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OUTLINES OF
GREEK AND ROMAN MEDICINE
[Illustration: From Wellcome's Medical Diary (Copyright) By permission
of Burroughs Wellcome & Co.
ASKLEPIOS
The ancient Greek Deity of Healing.]
OUTLINES OF
GREEK AND ROMAN MEDICINE
BY
JAMES SANDS ELLIOTT, M.D., Ch.B.(Edin.)
_Editor of the "New Zealand Medical Journal,"
Honorary Surgeon to the Wellington Hospital, New Zealand._
Illustrated
milford house inc.
boston
This Milford House edition is an unabridged republication of the edition
of 1914.
Published in 1971 by MILFORD HOUSE INC. Boston, Massachusetts
Library of Congress Catalogue Card Number 76-165987
Standard Book Number 0-87821-036-9
Printed in the U.S.A.
TO MY FATHER
PREFACE.
I was stimulated to write these Outlines of Greek and Roman Medicine by
a recent sojourn in the south-eastern part of Europe. The name of the
book defines, to some extent, its limitations, for my desire has been to
give merely a general outline of the most important stages in the
advancement of the healing art in the two Empires to which modern
civilization is most deeply indebted. There are a few great works on the
history of medicine by continental writers, such, for instance, as those
by the German writers, Baas, Sprengel, and Puschmann, but, generally
speaking, the subject has been much neglected.
I cherish the hope that this little work may appeal to doctors, to
medical students, and to those of the public who are interested in a
narration of the progress of knowledge, and who realize that the
investigation of the body in health and disease has been one of the most
important features of human endeavour.
The medical profession deserves censure for neglect of its own history,
and pity 'tis that so many practitioners know nothing of the story of
their art. For this reason many reputed discoveries are only
re-discoveries; as Bacon wrote: "Medicine is a science which hath been,
as we have said, more professed than laboured, and yet more laboured
than advanced; the labour having been, in my judgment, rather in circle
than in progression. For I find much iteration, and small progression."
Of late years, however, the History of Medicine has been coming into its
kingdom. Universities are establishing courses of lectures on the
subject, and the Royal Society of Medicine recently instituted a
historical section.
The material I have used in this book has been gathered from many
sources, and, as far as possible, references have been given, but I have
sought for, and taken, information wherever it could best be found. As
Montaigne wrote: "I have here only made a nosegay of culled flowers, and
have brought nothing of my own but the thread that ties them together."
I have to express my indebtedness to my friend, Mr. J. Scott Riddell,
M.V.O., M.A., M.B., C.M., Senior Surgeon, Aberdeen Royal Infirmary, for
his great kindness in reading the proof-sheets, preparing the index and
seeing this book through the press and so removing one of the
difficulties which an author writing overseas has to encounter; also to
my publishers for their courtesy and attention.
JAMES SANDS ELLIOTT.
_Wellington,
New Zealand._
_January 5, 1914._
CONTENTS.
PAGE
CHAPTER I.
EARLY ROMAN MEDICINE. 1
Origin of Healing--Temples--Lectisternium--Temple of
Æsculapius--Archagathus--Domestic Medicine--Greek
Doctors--Cloaca Maxima--Aqueducts--State of the early Empire
CHAPTER II.
EARLY GREEK MEDICINE. 13
Apollo--Æsculapius--Temples--Serpents--Gods of
Health--Melampus--Homer--Machaon--Podalarius--Temples of
Æsculapius--Methods of Treatment--Gymnasia--Classification of
Renouard--Pythagoras--Democedes--Greek Philosophers
CHAPTER III.
HIPPOCRATES. 25
His life and works--His influence on Medicine
CHAPTER IV.
PLATO, ARISTOTLE, THE SCHOOL OF ALEXANDRIA, AND
EMPIRICISM. 39
Plato--Aristotle--Alexandrian School--Its Origin--Its
Influence--Lithotomy--Herophilus--Erasistratus--Cleombrotus--
Chrysippos--Anatomy--Empiricism--Serapion of Alexandria
CHAPTER V.
