Roman Medicine At The End Of The Republic And The Beginning Of The
EMPIRE.
Asclepiades of Prusa--Themison of Laodicea--Methodism--Wounds of
Julius Caesar--Systems of Philosophy--State of the country--Roman
quacks--Slaves and Freedmen--Lucius Horatillavus.
Asclepiades of Prusa, in Bithynia, was a famous physician in Rome
early in the first century before Christ. He studied both rhetoric and
medicine at Alexandria and at Athens. H
in Rome, but, although he was the friend of Cicero, he was not very
successful, and abandoned this study for the practice of medicine. He
had a great deal of ability and shrewdness, but no knowledge of anatomy
or physiology, and he condemned all who thought that these subjects of
study were the foundation of the healing art. He specially inveighed
against Hippocrates, and with some reason, for the disciples of
Hippocrates had elevated the teaching of their master almost into a
religion, and were bound far too closely to his authority, to the
exclusion of original thought and progress.
Asclepiades had many pupils, and his teaching led to the foundation of
the Medical School of the Methodists. His most important maxim was that
a cure should be effected "tuto, celeriter, ac jucunde," and he
believed that what the physician could do was of primary importance, and
vis medicatrix naturae only secondary. He was thus directly opposed to
the teaching of Hippocrates. He had little or no faith in drugs, and
relied mainly upon diet, exercises and massage, and, to some extent,
upon surgery. His practice of prescribing wine in liberal doses added to
his popularity. It was the custom to take wine very much diluted with
water, but Asclepiades ordered wine in full strength or only slightly
diluted. He practised bronchotomy and tracheotomy, and recommended in
suitable cases of dropsy scarification of the ankles, and advised that,
in tapping, an opening as small as possible should be made. He also
observed spontaneous dislocation of the hip. He was a very famous man in
the Roman Republic, and was well acquainted with philosophy, especially
the philosophy of the Epicureans. Although he was almost entirely
ignorant of anatomy, he was far from being a quack. He had great powers
of observation and natural shrewdness, and his success largely
contributed to the establishment of Greek doctors and their methods in
Rome. There is grim humour in his description of the Hippocratic
treatise on therapeutics, which he called "a meditation on death." Pliny
relates that Asclepiades wagered that he would never die of disease, and
he won the wager, for he lived to old age and died of an accident!
Themison, of Laodicea, lived in the first century before Christ, and
was a pupil of Asclepiades of Prusa, the founder of the School of
Methodism. His views on atoms and pores led him to adopt a very simple
explanation of health and disease, for he considered that these pores
must be either constricted or dilated, and the aim of the physician
should be to dilate the constriction, and vice versa. This epitomized
system of medicine did away with the use of many classes of drugs, and,
from its simplicity, was quickly learned. A jeering opponent of the
system of the Methodici said that it could be taught in six months, and
Galen, in later years, ridiculed it, and called its practitioners "the
asses of Thessaly."
The great fault of Dogmatism was its absolute reliance on the wisdom of
Hippocrates, and Methodism was marred by its insufficiency and
sophistry.
In spite of his extravagant theories, Themison possessed skill in
practice. He was the first physician to describe rheumatism, and he also
is thought to have been the pioneer in the medicinal use of leeches. A
book on elephantiasis ascribed to him is not definitely known to be
authentic. It is worthy of note that he was anxious to write on
hydrophobia, but a case he had seen in early youth so impressed his mind
with horror that the mere thought of the disease caused him to suffer
some of the symptoms.
The views of the Methodists were less extreme than those of the
Dogmatists and Empirics. Celsus wrote of the Methodists: "They assert
that the knowledge of no cause whatever bears the least relation to the
method of cure; and that it is sufficient to observe some general
symptoms of distempers; and that there are three kinds of diseases, one
bound, another loose, and the third is a mixture of these."[11]
There were several physicians of the name of Themison at different
times, and it is probably the founder of the Methodici who was satirized
by Juvenal thus:--
"How many patients Themison dispatched
In one short autumn."[12]
The joke which is based on attributing a cure to Nature alone, and death
solely to the physician's want of skill, is one of the most
time-honoured.
Themison lived at the close of the Roman Republic, and it will now be
necessary to consider the state of the healing art in Rome under the
rule of the emperors.
Julius Caesar--one of the first triumvirate--invaded and conquered Gaul
and Britain, and after these great military achievements, found that he
could not sheath his sword until he had met in battle his rival Pompey.
