Medicine in ancient Rome
Medicine in ancient Rome combined various techniques using different tools. There was a strong Greek influence on Roman medicine, with Greek physicians including Dioscorides and Galen working and writing on medicine in the Roman Empire with knowledge of hundreds of herbal and other medicines.
Ancient Roman medicine was divided into specializations such as ophthalmology and urology. A variety of surgical procedures were carried out using many different instruments including forceps, scalpels and catheters.
The Roman Empire was a complex and vigorous combination of Greek and Roman cultural elements forged through centuries of war. Later Latin authors, notably Cato and Pliny believed in a specifically Roman type of healing based on herbs, chants, prayers and charms easily available to any head of a household. It was not until the establishment and development of military and political contacts between Greece that Greek medicine made its entry into Italy. However, It was not until the introduction of the healing god Asclepius in 291 BC and the arrival of the Greek doctor Archagathus in 219 BC that foreign medicine was publicly accepted.
Setting aside some of the broader implications of the Greek influence on Roman society, the effect of Greek medicine, ethnography, and meteorology was particularly pertinent in two fields: architecture and health care. This was particularly important from the perspective of the Roman army. Within the scope of the Roman military, there were many medical advancements. A medical corpus was established, permanent physicians were fixed, the valetudinarium (military hospitals) were established, and in Caesars time, the first traces of systematic care for the wounded was founded; It is also important to note that the variety and nature of the surgical instruments discovered in Roman remains indicate a good knowledge of surgery.
Greek influences on Roman medicine
Roman medicine was highly influenced by the Greek medical tradition. Similar to Greek physicians, Roman physicians relied on naturalistic observations to heal the sick rather than spiritual rituals, but that does not imply an absence of spiritual belief. Tragic famines and plagues were often attributed to divine punishment and appeasement to the deities through rituals was believed to alleviate such events. Miasma was perceived to be the root cause of many diseases, whether caused by famine, wars, or plague. The concept of contagion was formulated, resulting in practices of quarantine and improved sanitation.
One of the first prominent doctors to appear in ancient Rome was Galen. He became an expert on the human anatomy from dissecting animals, including monkeys in Greece. Due to his prominence and expertise in ancient Rome, Galen became Emperor Marcus Aurelius' personal physician.
The Romans also conquered the city of Alexandria, which was famous for its comprehensive libraries and advanced universities. In ancient times, Alexandria was an important center for learning, and its Great Library held countless volumes of ancient Greek medical information. The ancient Romans adopted many of the practices and procedures they found in the Great Library into their medical practices.
Additionally, Greek symbols and gods greatly influenced ancient Roman medicine. The caduceus, pictured right, was originally associated with the Greek god, Hermes. Hermes was the Greek God of commerce. He carried a staff wrapped with two snakes, known as the caduceus. This symbol later became associated with the Roman God, Mercury, under the Roman Empire. Later during the 7th century, the caduceus became associated with health and medicine due to its association with the Azoth, the alchemical "universal solvent".
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Many Roman doctors came from Greece and strongly believed in achieving the right balance of the four humors and restoring the natural heat of patients.
Pedanius Dioscorides (circa 40-90 CE), was a Greek botanist, pharmacologist and physician who practised in Rome during the reign of Nero. He became a famous Roman Army doctor. Dioscorides wrote a 5-volume encyclopedia - De Materia Medica - which listed over 600 herbal cures, forming an influential and long-lasting pharmacopeia. De Materia Medica was used extensively by doctors for the following 1,500 years.
Soranus was a Greek physician, born at Ephesus, who lived during the reigns of Trajan and Hadrian (98-138 CE). According to the Suda, he practised in Alexandria and subsequently in Rome. He was the chief representative of the Methodic school of physicians. His treatise Gynaecology is extant (first published in 1838, later by V. Rose, in 1882, with a 6th-century Latin translation by Muscio, a physician of the same school).
