VI. ROMAN MEDICINE
They did better in medicine. Medical science too they borrowed from the Greeks, but they formulated it well, and applied it ably to personal and public hygiene. Rome, almost surrounded by marshes, and subject to mephitic floods, had particular need of public sanitation. About the second century B.C. we hear of malaria in Rome; the anopheles mosquito had settled down in the Pontine swamps.95 Gout spread as luxury increased; the younger Pliny tells how his friend Corellius Rufus suffered its pains from his thirty-third to his sixty-seventh year before committing suicide, just to have the pleasure of outliving by one day “that brigand Domitian.”96 Some passages in the Roman satirists suggest the appearance of syphilis in the first century A.D.97 Great epidemics swept central Italy in 23 B.C., A.D. 65, 79, and 166.
The people had of old tried to meet disease and plague with magic and prayer; even now they begged the skeptical but complaisant Vespasian to heal their blindness with his spittle and their lameness with the touch of his foot.98 They brought their illnesses and votive offerings to the temples of Aesculapius and Minerva and many left gifts in gratitude for cures. But in the first century B.C. they turned more and more to secular medicine. There was as yet no state regulation of medical practice; shoemakers, barbers, carpenters, added it to their operations as they pleased, called in magic to their aid, and compounded, touted, and sold their own drugs.99 There were the usual satires and complaints. Pliny repeated old Cato’s imprecations upon Greek physicians who “seduce our wives, grow rich by feeding us poisons, learn by our suffering, and experiment by putting us to death.”100 Petronius, Martial, and Juvenal joined in the assault; and a century later Lucian would score incompetent practitioners who hide their incapacity under the elegance of their apparatus.101
Nevertheless, medicine, as we shall see, had made great progress in Alexandria, Cos, Tralles, Miletus, Ephesus, and Pergamum; and from these centers came Greek physicians who so raised the level of Roman practice that Caesar enfranchised the profession in Rome, and Augustus exempted it from taxation. Asclepiades of Prusa won the friendship of Caesar, Crassus, and Antony. He declared that the heart pumps blood and air through the body; rarely prescribed drugs or drastic purges; and accomplished impressive cures by hydrotherapy (baths, fomentations, enemas), massage, sunshine, exercise (walking, horseback riding), diet, fasting, and abstinence from meat. He was distinguished for his treatment of malaria, his operations on the throat, and his humane handling of the insane.102 He gathered pupils about him and took some of them with him on his rounds. After his death they and similar students formed themselves into collegia and built for themselves a meeting place, on the Esquiline, called Schola Medicorum.
Under Vespasian auditoria were opened for the teaching of medicine, and recognized professors were paid by the state. Greek was the language of instruction, as Latin is now the language of prescription, and for a like reason-its intelligibility to persons of diverse tongues. Graduates of these state schools received the title of medicus a republica, and after Vespasian they alone could legally practice medicine in Rome.103 The lex Aquilia provided for state supervision of physicians, and held them responsible for negligence; and the lex Cornelia severely punished practitioners whose carelessness or culpable ignorance caused the death of a patient.104 Quacks continued, but sound practice increased. Midwives saw most Romans into the world, but many of these women were well trained.105 About A.D. 100 military medicine reached its ancient zenith: every legion had twenty-four surgeons, first-aid and field-ambulance service were well organized, and hospitals were maintained near every important encampment.106 Private hospitals (valetudinaria) were opened by physicians; from these evolved the public hospitals of the Middle Ages. Doctors were appointed and paid by the state to give free treatment to the poor.107 Rich men kept their own physicians, and well-paid archiatri(“chief healers”) took care of the emperor, his family, his servants, and his aides. Sometimes families would contract with a doctor to attend to their health and illnesses for a period of time; in this way Quintus Stertinius made 600,000 sesterces a year.108 The surgeon Alcon, fined 10,000,000 sesterces by Claudius, paid it with a few years’ fees.109
The profession now reached a high degree of specialization. There were urologists, gynecologists, obstetricians, ophthalmologists, eye and ear specialists, veterinarians, dentists. Romans could have gold teeth, wired teeth, false teeth, bridgework, and plates.110There were many women physicians; some of them wrote manuals of abortion, which were popular among great ladies and prostitutes. Surgeons were divided into further specialities and seldom engaged in general practice. Mandragora juice or atropin was used as an anesthetic.111 Over 200 different surgical instruments have been found in the ruins of Pompeii. Dissection was illegal, but the examination of wounded or dying gladiators offered a frequent substitute. Hydrotherapy was popular; in a measure the greatthermae were hydrotherapeutic institutes. Charmis of Marseilles made a fortune by administering cold baths. Consumptives were sent to Egypt or north Africa. Sulphur was used as a skin specific and to fumigate rooms after an infectious disease.112 Drugs were a final but frequent resort. Physicians made then by processes kept secret from the public and charged for them all that patients could be persuaded to pay.113 Repulsive drugs were held in high honor: the offal of lizards was used as a purgative, human entrails were sometimes prescribed, Antonius Musa recommended the excreta of dogs for angina, Galen applied a boy’s dung to swellings of the throat.114 In compensation for all this a cheerful quack offered to cure almost any ailment with wine.115
Of the known medical writers in this age only one was a Roman, and he was not a physician. Aurelius Cornelius Celsus was an aristocrat who about A.D. 30 gathered into an encyclopedia De Artibus his studies in agriculture, war, oratory, law, philosophy, and medicine; only the section De Medicina survives. It is the greatest work on medicine that has come down to us from the six centuries between Hippocrates and Galen; it has also the distinction of being written in such pure and classical Latin that Celsus was dubbed Cicero medicorum. The Latin terms into which he translated the nomenclature of Greek medicine have ruled the science ever since. The sixth book shows considerable knowledge, in antiquity, of venereal disease. The seventh is an illuminating description of surgical methods; it contains the earliest known account of ligature, and describes tonsillectomy, lateral lithotomy, plastic surgery, and operations for cataract. Altogether this is the soundest achievement in Roman scientific literature, and suggests that we might have a better opinion of Roman science if Pliny had not been preserved. It is a pity that scholarship has concluded that Celsus’ treatise is largely a compilation or paraphrase of Greek texts.116 Lost in the Middle Ages, it was rediscovered in the fifteenth century, was printed before Hippocrates or Galen, and took a leading part in stimulating the reconstruction of medicine in modern times.