes of learning new ideas or spreading their own. They were particularly drawn to the city thanks to its potent blend of ancient Egyptian tradition, historical reputation, and political patronage. These compounded to make Alexandria (and Egypt in general) a hotbed for medical research and practice.
Egypt's ancient tradition of mummification normalised the exhumation and dissection of corpses, whereas in other parts of the ancient world it was taboo to cut open dead bodies, so knowledge of internal anatomy elsewhere was mostly derived from non-human animal analogues. This openness for the anatomical arts was made all the more enticing by Egypt’s fame as a locus of medical wonders and talents. In the Odyssey, Homer writes that Egypt’s soil grew “the greatest store of drugs, many that are healing when mixed”, adding that in “[Egypt] every man is a physician, wise above human kind.”
Already blessed with healing plants and people, Egypt’s medical renown would be further enriched by historical developments within the region. An external rampaging force was to assert itself on the fertile underbelly of Egyptian intellectual life. Marching out of Macedonia was a tumultuous tide of Hellenism marshalled by the young general Alexander, whose martial spirit tempered with Aristotelian education was to set most of the known world awash in Greek scholarship. “One city after another,” writes Peter Frankopan in The Silk Roads, “surrendered to him as he took over the territories controlled by his defeated rivals.” And soon enough, “[p]laces of legendary size, wealth and beauty fell before the young hero.”
But endless waves of military activity took a massive toll on the general’s health. When the young Alexander got so tired of campaigning, he decided to sleep forever in 323 BCE at the old age of 33. Some speculate that mutinous voices within the ranks helped serenade Alexander to sleep, turning his loud snores into silent groans with poison. But while intrigue might make for a good political drama, those responsible for Alexander’s demise might not be murderous men, but simply malarial mosquitoes. Whatever the case, the Hellenic empire Alexander had started and stretched soon crumbled after his death, leaving his generals to govern over large patches of territory. Egypt fell into the hands of Ptolemy I Soter, the progenitor of the Ptolemaic dynasty, one of Egypt’s most significant and easily recognisable royal families. It was under their rule when the famous Museum of Alexandria, along with its equally famous library, was built some time around the 290s BCE. Alexander may have given his name to the city, but it was the Ptolemies that made Alexandria truly great like its namesake.
Our best extant description of how the museum may have looked like comes to us from the writings of Strabo, a 1st century BCE Greek geographer. He writes in Geographia that the Museum was part of the Ptolemaic palatial complex, built with a “public walk and a place furnished with seats, and a large hall, in which the men of learning, who belong to the Museum, take their common meal.” It was unlike today’s museums which mostly serve to display antique memorabilia and artifacts for a daily rotation of tourists, students, and regular guests. The Museum of Alexandria on the other hand was a channel from where the living could interact with the divine muses, that is, it was a venue for active intellectual, artistic, and philosophical inspiration. People went there not to see the displays, but went there to discuss, dine, and debate. Probably in that order
Among the museum’s frequent patrons were doctors and medical scholars. Some of them even held administrative positions in the museum, like the Alexandrian physician Chrysermus, who, as a friend of the ruling Ptolemies, served as its director. Whether nepotism was involved in him landing the job or it was thanks to his actual skills, we cannot know for sure, but his placement does point to a prestige bestowed upon medical minds. While physicians were a common sight and presence in the museum, there are no surviving records of them having students, if they even had any, in the museum for regular lessons. However, it can be reasonably surmised that they held informal lectures in the available halls.
Adjoining the museum was a library, the one supposedly burned down by Julius Caesar. The juxtaposition of these two institutions bridged two medical traditions into one coherent unity: while the museum welcomed scholars, the library hosted records of scholarship - together, they melded the thriving Alexandrian specialty in anatomy with Hippocratic learning. Students and scholars studying Egyptian medicine found support for and even criticism of their methods in the available Hippocratic texts stored in the library, which were part of its treasured Greek catalogue. And there were plenty of such reading materials for review thanks to the tireless energy of its personnel to acquire copies. One of the ways that the librarians obtained Greek texts is equally admirable and deplorable. “[B]oats arriving at the ports,” writes Vivian Nutton in Hellenistic and Roman Medicine, “were searched for rare books, which were then confiscated for copying.”
There were other avenues for medical education in Alexandria aside from the museum. In his early years, Galen, who would later become the foremost medical authority in the Roman empire, searched far and wide to look for the physician Numisianus hoping to be admitted as his student. His pursuit eventually led him to Alexandria where he heard Numisianus to be already long dead. Despite the disappointment, his efforts weren’t at all futile, for Numisianus’ pupil, Pelops, took young Galen under his wing. Galen doesn’t mention meeting Pelops in the museum, and in fact, he doesn’t even mention the museum at all in any of his texts, so it’s likely that their exchanges and discussions happened elsewhere in Alexandria.
Two famous Greek anatomists stationed in the city, Herophilus and Erasistratus, also conducted some of the earliest human dissections outside the museum. Their exploits were made possible by the Ptolemies’ trenchant support for the anatomical arts; the royal household was happy to provide the artists with the canvas for their bloody craft. Herophilus and Erasistratus did their examinations “in the best way”, writes Celsus in De medicina, “by dissecting, while still alive, criminal prisoners received from the kings.” Herophilus, in particular, enjoyed the full extent of this royal sponsorship. More living and dead bodies landed on his table, mostly involuntarily, to be cut open, much to his delight. According to Tertullian in De Anima, Herophilus “dissected six hundred persons”, all because he wanted to “scrutinise nature”. It was a small price to pay for Herophilus because he understood the results of his actions: “he hated man that he might gain knowledge.” Not even the most ruthless of soldiers could boast of having such a record of dismembered and disemboweled bodies.
Dissections in Alexandria lasted for centuries, and its grisly reputation permeated throughout the ancient world, even leading St. Augustine (354-430 CE) to comment that:
"...with a cruel zeal for science, some medical men, who are called anatomists, have dissected the bodies of the dead, and sometimes even of sick persons who died under their knives, and have inhumanly pried into the secrets of the human body to learn the nature of the diseases and its exact seat, and how it might be cured".
-St. Augustine, The City of God
In later centuries, especially during the Roman occupation of Egypt, the medical programme in Alexandria started to become standardised, with students expected to follow a recommended curriculum comprised of Galenic and Hippocratic texts. According to Owsei Temkin in Studies in Late Alexandrian Medicine, students had to first read a total of 28 introductory books, 16 by Galen and 12 by Hippocrates, before they could advance to more specialised and complex subjects. Think of it as ancient premed courses.
Alexandria enjoyed a prestigious run of being the intellectual centre of the ancient world. Its role in the development of medicine and in training physicians were paramount. Indeed, the mere mention of having been educated in Alexandria was enough to establish one’s medical credibility without needing to show actual skills, as claimed by Ammianus Marcellinus in Res Gestae. This, of course, is outrageous when compared to modern conventions. But it was with good reason back then. Nowhere else could one get such an intimate familiarity with anatomy and access to hundreds of medical texts than in Alexandria. You wouldn’t want to gamble your life with someone who has little to no expertise in anatomy, especially if medical skull drilling is recommended, would you?
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