Galen (129 CE) –ca. 200 or 216 CE of Pergamon was a prominent ancient Greek physician, whose theories dominated Western medical science for well over a millennium. By the age of 20, he had served for four years in the local temple as a therapeutes ("attendant" or "associate") of the god Asclepius. Although Galen studied the human body, dissection of human corpses was against Roman law, so instead he used pigs, apes, and other animals.
Galen moved to Rome in 162. There he lectured, wrote extensively, and performed public demonstrations of his anatomical knowledge. He soon gained a reputation as an experienced physician, attracting to his practice a large number of clients. Among them was the consul Flavius Boethius, who introduced him to the imperial court, where he became a physician to Emperor Marcus Aurelius.
Despite being a member of the court, Galen reputedly shunned Latin, preferring to speak and write in his native Greek, a tongue that was actually quite popular in Rome. He would go on to treat Roman luminaries such as Lucius Verus, Commodus, and Septimius Severus. However, in 166 Galen returned to Pergamon again, where he lived until he went back to Rome for good in 169.
Galen followed Hippocrates theory of the four humours believing that ones health depended on the balance between the four main fluids of the body (blood, yellow bile, black bile and phlegm). Food was believed to be the initial object that allowed the stabilization of these humours. By contrast, drugs, venesection, cautery and surgery were drastic and were to be used only when diet could no longer help.
The survival and amendment of Hippocratic medicine is attributed to Galen. Galen writes that a physician "must be skilled at reasoning about the problems presented to him, must understand the nature and function of the body within the physician world and must ‘practice temperance and despise all money’". The ideal physician treats both the poor and elite fairly and is a student of all that affects health. Galen often references Hippocrates throughout his writings, attributing Hippocratic literature as the basis for physician conduct and treatments. The writings of Galen survived more than other medical writings in antiquity.
The Roman medical system saw to the establishment of the first hospitals. Unlike modern hospitals, Roman hospitals were reserved for slaves and soldiers. Physicians were assigned to follow armies or ships, tending to the injured. Medical care for the poor was almost non-existent, resulting in the poor to resort to spiritual aid.
The earliest known hospitals of the Ancient Roman Empire were built during the first and second century A.D under the reign of Emperor Trajan. The army's expansion beyond the Italian Peninsula meant that the wounded could no longer be trusted in the care of private homes. It was because of this reason that that valetudinarium was established.
The Valetudinarium is known as the Field Hospitals or Flying Military Camps and began as a small cluster of tents and fortresses dedicated to wounded soldiers. Over time, the temporary forts developed into permanent facilities. While the original hospitals were built along major roads they soon became part of Roman fort architecture and were usually placed near the outer wall in a quiet part of the fortification.
A standard valetudinarium was structured into a rectangular building, consisting of four wings that were connected by an entrance hall that could be pressed into the service of a triage center. Each legion hospital was constructed to accommodate 6-10 percent of the legions 5,000 men. The building also included a large hall, reception ward, dispensary, kitchen, staff quarters, washing and latrine facilities.
A variety of surgical instruments are known from archaeology and Roman medical literature, including for example:
- Could be made of either steel or bronze. Ancient scalpels had almost the same form and function as those of today. The most ordinary type of scalpels in antiquity were the longer, steel scalpels. These long scalpels could be used to make a variety of incisions, but they seem to be particularly suited for deep or long cuts. Smaller, bronze scalpels, referred to as bellied scalpels, were also used frequently by surgeons in antiquity since the shape allowed for delicate and precise cuts to be made.
- Obstetrical Hooks
- A common instrument used regularly by Roman and Greek doctors. The ancient doctors used two basic types of hooks: sharp hooks and blunt hooks. Blunt hooks were used primarily as probes for dissection and for raising blood vessels. Sharp hooks, on the other hand, were used to hold and lift small pieces of tissue so that they could be extracted, and to retract the edges of wounds.
- Bone Drills
- Driven in their rotary motion by means of a thong in various configurations. Roman and Greek physicians used bone drills in order to remove diseased bone tissue from the skull and to remove foreign objects (such as a weapon) from a bone.
