Roman Medicine and Medical Knowledge

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Origin of Healing--Temples--Lectisternium--Temple of
Æsculapius--Archagathus--Domestic Medicine--Greek Doctors--Cloaca
Maxima--Aqueducts--State of the early Empire.

The origin of the healing art in Ancient Rome is shrouded in uncertainty. The earliest practice of medicine was undoubtedly theurgic, and common to all primitive peoples. The offices of priest and of medicine-man were combined in one person, and magic was invoked to take the place of knowledge. There is much scope for the exercise of the imagination in attempting to follow the course of early man in his efforts to bring plants into medicinal use. That some of the indigenous plants had therapeutic properties was often an accidental discovery, leading in the next place to experiment and observation. Cornelius Agrippa, in his book on occult philosophy, states that mankind has learned the use of many remedies from animals. It has even been suggested that the use of the enema was discovered by observing a long-beaked bird drawing up water into its beak, and injecting the water into the bowel. The practice of healing, crude and imperfect, progressed slowly in ancient times and was conducted in much the same way in Rome, and among the Egyptians, the Jews, the Chaldeans, Hindus and Parsees, and the Chinese and Tartars.

The Etruscans had considerable proficiency in philosophy and medicine, and to this people, as well as to the Sabines, the Ancient Romans were indebted for knowledge. Numa Pompilius, of Sabine origin, who was King of Rome 715 B.C., studied physical science, and, as Livy relates, was struck by lightning and killed as the result of his experiments, and it has therefore been inferred that these experiments related to the investigation of electricity. It is surprising to find in the Twelve Tables of Numa references to dental operations. In early times, it is certain that the Romans were more prone to learn the superstitions of other peoples than to acquire much useful knowledge. They were cosmopolitan in medical art as in religion. They had acquaintance with the domestic medicine known to all savages, a little rude surgery, and prescriptions from the Sibylline books, and had much recourse to magic. It was to Greece that the Romans first owed their knowledge of healing, and of art and science generally, but at no time did the Romans equal the Greeks in mental culture.

Pliny states that "the Roman people for more than six hundred years were not, indeed, without medicine, but they were without physicians." They used traditional family recipes, and had numerous gods and goddesses of disease and healing. Febris was the god of fever, Mephitis the god of stench; Fessonia aided the weary, and "Sweet Cloacina" presided over the drains. The plague-stricken appealed to the goddess Angeronia, women to Fluonia and Uterina. Ossipaga took care of the bones of children, and Carna was the deity presiding over the abdominal organs.

Temples were erected in Rome in 467 B.C. in honour of Apollo, the reputed father of Æsculapius, and in 460 B.C. in honour of Æsculapius of Epidaurus. Ten years later a pestilence raged in the city, and a temple was built in honour of the Goddess Salus. By order of the Sibylline books, in 399 B.C., the first lectisternium was held in Rome to combat a pestilence. This was a festival of Greek origin. It was a time of prayer and sacrifice; the images of the gods were laid upon a couch, and a meal was spread on a table before them. These festivals were repeated as occasion demanded, and the device of driving a nail into the temple of Jupiter to ward off "the pestilence that walketh in darkness," and "destruction that wasteth at noonday" was begun 360 B.C. As evidence of the want of proper surgical knowledge, the fact is recorded by Livy that after the Battle of Sutrium (309 B.C.) more soldiers died of wounds than were killed in action. The worship of Æsculapius was begun by the Romans 291 B.C., and the Egyptian Isis and Serapis were also invoked for their healing powers.

At the time of the great plague in Rome (291 B.C.), ambassadors were sent to Epidaurus, in accordance with the advice of the Sibylline books, to seek aid from Æsculapius. They returned with a statue of the god, but as their boat passed up the Tiber a serpent which had lain concealed during the voyage glided from the boat, and landing on the bank was welcomed by the people in the belief that the god himself had come to their aid. The Temple of Æsculapius, which was built after this plague in 291 B.C., was situated on the island of the Tiber. Tradition states that, when the Tarquins were expelled, their crops were thrown into the river, and soil accumulated thereon until ultimately the island was formed. In consequence of the strange happening of the serpent landing from the ship the end of the island on which the Temple of Æsculapius stood was shaped into the form of the bow of a ship, and the serpent of Æsculapius was sculptured upon it in relief.

