Part 14

The original native Roman medical system was quite devoid of scientific elements and was that of a people of the lower culture. Interwoven, as is all primitive Medicine, with ideas that trespass on the domains of religion and magic, it possessed that multitude of ‘specialist deities’ which was so characteristic of the Roman cults. The entire external aspect of Roman medicine was changed by the advent of Greek science. Yet, notwithstanding the large medical field that the Western Empire provided, and the wide acceptance of Greek medicine by the upper classes, it is remarkable that the Latin-speaking peoples produced no eminent physician.

At first scientific medical education at Rome was entirely a matter of private teaching. The earliest important scientific teacher there was the Greek Asclepiades of Bithynia (died c. 40 B.C.), a contemporary of the poet Lucretius and, like him, an Epicurean. Asclepiades, like Erasistratus, imported the atomic view of Democritus into Medicine. He deeply influenced the course of later medical thought, ridiculed the Hippocratic attitude of relying on the ‘healing power of nature’ which he regarded as a mere ‘meditation on death’, and urged that active measures were needed for the process of cure to be ‘seemly, swift and sure’. He founded a regular school at Rome which continued after him.

At first the school was the mere personal following of the physician, who took his pupils and apprentices round with him on his visits. At a later stage such groups combined to form societies or colleges, where problems of the art were debated. Towards the end of the reign of Augustus (27 B.C.-14 A.D.) or the beginning of that of Tiberius (14 A.D.-37 A.D.), these societies constructed for themselves a meeting-place on the Esquiline Hill. Finally the emperors built halls or auditoria for the teaching of Medicine. The professors at first received only the pupils’ fees. It was not until the time of the Emperor Vespasian (reigned A.D. 70-9) that medical teachers were given a salary at the public expense. The system was extended by later emperors.

Thus Rome became a center of medical instruction. After a time subsidiary centers were established in other Italian towns. From Italy the custom spread and we meet traces of such schools at the half-Greek Marseilles as well as at Bordeaux, Arles, Nîmes, Lyons, and Saragossa. For the most part these provincial schools produced workaday medical men, few of whose writings have come down to us. They were perhaps largely training-places for the army surgeons. That class seldom had scientific interests, though Dioscorides, one of the most prominent physicians of antiquity, one who earned the respect of Galen and has deeply influenced the modern pharmacopoeia, served in the army under Nero. His book is, in fact, an extremely useful though ill-arranged compendium of drugs. Dioscorides wrote in Greek, and his work was not translated into Latin until the sixth century of our era.

The earliest scientific medical work in Latin is the De re medica of Celsus, which was prepared about A.D. 30. It is in many ways the most readable and well-arranged ancient medical work that we have. It is, however, not an original work but a compilation from the Greek, and the sole surviving part of a complete encyclopaedia of knowledge. Many of its phrases are closely reminiscent of the Hippocratic Collection. The ethical tone is high and the general line of treatment sensible and humane. Celsus, though almost forgotten in the Middle Ages, was the first classical medical writer to be printed (A.D. 1476).

The treatise of Celsus opens with an interesting account of the History of Medicine. It then passes on to deal with diet and the general principles of therapeutics and pathology, next it discusses internal disease, and then turns to external diseases. The last part of the work is devoted to surgery, and is perhaps the most valuable of the whole.

Celsus professes himself a follower of Asclepiades of Bithynia (p. 41), but, unlike his master, he by no means despises the Hippocratic expectant method of ‘waiting on the disease’. In many matters we are struck with

his boldness as a surgeon. Thus he describes plastic operations on the face and mouth, and the removal of polypus from the nose. He tells too of the very dangerous operation for extirpating a goiter (p. 303), and of cutting for stone. He gives an excellent account of what might be thought the modern operation for removal of tonsils. Noteworthy also is his description of dental practice which includes the wiring of loose teeth and an account of a dental mirror. An idea of the surgical instruments in use in his time can be obtained from those recovered from Pompeii (Fig. 15).

a. Forceps, probably for extracting teeth.

b. Small pocket-case of instruments containing sharp spoon, probe, &c.

c. Fine-toothed forceps.

d. Trocar and cannula for tapping fluids confined in cavities.

e. Speculum for examining orifices and cavities.

f. Instrument for dilating wounds that they may be more fully examined. ]

§ 3. Medical Services of the Roman Empire.