ROMAN MEDICINE AT THE END OF THE REPUBLIC AND THE
BEGINNING OF THE EMPIRE. 51
Asclepiades of Prusa--Themison of Laodicea--Methodism--Wounds of
Julius Cæsar--Systems of Philosophy--State of the country--Roman
quacks--Slaves and Freedmen--Lucius Horatillavus
CHAPTER VI.
IN THE REIGN OF THE CÆSARS TO THE DEATH OF NERO. 63
Augustus--His illnesses--Antonius Musa--Mæcenas--Tiberius--
Caligula--Claudius--Nero--Seneca--Astrology--Archiater--Women
poisoners--Oculists in Rome
CHAPTER VII.
PHYSICIANS FROM THE TIME OF AUGUSTUS TO THE DEATH
OF NERO. 72
Celsus--His life and works--His influence on Medicine--Meges of
Sidon--Apollonius of Tyana--Alleged miracles--Vettius
Valleus--Scribonius Longus--Andromachus--Thessalus of
Tralles--Pliny
CHAPTER VIII.
THE FIRST AND SECOND CENTURIES OF THE CHRISTIAN ERA. 86
Athenæus--Pneumatism--Eclectics--Agathinus--Aretæus--Archigenes--
Dioscorides--Cassius Felix--Pestilence in Rome--Ancient surgical
instruments--Herodotus--Heliodorus--Cælius Aurelianus--Soranus--
Rufus of Ephesus--Marinus--Quintus
CHAPTER IX.
GALEN. 96
His life and works--His influence on Medicine
CHAPTER X.
THE LATER ROMAN AND BYZANTINE PERIOD. 111
Beginning of Decline--Neoplatonism--Antyllus--Oribasius--Magnus--
Jacobus Psychristus--Adamantius--Meletius--Nemesius--Ætius--
Alexander of Tralles--The Plague--Moschion--Paulus Ægineta--Decline
of Healing Art
CHAPTER XI.
INFLUENCE OF CHRISTIANITY ON ALTRUISM AND THE
HEALING ART. 127
Essenes--Cabalists and Gnostics--Object of Christ's
Mission--Stoics--Constantine and Justinian--Gladiatorial
Games--Orphanages--Support of the Poor--Hospitals--Their
Foundation--Christianity and Hospitals--Fabiola--Christian
Philanthropy--Demon Theories of Disease receive the Church's
Sanction--Monastic Medicine--Miracles of Healing--St. Paul--St.
Luke--Proclus--Practice of Anatomy denounced--Christianity the
prime factor in promoting Altruism
CHAPTER XII.
GYMNASIA AND BATHS. 143
Gymnastics--Vitruvius--Opinions of Ancient Physicians on
Gymnastics--The Athletes--The Baths--Description of Baths at
Pompeii--Thermæ--Baths of Caracalla
CHAPTER XIII.
SANITATION. 155
Water-supply--Its extent--The Aqueducts--Distribution in
city--Drainage--Disposal of the Dead--Cremation and
Burial--Catacombs--Public Health Regulations
APPENDIX.
FEES IN ANCIENT TIMES 162
ILLUSTRATIONS.
Asklepios, the ancient Greek Deity of Healing _frontispiece_
Machaon (Son of Asklepios), the first Greek Military
Surgeon, attending to the wounded Menelaus _p._ 17
PLATE I.--Bust of Æsculapius _face p._ 13
" II.--Hygeia, the Greek Deity of Health " 15
" III.--Facade of Temple of Asklepios, restored (Delfrasse) " 18
" IV.--Health Temple, restored (Caton) " 20
OUTLINES OF Greek and Roman Medicine
CHAPTER I.
EARLY ROMAN MEDICINE.
Origin of Healing--Temples--Lectisternium--Temple of
Æsculapius--Archagathus--Domestic Medicine--Greek Doctors--Cloaca
Maxima--Aqueducts--State of the early Empire.
