Roman medicine

Medicine of ancient Rome; a civilization founded on the city of Rome that lasted from 753 BC to AD 476, and stretched at its peak in the 1st century AD from Britain to Mesopotamia (modern Iraq) and much of North Africa. Pliny the Elder regarded the art of medicine as a Greek invention, writing in the 1st century AD that the Roman people had survived without medicine for more than six centuries before adopting the practices of Greek medicine. There is evidence that a medicine without doctors was in fact more characteristic of Roman life; most doctors practising in the Roman Empire were Greek. The Romans believed that health was dependent on diet and lifestyle, with some conditions - in particular, epidemic diseases - coming from the gods.

Traditional folk medicine In the early Roman republic, preserving health and curing sickness were mainly a matter for the family. The head of the household was responsible for the well-being and fertility of family members, slaves, and domestic animals. Remedies were based on easily available substances; in his handbook on agriculture, De Agri Cultura/On Farming (c. 160 BC), Marcus Porcius Cato recommended the use of cabbage for medicinal purposes, with bruised leaves being applied to cure external conditions, and concoctions drunk for internal complaints. Pliny the Elder also advised readers of his encyclopedia Historia naturalis/Natural History (completed c. AD 77), to use cabbage, wool, and eggs to heal many diseases. Substances could be applied to the accompaniment of magic chants. In the 1st century AD Celsus compiled an encyclopedia of information that every literate Roman should know; only the eight books on medicine survive. These cover a healthy diet, and outline the diseases that can affect the whole body and its constituent parts.

Greek medicine in Rome By the mid-2nd century BC, Rome had conquered much of the Greek world, and in the process was being influenced in areas such as art, architecture, and medicine. The Romans adopted the Greek god of healing, Asclepius, in 295 BC. Greek doctors who followed the teachings of Hippocrates believed in the importance of the individual regulating every aspect of life, keeping a balance between the constituent fluids of the body (the theory of the humours) by monitoring diet and exercise according to personal physique, the season, and the environment in which one lived. Some Romans were suspicious of Greek medicine, regarding it as too theoretical, particularly in its use of very complex drug recipes involving many ingredients. They could not understand how different doctors could hold such different beliefs about the causes of disease, and they were disturbed by the fact that these doctors expected a fee for their services. They feared that Greek doctors were out to poison their Roman conquerors; indeed, the first Greek doctor to be given citizen's rights in Rome, Archagathus, was colloquially known as ‘The Executioner’ (carnifex) because of his enthusiasm for surgery and cauterization. But, by the 1st century AD, the majority of doctors in the Roman world were Greeks.

Doctors were largely an urban phenomenon. Traditional, cheap herbal remedies were not easily available to city dwellers, but in their place were many expensive imported drugs from all over the Roman Empire.

Social status of doctors Many Greek doctors in the western part of the Roman Empire were of slave or freedman status. In the Greek-speaking East, doctors had higher status, and many served as local officials in their cities. Like other craftspeople, doctors belonged to trade guilds that acted as social clubs and looked after their members' welfare. Some learned their craft from family members, or by apprenticeship, but - in the absence of formal medical training - anyone could set up as a doctor. The best way to win a reputation as a good doctor was simply to score a success in treating a rich and famous patient.

Galen of Pergamum Galen (129-200 AD) was the best-known, most prolific (writing about 350 books), and subsequently most influential Greek doctor in the Roman world. After treating the gladiators at Pergamum from 157 onwards, he moved to Rome in 161 and went on to become personal physician to the emperor Marcus Aurelius and his family. His medical theories combined Aristotle's logic, Plato's notion of three body systems governed respectively by the liver, the heart, and the brain, and the Hippocratic four humours: blood, black bile, yellow bile, and phlegm. He claimed that he carried out animal dissections every day, in order to understand the structure of the body. However, he was forbidden by Roman law to dissect human corpses, leading to numerous errors in the understanding of human anatomy. Galen's work remained largely unchallenged for over 1,000 years, influencing Islamic medicine and forming the basis of medieval medicine, until advances in the understanding of human anatomy in Renaissance medicine proved many of Galen's theories to be wrong.

Public health The government in Rome developed a highly structured public health system that was copied in other cities and towns of the Roman Empire. Rome was famous for the aqueducts and sewers among its feats of civil engineering. Apart from delivering fresh water to the street fountains, aqueducts were also often built to show the civic spirit of the person funding them, and as a way of boosting a town's image. Living conditions in most cities were poor compared to the countryside, but by the 1st century BC most Roman towns had a public bath, and villas and large town houses often had a private bath complex. Although the primary purpose of baths was social, as they provided a meeting place, the health of the population was improved by the custom. Public toilets were also provided and sewers constructed to carry away the waste, although there was no proper understanding of the connection between sewage and disease. People believed that bad air and smells carried disease. Indeed, substances such as urine and faeces were considered to be effective substances in medical treatments. Some cities appointed a public physician for their inhabitants. By the end of the Roman Empire the Roman public health system was more advanced than any system of public health would be in Europe for the next 1,400 years: see also public health, public health in the Roman Empire.

The dangers of empire Many Romans believed that conquest damaged their health, because it exposed them to a wide range of new exotic imports, including new foods and drinks, which they thought caused new diseases to arise in their bodies. Greek medicine, by offering drugs to produce vomiting in those who had overeaten, was condemned as treating the symptoms rather than the cause. Roman writers instead recommended a simple diet and a sensible lifestyle, taking responsibility for oneself and relying on nature to provide healing.

Hospitals and temples In large households, sick slaves could be cared for in special buildings called valetudinaria. In the army, the general was responsible for the health of his soldiers; in permanent forts, purpose-built hospitals were set up, with a set of rooms opening off a square courtyard. For most people, however, care remained in the family, although it was also possible to visit the temple of a god or goddess associated with health. The most famous of these were dedicated to Asclepius, whose daughter Hygieia was the personification of good health.