(BEING CONTINUED FROM 19/06/16)
The Doctor In Roman Society
Apprenticeship and Quackery
As a profession, medicine was more highly regarded in Greece than in Rome. Physicians were basically craftsmen, probably enjoying some esteem among their customers, but not being part of the socio-political elite.
Roman doctors did not fare so well. Many doctors were freed Greek slaves, hence the social standing of doctors was quite low. Because recovery rates were so low, many people were skeptical or even scornful of doctors. Their skepticism is easily understood. Roman literature tells us much about the reactions of individuals to medicine and doctors. Listening to the Roman authors, we hear tales of quackery and chicanery at all levels of society:
Some doctors charge the most excessive prices for the most worthless medicines and drugs, and others in the craft attempt to deal with and treat diseases they obviously do not understand. ~Gargilius Martialis, Preface, 7
There were no licensing boards and no formal requirements for entrance to the profession. Anyone could call himself a doctor. If his methods were successful, he attracted more patients; if not, he found himself another profession.
Until recently, Diaulus was a doctor; now he is an undertaker. He is still doing as an undertaker, what he used to do as a doctor. ~Martial, Epigrams 1.47
You are now a gladiator, although until recently you were an ophthalmologist. You did the same thing as a doctor that you do now as a gladiator. ~Martial, Epigrams 8.74
Medical training consisted mostly of apprentice work. Men trained as doctors by following around another doctor.
I felt a little ill and called Dr. Symmachus. Well, you came, Symmachus, but you brought 100 medical students with you. One hundred ice cold hands poked and jabbed me. I didn’t have a fever, Symmachus, when I called you, but now I do. ~Martial, Epigrams 5.9
Plutarch grumbles that practitioners used all sorts of questionable methods to gain patients, ranging from escorting the prospective patient home from bars to sharing dirty jokes with him.
Evidence for the public mistrust of physicians is plentiful, including these epigrams from the Greek Anthology:
Socles, promising to set Diodorus’s crooked back straight, piled three solid stones, each four feet square, on the hunchback’s spine. He was crushed and died, but he became straighter than a ruler. ~Greek Anthology XI, 120
Alexis the physician purged by a clyster five patients at one time, and five other by drugs; he visited five, and again he rubbed five with ointment. And for all there was one night, one medicine, one coffin-maker, one tomb, one Hades, one lamentation. ~Greek Anthology XI, 122
Phidon did not purge me with a clyster or even feel me, but feeling feverish I remembered his name and died. ~Greek Anthology XI, 118
Contraception, C-sections, and the Wandering Womb
In ancient Greek society, male dominance extended even to childbirth. Greek medicine cast man as the bringer of sanity and health to the biologically defective, subservient woman through intercourse, which was believed to relieve the buildup of menstrual blood around the heart. Men also received full credit for conception, since the womb was seen mainly as a receptacle for sperm. Abortion, if not condoned in the Hippocratic Oath, was permitted under Greek law, and infanticide, particularly of female newborns, was widely practiced.
Women in the ancient world practiced birth control with little interference from religious or political authorities. A precise knowledge of plants which could either block conception or cause abortion was resident in the oral female culture of herbalists and midwives.
One of the most common contraceptive agents used in the ancient Mediterranean world was silphiumwhich grew exclusively in the area of Cyrene in North Africa. Since Cyrene was the sole exporter of the plant, it became the city’s official symbol on its coinage, and it remained the city’s primary source of income until the first century BCE.
Other plants used in classical times as contraceptives or abortifacients included pennyroyal, artemisia,myrrh, and rue. In Aristophanes’s comedy Peace, first performed in 421 BCE, Hermes provides Trigaius with a female companion. Trigaius wonders if the woman might become pregnant. “Not if you add a dose of pennyroyal,” advises Hermes. Pennyroyal grows in the wild and would have been readily available to ancient women. Recent studies show that pennyroyal contains a substance calledpulegone that terminates pregnancy in humans and animals.
Dioscorides, Galen, and other ancient medical writers believed that the pomegranate possessed antifertility properties. The best known literary reference to its contraceptive power is in the Greek myth of Persephone and Hades. For every pomegranate kernel that Persephone ate, that many months were allotted to the infertile fall and winter.
The Caesarean section operation did not derive its name from the story that Julius Caesar was born in this manner. It was called Caesarean because the Roman, or Caesarean, law demanded that when a pregnant woman died, her body could not be buried until the child had been removed. The law also stipulated that a Caesarean section could not be performed on a living pregnant woman until the tenth month of gestation. Ancient physicians were unable to save the life of the mother in such cases, thus the procedure was rarely performed. We know from ancient sources that Julius Caesar could not have been born by Caesarean section, because his mother, Aurelia, lived to be an adviser to her grown son.