The origin of the healing art in Ancient Rome is shrouded in
uncertainty. The earliest practice of medicine was undoubtedly theurgic,
and common to all primitive peoples. The offices of priest and of
medicine-man were combined in one person, and magic was invoked to take
the place of knowledge. There is much scope for the exercise of the
imagination in attempting to follow the course of early man in his
efforts to bring plants into medicinal use. That some of the indigenous
plants had therapeutic properties was often an accidental discovery,
leading in the next place to experiment and observation. Cornelius
Agrippa, in his book on occult philosophy, states that mankind has
learned the use of many remedies from animals. It has even been
suggested that the use of the enema was discovered by observing a
long-beaked bird drawing up water into its beak, and injecting the water
into the bowel. The practice of healing, crude and imperfect, progressed
slowly in ancient times and was conducted in much the same way in Rome,
and among the Egyptians, the Jews, the Chaldeans, Hindus and Parsees,
and the Chinese and Tartars.
The Etruscans had considerable proficiency in philosophy and medicine,
and to this people, as well as to the Sabines, the Ancient Romans were
indebted for knowledge. Numa Pompilius, of Sabine origin, who was King
of Rome 715 B.C., studied physical science, and, as Livy relates, was
struck by lightning and killed as the result of his experiments, and it
has therefore been inferred that these experiments related to the
investigation of electricity. It is surprising to find in the Twelve
Tables of Numa references to dental operations. In early times, it is
certain that the Romans were more prone to learn the superstitions of
other peoples than to acquire much useful knowledge. They were
cosmopolitan in medical art as in religion. They had acquaintance with
the domestic medicine known to all savages, a little rude surgery, and
prescriptions from the Sibylline books, and had much recourse to magic.
It was to Greece that the Romans first owed their knowledge of healing,
and of art and science generally, but at no time did the Romans equal
the Greeks in mental culture.
Pliny states that "the Roman people for more than six hundred years were
not, indeed, without medicine, but they were without physicians." They
used traditional family recipes, and had numerous gods and goddesses of
disease and healing. Febris was the god of fever, Mephitis the god of
stench; Fessonia aided the weary, and "Sweet Cloacina" presided over the
drains. The plague-stricken appealed to the goddess Angeronia, women to
Fluonia and Uterina. Ossipaga took care of the bones of children, and
Carna was the deity presiding over the abdominal organs.
Temples were erected in Rome in 467 B.C. in honour of Apollo, the
reputed father of Æsculapius, and in 460 B.C. in honour of Æsculapius of
Epidaurus. Ten years later a pestilence raged in the city, and a temple
was built in honour of the Goddess Salus. By order of the Sibylline
books, in 399 B.C., the first _lectisternium_ was held in Rome to combat
a pestilence. This was a festival of Greek origin. It was a time of
prayer and sacrifice; the images of the gods were laid upon a couch, and
a meal was spread on a table before them. These festivals were repeated
as occasion demanded, and the device of driving a nail into the temple
of Jupiter to ward off "the pestilence that walketh in darkness," and
"destruction that wasteth at noonday" was begun 360 B.C. As evidence of
the want of proper surgical knowledge, the fact is recorded by Livy
that after the Battle of Sutrium (309 B.C.) more soldiers died of wounds
than were killed in action. The worship of Æsculapius was begun by the
Romans 291 B.C., and the Egyptian Isis and Serapis were also invoked for
their healing powers.
At the time of the great plague in Rome (291 B.C.), ambassadors were
sent to Epidaurus, in accordance with the advice of the Sibylline books,
to seek aid from Æsculapius. They returned with a statue of the god, but
as their boat passed up the Tiber a serpent which had lain concealed
during the voyage glided from the boat, and landing on the bank was
welcomed by the people in the belief that the god himself had come to
their aid. The Temple of Æsculapius, which was built after this plague
in 291 B.C., was situated on the island of the Tiber. Tradition states
that, when the Tarquins were expelled, their crops were thrown into the
river, and soil accumulated thereon until ultimately the island was
formed. In consequence of the strange happening of the serpent landing
from the ship the end of the island on which the Temple of Æsculapius
stood was shaped into the form of the bow of a ship, and the serpent of
Æsculapius was sculptured upon it in relief.
The island is not far from the Æmilian Bridge, of which one broken arch
remains.
Ovid represents this divinity as speaking thus:--
"I come to leave my shrine;
This serpent view, that with ambitious play
My staff encircles, mark him every way;
His form--though larger, nobler, I'll assume,
And, changed as gods should be, bring aid to Rome."
(Ovid, "Metamorphoses," xv.)
He is said to have resumed his natural form on the island of the Tiber.