Caesar defeated Pompey at Pharsalia, in Thessaly (48 B.C.), and pursued
him to Egypt. Pompey was murdered in Egypt, and his last followers
finally defeated in Spain, and in 45 B.C. Julius Caesar returned to Rome,
and was declared perpetual imperator. On March 15, 44 B.C., he was
assassinated. It is possible that the career of this great man may have
promoted the surgery of the battlefield, but his reign as Emperor was
too short, and the political situation of his time too acute, to permit
of much progress in the arts of peace generally, and in the medical art
particularly. Julius Caesar bestowed the right of Roman citizenship on
all medical practitioners in the city.
Referring to the death of Julius Caesar, Suetonius writes that among so
many wounds there was none that was mortal, in the opinion of the
surgeon Antistus, except the second, which he received in the breast.
Octavianus was appointed one of the second triumvirate, his colleagues
being Mark Antony and Lepidus. Lepidus was first forced out of the
triumvirate, and Octavianus and Mark Antony then came into conflict.
During these rivalries, a great civic work was accomplished by Marcus
Agrippa, who built the aqueduct known as Aqua Julia. A landmark in
history is the battle of Actium, in which Octavianus defeated Mark
Antony and his ally Cleopatra, and within a few years Octavianus was
proclaimed Emperor as Augustus Caesar (27 B.C.). Under his rule Rome
greatly prospered, and we shall now consider the state of medicine and
of sanitation during his illustrious reign.
In the Roman Empire there was a spirit of toleration abroad, "and the
various modes of worship which prevailed in the Roman world were all
considered by the people as equally true; by the philosopher, as equally
false; and by the magistrate, as equally useful. And thus toleration
produced not only mutual indulgence, but even religious concord"
(Gibbon).
The systems of philosophy in vogue were those of the Stoics, the
Platonists, the Academics, and the Epicureans, and of these only the
Platonists had any belief in God, who was to them an idea rather than a
Supreme Being. The great aim of both the wise and the foolish was to
glorify their nationality, and their beliefs, their rites, and their
superstitions, were all for the glory of mighty Rome.
Educated Romans were able to speak and write both Latin and Greek, and
the latter language was the vehicle used by men of science and of
letters.
The population of the city of Rome at the beginning of the Augustan age
was not less than half a million of people, and probably exceeded this
number. There was no middle class, a comparatively small number of
gentry, a very numerous plebs or populace, and many slaves. The
Emperor Augustus boasted that after the war with Sextus Pompeius he
handed over 30,000 slaves, who had been serving with the enemy, to their
masters to be punished. The slaves were looked upon by their masters as
chattels. The plebs had the spirit of paupers and, to keep them
contented and pacific, were fed and shown brutalizing spectacles in the
arenas. Augustus wrote that he gave the people wild-beast hunts in the
circus and amphitheatres twenty-six times, in which about 3,500 animals
were killed. It was his custom to watch the Circensian games from his
palace in view of a multitude of spectators.
Throughout the country generally agriculture prospered, and the supply
of various grasses for feeding cattle in the winter increased the
multitude of the flocks and herds; great attention was given also to
mines and fisheries and all forms of industry. Virgil praised his
beautiful and fertile country:--
"But no, not Medeland with its wealth of woods,
Fair Ganges, Hermus thick with golden silt,
Can match the praise of Italy....
Here blooms perpetual spring, and summer here
In months that are not summer's; twice teem the flocks:
Twice does the tree yield service of her fruit.
Mark too, her cities, so many and so proud,
Of mighty toil the achievement, town on town
Up rugged precipices heaved and reared,
And rivers gliding under ancient walls."[13]
The city of Rome was not a desirable place for medical practice, for the
lower classes were degraded and thriftless, and the relatively small
upper classes were tyrannical, debauched, superstitious, selfish and
cruel. The younger Pliny, who was one of the best type of Romans, tried
to investigate the purity of the lives of the Christians, and did not
hesitate to put to torture two women, deaconesses, who belonged to the
new religion, but he "could discover only an obstinate kind of
superstition carried to great excess." His conduct and his opinion speak
eloquently of the nature of a Roman gentleman of the Empire. As for the
state of the poor under Augustus, 200,000 persons in Rome received
outdoor relief. Although the rich had every luxury that desire could
suggest and wealth afford, the great need of the common people was food.
The city had to rely mainly on imported corn, and the price of this at
times became prohibitive owing to scarcity--sometimes the result of
piracy and the dangers of the sea, but often caused by artificial means
owing to the merchants "cornering" the supply--and it was necessary for
the State, through the Emperor, to intervene to make regulations and to
distribute the grain free or below its market value. It has been
computed that about 50,000 strangers lived in Rome, many of whom were
adventurers.