The island is not far from the Æmilian Bridge, of which one broken arch remains.

Ovid represents this divinity as speaking thus:--

"I come to leave my shrine;
This serpent view, that with ambitious play My staff encircles, mark him every way; His form--though larger, nobler, I'll assume, And, changed as gods should be, bring aid to Rome."

(Ovid, "Metamorphoses," xv.)

He is said to have resumed his natural form on the island of the Tiber.

"And now no more the drooping city mourns; Joy is again restored and health returns."

It was the custom for patients to sleep under the portico of the Temple of Æsculapius, hoping that the god of the healing art might inspire them in dreams as to the system of cure they should adopt for their illnesses. Sick slaves were left there by their masters, but the number increased to such an extent that the Emperor Claudius put a stop to the cruel practice. The Church of St. Bartholomew now stands on the ruins of the Temple of Æsculapius.

Even in very early times, however, Rome was not without medical practitioners, though not so well supplied as some other nations. The Lex Æmilia, passed 433 B.C., ordained punishment for the doctor who neglected a sick slave. In Plutarch's "Life of Cato" (the Censor, who was born in 234 B.C.), we read of a Roman ambassador who was sent to the King of Bithynia, in Asia Minor, and who had his skull trepanned.

The first regular doctor in Rome was Archagathus, who began practice in the city 219 B.C., when the authorities received him favourably and bought a surgery for him; but his methods were rather violent, and he made much use of the knife and caustics, earning for himself the title of "butcher," and thus having fallen into disfavour, he was glad to depart from Rome. A College of Æsculapius and of Health was established 154 B.C., but this was not a teaching college in the present meaning of the term.

The doctors of Ancient Rome took no regular course of study, nor were any standards specified, but as a rule knowledge was acquired by pupilage to a practising physician, for which a honorarium was paid. Subsequently the Archiatri, after the manner of trade guilds, received apprentices, but Pliny had cause to complain of the system of medical education, or rather, to deplore the want of it. He wrote: "People believed in anyone who gave himself out for a doctor, even if the falsehood directly entailed the greatest danger. Unfortunately, there is no law which punishes doctors for ignorance, and no one takes revenge on a doctor if through his fault someone dies. It is permitted him by our danger to learn for the future, at our death to make experiments, and, without having to fear punishment, to set at naught the life of a human being."

Before the time when Greek doctors settled in Rome, medical treatment was mainly under the direct charge of the head of each household. The father of a family had great powers conferred upon him by the Roman law, and was physician as well as judge over his family. If he took his new-born infant in his arms he recognized him as his son, but otherwise the child had no claim upon him. He could inflict the most dire punishments on members of his household for which they had no redress.

Cato, the Elder, who died in B.C. 149, wrote a guide to domestic medicine for the use of Roman fathers of the Republic, but he was a quack and full of self-conceit. He hated the physicians practising in Rome, who were mostly Greeks, and thought that their knowledge was much inferior to his own. Plutarch relates that Cato knew of the answer given to the King of Persia by Hippocrates, when sent for professionally, "I will never make use of my art in favour of barbarians who are enemies of the Greeks," and pretended to believe that all Greek physicians were bound by the same rule, and animated by the same motives. However, Cato did a great deal of good by attempting to lessen the vice and luxury of his age.

The Greeks in Rome were looked at askance as foreign adventurers, and there is no doubt that although many were honourable men, others came to Rome merely to make money out of the superstitious beliefs and credulity of the Roman people. Fine clothes, a good house, and the giving of entertainments, were the best introduction to practice that some of these practitioners could devise.

The medical opinions of Cato throw a sidelight upon the state of medicine in his time. He attempted to cure dislocations by uttering a nonsensical incantation: "Huat hanat ista pista sista damiato damnaustra!" He considered ducks, geese and hares a light and suitable diet for the sick, and had no faith in fasting.