"And now no more the drooping city mourns;
Joy is again restored and health returns."
It was the custom for patients to sleep under the portico of the Temple
of Æsculapius, hoping that the god of the healing art might inspire them
in dreams as to the system of cure they should adopt for their
illnesses. Sick slaves were left there by their masters, but the number
increased to such an extent that the Emperor Claudius put a stop to the
cruel practice. The Church of St. Bartholomew now stands on the ruins of
the Temple of Æsculapius.
Even in very early times, however, Rome was not without medical
practitioners, though not so well supplied as some other nations. The
Lex Æmilia, passed 433 B.C., ordained punishment for the doctor who
neglected a sick slave. In Plutarch's "Life of Cato" (the Censor, who
was born in 234 B.C.), we read of a Roman ambassador who was sent to the
King of Bithynia, in Asia Minor, and who had his skull trepanned.
The first regular doctor in Rome was Archagathus, who began practice in
the city 219 B.C., when the authorities received him favourably and
bought a surgery for him; but his methods were rather violent, and he
made much use of the knife and caustics, earning for himself the title
of "butcher," and thus having fallen into disfavour, he was glad to
depart from Rome. A College of Æsculapius and of Health was established
154 B.C., but this was not a teaching college in the present meaning of
the term.
The doctors of Ancient Rome took no regular course of study, nor were
any standards specified, but as a rule knowledge was acquired by
pupilage to a practising physician, for which a honorarium was paid.
Subsequently the Archiatri, after the manner of trade guilds, received
apprentices, but Pliny had cause to complain of the system of medical
education, or rather, to deplore the want of it. He wrote: "People
believed in anyone who gave himself out for a doctor, even if the
falsehood directly entailed the greatest danger. Unfortunately, there is
no law which punishes doctors for ignorance, and no one takes revenge on
a doctor if through his fault someone dies. It is permitted him by our
danger to learn for the future, at our death to make experiments, and,
without having to fear punishment, to set at naught the life of a human
being."
Before the time when Greek doctors settled in Rome, medical treatment
was mainly under the direct charge of the head of each household. The
father of a family had great powers conferred upon him by the Roman law,
and was physician as well as judge over his family. If he took his
new-born infant in his arms he recognized him as his son, but otherwise
the child had no claim upon him. He could inflict the most dire
punishments on members of his household for which they had no redress.
Cato, the Elder, who died in B.C. 149, wrote a guide to domestic
medicine for the use of Roman fathers of the Republic, but he was a
quack and full of self-conceit. He hated the physicians practising in
Rome, who were mostly Greeks, and thought that their knowledge was much
inferior to his own. Plutarch relates that Cato knew of the answer given
to the King of Persia by Hippocrates, when sent for professionally, "I
will never make use of my art in favour of barbarians who are enemies of
the Greeks," and pretended to believe that all Greek physicians were
bound by the same rule, and animated by the same motives. However, Cato
did a great deal of good by attempting to lessen the vice and luxury of
his age.
The Greeks in Rome were looked at askance as foreign adventurers, and
there is no doubt that although many were honourable men, others came to
Rome merely to make money out of the superstitious beliefs and credulity
of the Roman people. Fine clothes, a good house, and the giving of
entertainments, were the best introduction to practice that some of
these practitioners could devise.
The medical opinions of Cato throw a sidelight upon the state of
medicine in his time. He attempted to cure dislocations by uttering a
nonsensical incantation: "_Huat hanat ista pista sista damiato
damnaustra!_" He considered ducks, geese and hares a light and suitable
diet for the sick, and had no faith in fasting.
Although the darkness was prolonged and intense before the dawn of
medical science in Rome, yet, in ancient times, there was a considerable
amount of knowledge of sanitation. The great sewer of Rome, the _Cloaca
Maxima_, which drained the swampy valley between the Capitoline and
Palatine Hills, was built by order of Tarquinius Priscus in 616 B.C. It
is wonderful that at the present time the visitor may see this ancient
work in the Roman Forum, and trace its course to the Tiber. In the
Forum, too, to the left of the Temple of Castor, is the sacred district
of Juturna, the nymph of the healing springs which well up at the base
of the Palatine Hill. _Lacus Juturnæ_ is a four-sided basin with a
pillar in the middle, on which rested a marble altar decorated with
figures in relief. Beside the basin are rooms for religious purposes.