The imperial city was the happy hunting-ground of quacks, who gave
themselves high-sounding names and wore gorgeous raiment. They went
about followed by a retinue of pupils and grateful patients. In some
cases the patients were compelled to promise, in the event of being
cured, that they would serve their doctor ever afterwards. The retinue
of students, no doubt, was rather disturbing to a nervous patient, and
Martial wrote:--
"Faint was I only, Symmachus, till thou
Backed by an hundred students, throng'dst my bed;
An hundred icy fingers chilled my brow:
I had no fever; now I'm nearly dead."[14]
Besides quack doctors there were drug sellers (pharmacopola), who sold
their medicines in booths or hawked them in the city and the country. In
the time of the Empire the medicines of the regular practitioners were
sold with a label which specified the name of the drug and of the
inventor, the ingredients, the disease it was to be used for, and the
method of taking it. Drug sellers dispensed cosmetics as well as
medicines, and some of the itinerant dealers sold poison. The regular
physicians bought medicines already compounded by the druggists, and the
latter, as in our own day, prescribed as well as the physicians.
Depilatories were much in vogue, and were usually made of arsenic and
unslaked lime, but also from the roots and juices of plants. They were
first used only by women, but in later times also by effeminate men.
Tweezers have been discovered which were adapted for pulling out hairs,
and most of the depilatories were recommended to be applied after the
use of the tweezers. The duty of pulling out hairs was performed by
slaves.
Most of the medical practitioners in the time of Augustus were either
slaves or freedmen. Posts of responsibility and of honour were sometimes
assigned to freedmen, as is shown by the appointment by Nero of Helius,
a freedman, to the administration of Rome in the absence of his imperial
master. Cicero wrote letters to his freedman Tiro in terms of friendship
and affection. The master of a great household selected a slave for his
ability and aptitude, and had him trained to be the medical adviser of
the household; and the skill shown by the doctor sometimes gained for
him his freedom.
There were 400 slaves in one great household of Rome, and they were all
executed for not having prevented the murder of their master.[15] It is
recorded that physicians were sometimes compelled to do the disgusting
work of mutilating slaves.[16] The price of a slave physician was fixed
at sixty solidi.[17] The great majority of physicians in Rome were
freedmen who had booths in which they prescribed and compounded, and
they were aided by freedmen and slaves who were both assistants and
pupils. The medical profession, as has been shown, never attained the
same dignity as in Greece. It should be understood that there was a
class of practising physicians in Rome quite distinct from the slave
doctors. The following account of Lucius Horatillavus, a Roman quack of
the time of Augustus, is taken from the British Medical Journal of
June 10, 1911, and originated in an article in the Societe Nouvelle,
written by M. Fernand Mazade:--
"He was a handsome man, and came from Naples to Rome, his sole outfit
being a toga made of a piece of cloth adorned with obscene pictures and
a small Asiatic mitre. Like many of his kind at that day, he sold
poisons and invented five or six new remedies which were more or less
haphazard mixtures of wine and poisonous substances. He had the good
luck to cure his first patient, Titus Cnoeus Leno, who, being a poet,
straightway constituted himself the vates sacer of his physician, and
induced some of his fashionable mistresses to place themselves under his
hands. So profitable was Horatillavus's practice that he is said to have
saved 150,000 sesterces in a few months. But for a moment his good
fortune seemed to abandon him. A Roman lady, Sulpicia Pallas, died
suddenly under his ministrations. This may have been due to his
ignorance or carelessness; but he was accused of having poisoned his
patient. This event might have been expected to bring his career to an
end; but it was not long before he recovered the confidence of the
people whom he deluded with his mystical language and promises of cure.
He had three methods of treatment, all consisting of baths--hot, tepid,
or cold--preceded or followed by the taking of wonder-working medicines.
Horatillavus treated every kind of disease, internal and external; he
even practised midwifery, which was then in the hands of women. Ten
years after he settled in Rome he had accumulated a fortune of some
6,000,000 sesterces. He had a villa at Tusculum, whither he went three
times a month; there he led a luxurious life in the most beautiful
surroundings, and there his evil fate overtook him. His orchard was his
especial pride. One day he found that birds had played havoc with his
figs, the like of which were not to be found in Italy. Determined to
prevent similar depredations in future, he poisoned the fig trees.
Continuing his walk, he plucked fruits of various kinds here and there.
While eating the fruit he had culled and drinking choice wine, he put
into his mouth a poisoned fig, which he had inadvertently gathered, and
quickly died in convulsions. Before passing away, however, he is said to
have composed his own epitaph. This M. Mazade believes he has found. It
reads: "The manes of Sulpicia Pallas have avenged her. Here lies Lucius
Horatillavus, physician, who poisoned himself." If the epitaph is
genuine, it is a confession of guilt. The death of the quack by his own
poison is a curious Nemesis. The manner of his death proves that it was
accidental, as few quacks are bold enough to take their own medicines."
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