Although the darkness was prolonged and intense before the dawn of medical science in Rome, yet, in ancient times, there was a considerable amount of knowledge of sanitation. The great sewer of Rome, the Cloaca Maxima, which drained the swampy valley between the Capitoline and Palatine Hills, was built by order of Tarquinius Priscus in 616 B.C. It is wonderful that at the present time the visitor may see this ancient work in the Roman Forum, and trace its course to the Tiber. In the Forum, too, to the left of the Temple of Castor, is the sacred district of Juturna, the nymph of the healing springs which well up at the base of the Palatine Hill. Lacus Juturnæ is a four-sided basin with a pillar in the middle, on which rested a marble altar decorated with figures in relief. Beside the basin are rooms for religious purposes. These rooms are adorned with the gods of healing, Æsculapius with an acolyte holding a cock, the Dioscuri and their horses, the head of Serapis, and a headless statue of Apollo.

The Cloaca Maxima was formed of three tiers of arches, the vault within the innermost tier being 14 ft. in diameter. The administration of the sewers, in the time of the Republic, was in the hands of the censors, but special officers called curatores cloacarum were employed during the Empire, and the workmen who repaired and cleansed the sewers were condemned criminals. These ancient sewers, which have existed for twenty-five centuries, are monuments to the wisdom and power of the people who built them. In the time of Furius Camillus private drains were connected with the public sewers which were flushed by aqueduct and rain water. This system has prevailed throughout the centuries.

The Aqueducts were also marvellous works, and although they were added to in the time of the Empire, Sextus Julius Frontinus, curator of waters in the year A.D. 94, gives descriptions of the nine ancient aqueducts, some of which were constructed long before the Empire. For instance, the Aqua Appia was conducted into the city three hundred and twelve years before the advent of Christ, and was about seven miles long. The Aqua Anio Vetus, sixty-two miles in length, built in B.C. 144, was conveyed across the Campagna from a source in the country beyond Tivoli. Near this place there is a spring of milky-looking water containing sulphurous acid, sulphurated lime, and bicarbonate of lime, used now, and in ancient times for the relief of skin complaints. This water, at the present day, has an almost constant temperature of 75°.

In course of time, when the Roman power was being extended abroad, the pursuit of conquest left little scope for the cultivation of the peaceful arts and the investigation of science, and life itself was accounted so cheap that little thought was given to improving methods for the treatment of the sick and wounded. On a campaign every soldier carried on his person a field-dressing, and the wounded received rough-and-ready first-aid attention from their comrades in arms.

Later, when conquest was ended, and attention was given to the consolidation of the provinces, ease and happiness, as has been shown by Gibbon, tended to the decay of courage and thus to lessen the prowess of the Roman legions, but there was compensation for this state of affairs at the heart of the Empire because strong streams of capable and robust recruits flowed in from Spain, Gaul, Britain and Illyricum.

At its commencement, the Empire was in a peaceful, and, on the whole, prosperous condition, and the provincials, as well as the Romans, "acknowledged that the true principles of social life, laws, agriculture, and science, which had been first invented by the wisdom of Athens, were now firmly established by the power of Rome, under whose auspicious influence the fiercest barbarians were united by an equal government and common language. They affirm that with the improvement of arts the human species was visibly multiplied. They celebrate the increasing splendour of the cities, the beautiful face of the country, cultivated and adorned like an immense garden; and the long festival of peace, which was enjoyed by so many nations, forgetful of their ancient animosities, and delivered from the apprehension of future danger." Thus wrote the Roman historian, and Gibbon states that when we discount as much of this as we please as rhetorical and declamatory, the fact remains that the substance of this description is in accordance with the facts of history. Never until the Christian era was any thought given to the regular care of the helpless and the abject. Slaves were often treated like cattle, and the patricians had no bond of sympathy with the plebeians. Provisions were sometimes distributed to the poor, and taxes remitted, but for reasons of State and not from truly charitable motives. Authority was also given to parents to destroy new-born infants whom they could not support. The idea of establishing public institutions for the relief of the sick and the poor did not enter the minds of the ancient Romans.

Before considering the state of the healing art throughout the period of the Roman Empire, it is necessary to devote the next chapters to a consideration of the rise and progress of medical science in Greece, for it cannot be too strongly emphasized that Roman philosophy and Roman medicine were borrowed from the Greeks, and it is certain also that the Greeks were indebted to the Egyptians for part of their medical knowledge. The Romans were distinguished for their genius for law-giving and government, the Greeks for philosophy, art, and mental culture generally.

[Illustration: Plate I. BUST OF ÆSCULAPIUS.]

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