These rooms are adorned with the gods of healing, Æsculapius with an
acolyte holding a cock, the Dioscuri and their horses, the head of
Serapis, and a headless statue of Apollo.
The Cloaca Maxima was formed of three tiers of arches, the vault within
the innermost tier being 14 ft. in diameter. The administration of the
sewers, in the time of the Republic, was in the hands of the censors,
but special officers called _curatores cloacarum_ were employed during
the Empire, and the workmen who repaired and cleansed the sewers were
condemned criminals. These ancient sewers, which have existed for
twenty-five centuries, are monuments to the wisdom and power of the
people who built them. In the time of Furius Camillus private drains
were connected with the public sewers which were flushed by aqueduct and
rain water. This system has prevailed throughout the centuries.
The Aqueducts were also marvellous works, and although they were added
to in the time of the Empire, Sextus Julius Frontinus, curator of waters
in the year A.D. 94, gives descriptions of the nine ancient aqueducts,
some of which were constructed long before the Empire. For instance, the
_Aqua Appia_ was conducted into the city three hundred and twelve years
before the advent of Christ, and was about seven miles long. The _Aqua
Anio Vetus_, sixty-two miles in length, built in B.C. 144, was conveyed
across the Campagna from a source in the country beyond Tivoli. Near
this place there is a spring of milky-looking water containing
sulphurous acid, sulphurated lime, and bicarbonate of lime, used now,
and in ancient times for the relief of skin complaints. This water, at
the present day, has an almost constant temperature of 75°.
In course of time, when the Roman power was being extended abroad, the
pursuit of conquest left little scope for the cultivation of the
peaceful arts and the investigation of science, and life itself was
accounted so cheap that little thought was given to improving methods
for the treatment of the sick and wounded. On a campaign every soldier
carried on his person a field-dressing, and the wounded received
rough-and-ready first-aid attention from their comrades in arms.
Later, when conquest was ended, and attention was given to the
consolidation of the provinces, ease and happiness, as has been shown by
Gibbon, tended to the decay of courage and thus to lessen the prowess of
the Roman legions, but there was compensation for this state of affairs
at the heart of the Empire because strong streams of capable and robust
recruits flowed in from Spain, Gaul, Britain and Illyricum.
At its commencement, the Empire was in a peaceful, and, on the whole,
prosperous condition, and the provincials, as well as the Romans,
"acknowledged that the true principles of social life, laws,
agriculture, and science, which had been first invented by the wisdom of
Athens, were now firmly established by the power of Rome, under whose
auspicious influence the fiercest barbarians were united by an equal
government and common language. They affirm that with the improvement of
arts the human species was visibly multiplied. They celebrate the
increasing splendour of the cities, the beautiful face of the country,
cultivated and adorned like an immense garden; and the long festival of
peace, which was enjoyed by so many nations, forgetful of their ancient
animosities, and delivered from the apprehension of future danger." Thus
wrote the Roman historian, and Gibbon states that when we discount as
much of this as we please as rhetorical and declamatory, the fact
remains that the substance of this description is in accordance with the
facts of history. Never until the Christian era was any thought given to
the regular care of the helpless and the abject. Slaves were often
treated like cattle, and the patricians had no bond of sympathy with the
plebeians. Provisions were sometimes distributed to the poor, and taxes
remitted, but for reasons of State and not from truly charitable
motives. Authority was also given to parents to destroy new-born infants
whom they could not support. The idea of establishing public
institutions for the relief of the sick and the poor did not enter the
minds of the ancient Romans.
Before considering the state of the healing art throughout the period of
the Roman Empire, it is necessary to devote the next chapters to a
consideration of the rise and progress of medical science in Greece,
for it cannot be too strongly emphasized that Roman philosophy and Roman
medicine were borrowed from the Greeks, and it is certain also that the
Greeks were indebted to the Egyptians for part of their medical
knowledge. The Romans were distinguished for their genius for law-giving
and government, the Greeks for philosophy, art, and mental culture
generally.
[Illustration: Plate I. BUST OF ÆSCULAPIUS.]