Hysteria and the Wandering Womb
The word “hysteria” is derived from the Greek word hystera, “womb.” Greco-Roman medical writers believed that hysteria was caused by violent movements of the womb and that it was, therefore, peculiar to women. As early as the sixth century BCE, medical writers believed that the womb was not a stationary object, but one that traveled throughout the body, often to the detriment of the woman’s health. Aretaeus of Cappadocia, a contemporary of Galen, included in his medical treatises a section describing the wandering womb.
In women, in the hollow of the body below the ribcage, lies the womb. It is very much like an independent animal within the body for it moves around of its own accord and is quite erratic. Furthermore, it likes fragrant smells and moves toward them, but it dislikes foul odors and moves away from them… When it suddenly moves upward [i.e., toward a fragrant smell] and remains there for a long time and presses on the intestines, the woman chokes, in the manner of an epileptic, but without any spasms. For the liver, the diaphragm, lungs and heart are suddenly confined in a narrow space. And therefore the woman seems unable to speak or to breathe. In addition, the carotid arteries, acting in sympathy with the heart, compress, and therefore heaviness of the head, loss of sense perception, and deep sleep occur… Disorders caused by the uterus are remedied by foul smells, and also by pleasant fragrances applied to the vagina…
Bath Houses, Aqueducts, and Latrines
Forum Baths, Pompeii, first century BCE, Caldarium
Giant bath houses, characteristic of Imperial Rome, could house not only bathing facilities but lecture halls, gymnasia, libraries and gardens. Hot (caudarium), tepid (tepidarium) and cold (frigidarium) baths were provided usually. The room pictured to the left was kept warm by hot air circulating through pipes in the walls and floor.
Authors as disparate as Celsus, Vitruvius, Pliny,Frontinus, Columella, Varro, and Vegetius, demonstrate the Roman concept of health interwoven with the normal life and ordinary process of government in the Roman Empire. Vitruvius, a practicing architect in the milieu of the Roman Empire, shows through his writing how important sanitary planning was for public buildings. His chapter on city planning begins with a discussion of the salubrity of sites. The influence of the Hippocratic tract On Airs, Waters, and Places is apparent:
In the case of the walls these will be the main points: First, the choice of the most healthy site. Now this will be high and free from clouds and frost, with an aspect neither hot nor cold but temperate. In this way a marshy neighborhood will be avoided. For when the morning breezes blow towards the town at sunrise, as they bring with them mists from the marshes and, mingled with the mist, the poisonous breath of the creatures of the marshes [i.e., microorganisms], to be wafted into the bodies of the inhabitants, they will make the site unhealthy. ~De Architectura I.2-5
Pont du Gard, Nimes, France, 14 CE
The aqueducts were the true triumph of Roman sanitary engineering and were used throughout their empire.Frontinus, the author of a treatise on Rome’s aqueducts, became water commissioner (curator aquarum) in 97 CE. He recognized the sanitary aspects of his position stating, “my office … concerns not only the usefulness of such a system, but also the very health and safety of Rome ….”
Public Latrines, Corinth, 4th century BCE
Latrines, either well drained or with the provision for semi-sanitary maintenance, became commonplace both in the houses of the wealthy and in bath complexes where there was a constant supply of running water. In lieu of toilet paper, Romans used a sponge tied to the end of a stick. After use it was returned to a bucket of saltwater.
Terra Cotta Statuette, 350-300 BCE, National Archaeological Museum of Taranto. Woman bathing. A woman, having removed her shoes, prepares to wash herself in a luterion.
Mosaic from Pompeii, 1st century CE, Naples National Archaeological Museum. This particular mosaic was used as a tabletop.
The skull symbolizes man’s fate and reminds us of the frailty of human existence. There are many extant examples of cups and dining areas adorned with skeletal motifs. Rather than shrink from signs of death, the Romans seem to have employed them as reminders to “seize the day.“
In Petronius’s Satyricon, in the middle of a great banquet, a slave brings in a silver skeleton put together with flexible joints, and after it was flung on the table several times, the host Trimalchio recited:
Man’s life, alas, is but a span,
So let us live it while we can,
We’ll be like this when dead.
Despite the advanced state of sanitation engineering in the Roman world, the average life span was only 30-40 years.
(TO BE CONTINUED)