- Bone Forceps
- Forceps were used to extract small fragments of bone which could not be grasped by the fingers.
- Male Catheters
- Used in order to open up a blocked urinary tract which allowed urine to pass freely from the body. Early catheters were hollow tubes made of steel or bronze, and had two basic designs. There were catheters with a slight S curve for male patients and a straighter one for females. There were similar shaped devices called bladder sounds that were used to probe the bladder in search of calcifications.
- Uvula (Crushing) Forceps
- These finely toothed jawed forceps were designed to facilitate the amputation of the uvula. The procedure called for the physician to crush the uvula with forceps before cutting it off in order to reduce bleeding.
- Vaginal Specula
- Among the most complex instruments used by Roman and Greek physicians. Most of the vaginal specula that have survived and been discovered consist of a screw device which, when turned, forces a cross-bar to push the blades outwards.
- This instrument was used to mix and apply various ointments to patients.
- Surgical saw
- This instrument was used to cut through bones in amputations and surgeries.
Diet was seen as being essential to healthy living. Food was perceived to have a healing effect or a causative affect on disease determined by its impact on the humors. The power of food and diet gave a person control of how they lived their life. Food and diet also put emphasis on prevention of disease rather than treatment. Moderation of foods was key to healthy living and gave rise to healthy eating philosophies. When diet no longer promoted health, drugs, phlebotomy, cautery, or surgery was sought out. People having control of their lives, managing their own preventative medical diets, and the freedom to seek physicians indicates patient autonomy was valued
Herbal and other medicines
Roman physicians used a wide range of herbal and other medicines. Their ancient names, often derived from Greek, do not necessarily correspond to individual modern species, even if these have the same names. Known medicines include:
|Probable substance||Latin/Greek name||Indication and Effects||Authority|
|Fennel||Ippomarathron||Cures painful urination; expels menstrual flow; stops bowel discharge; brings out breast milk; breaks kidney and urinary stones||Dioscorides|
|Rhubarb||Ra||For flatulence, convulsions, internal disorders (stomach, spleen, liver, kidneys, womb, peritoneum), sciatica, asthma, rickets, dysentery, etc.||Dioscorides|
|Gentian||Gentiane||Warming, astringent; for poisonous bites, liver disorders; induces abortion; treats deep ulcers, eye inflammation||Dioscorides|
|Birthwort||Aristolochia||Poisonous; assists in childbirth||Dioscorides|
|Liquorice||Glukoriza||Calms stomach; chest, liver, kidney and bladder disorders||Dioscorides|
|Aloe||Aloe||Heals wounds (applied dry); removes boils; purgative; treats alopecia||Dioscorides|
Statues and healing shrines were sights of prayer and sacrifice for both the poor and the elite, and were common throughout the Roman Empire. Reverence for shrines and statues ranged from people seeking healing, guidance, and alternatives to ineffectual human physicians and drugs.
Galenic medical texts embody the written medical tradition through classical antiquity. Little written word survived prior to this era. The volume of written works by Galen, however, nears close to 350. His surviving works far surpass any other writer from the period. Prior to Galen, much of medical reference survived through word of mouth. The tradition of transmission and translation originated with the De Materia Medica, an ancient encyclopedia written by Pedanius Dioscorides between 50 AD and 70 AD. Pedanius Dioscorides himself was a Roman physician of Greek descent. The manuscripts classified and illustrated over one thousand substances and their uses. De Materia Medica influenced medical knowledge for centuries due to its dissemination and translation to Greek, Arabic, and Latin. Galen wrote in Greek, but Arabic and Syriac translations survived as well. He referenced and challenged written works by Hippocratic physicians and authors, which gave insight into other popular medical philosophies. Herophilus, known for his texts on anatomy through dissection, and Erasistratus, also known for anatomy and physiology, survive through Galenic reference. Galen also referenced the written works of Methodist physician Soranus, known for his four book treatise regarding gynecology. His synthesis of earlier medical philosophies and broad range of subjects produced the textual legacy Galen left on the medical community for the next fifteen hundred years.
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