If, in Medicine itself, the Roman achieved but few advances, in the organization of medical service, and especially in the department which deals with public health, his position is far more noteworthy. All Latin writers on architecture give much attention to the orientation, position and drainage of buildings. From an early date sanitation and public health drew the attention of statesmen. Considering the dread of the neighborhood of marshes on the part of these practical sanitarians of Ancient Rome, and in view of modern knowledge of the mosquito-borne character of Malaria (pp. 284-5), it entertaining to find the mosquito net ridiculed by the poets Horace, Juvenal and Propertius!

Sanitation was a feature of Roman life. Rome was already provided with cloacae or subterranean sewers in the age of the Tarquins (6th cent. B.C.). The Cloaca Maxima itself, the main drain of Rome, which is still in use, dates back to that period.

The antiquity of hygienic ideas is seen in an interdict, by a law of about 450 B.C., against burials within the city walls and in the instructions issued to the town officials to attend to the cleanliness of the streets and to the distribution of water. Among these ancient laws we may note one attributed to the first king of Rome, which directed the opening of the body in the hope of extracting a living child in the case of a woman dying in pregnancy. It is the origin of the so-called ‘Caesarean section’ on the living mother, the method by which Caesar himself is said to have been brought into the world. At the date of these decrees physicians in Rome were either slaves or in an entirely subordinate position. Their status was improved by Julius Caesar (102-44 B.C.), who conferred citizenship on all who practised Medicine at Rome, in order to induce physicians to settle there.

(From an engraving by Piranesi.)]

The finest monument to the Roman care for the public health stands yet for all to see in the remains of the fourteen great aqueducts which supplied the city with 300,000,000 gallons of potable water daily. No modern city is better equipped (Fig. 16).

Under the early Empire a definite public medical service was constituted. Public physicians were appointed to the various towns and institutions. A statute of the Emperor Antoninus of about the year A.D. 160 regulates the appointment of these physicians, whose main duty was to attend to the poor. In the code of the Emperor Justinian (A.D. 533) is an article urging them to give this service cheerfully rather than the more subservient attendance on the wealthy. Their salaries were fixed by the municipal councillors. They were encouraged to undertake the training of pupils. Inscriptions attest the respect in which these state physicians were held in many towns.

It is in connection with the army that we see the Roman medical system at its best. There was an adequate supply of military medical attendants who were well organized (Fig. 17). The defects of the Roman army medical system were, however, absence of any elastic scheme for the ranking of medical officers, and complete subordination of the medical to the combatant officer. These facts are of a piece with the general Roman indifference to theoretical science, and explain

why the Roman army surgeons made no additions to knowledge. The social status of the medical staff in the Roman military hierarchy was that of the non-commissioned personnel, which included accountants, registrars and secretaries.

(From Trajan’s column.)

To the left two Roman soldiers assist a wounded comrade. To the right a Roman military surgeon bandages the wounded thigh of a friendly ally. The costume of the surgeon is almost identical with that of the soldiers, though he carries a case for ‘first aid’ slung over his shoulder.

§ 4. Roman Hospitals.

The great contribution of Rome to Medicine--and it is a very great one--is the hospital system. It is a scheme that naturally arose out of the Roman genius for organization and is connected with the Roman military system. Among the Greeks, iatreia, ‘surgeries’, were well known; they were, however, the private property of the medical man. Larger institutions were connected with Aesculapian temples and there is evidence of some degree of scientific medical treatment in these places. In the Republican period the Romans were no better off and, despite the vast numbers of slaves, there was no provision for them when sick. A temple to Aesculapius had been established on an island of the Tiber in Republican times. It became the custom to expose the sick and worn-out slaves on this island of Aesculapius, to avoid the trouble of treating them. The Emperor Claudius (A.D. 41-54) decreed that such slaves were free, and that, if they recovered, they need not return to the control of their masters. Thus, the island became a place of refuge for the sick poor. We may regard it as an early form of public hospital (Fig. 18).

Later writers speak of valetudinaria, ‘infirmaries’, for such persons, and give humane directions for their management. Such valetudinaria were in use even by free Romans. The excavations at Pompeii show that a physician’s house might even be built somewhat on the lines of a modern ‘nursing home’. It was probably in the provinces that private institutions first developed into subventioned public hospitals.