750-48 B.C.: Medicine migrates to Rome

A bust of Julius Caesar (100-44 B.C.)
Among his many accomplishments
was saving medicine for Rome.

Although they didn't know it at the time, the Latins had picked the perfect spot to build their village.  It was one of many built around the seven hills along the Tiber River in the Italian Peninsula somewhere around 750 B.C.  (1, page 112)

It was in the lowland, as compared with other Italian villages. While close to the sea it was built on a mountain side "where there was lava flow with a dominant position over the sea and the river Sarno."  (2)

Due to its volcanic origins, the "soil is naturally rich in water springs and minerals.  The hills were made of tufa rock, "a soft hardened rocky sponge," which the Romans were later able to use to make large buildings and monuments.  (2)

While it started out as a small village, it grew into a mighty city, and then into an empire that covered much of the known world.

At first the Romans were peaceful farmers and herders, but around 600 B.C. the Etruscans from up north along the Tiber decided to conquer the other villages.  For the next 100 years Rome was ruled by the Etruscans.  In 509 B.C. the people of Rome rebelled and set up what became the world's first republic. (1, page 112)

The people of Rome didn't forget what had happened, and they continued to build a mighty military. Many of the people became skilled soldiers, and they decided to fight for more land.  By 270 B.C. they took over the entire Italian Peninsula, and then after 23 years of Punic wars, in 146 B.C., the Romans conquered the city of Carthage along the north coast of Africa, where the Phoenicians settled. (1, 113-114)

There were ultimately three wars with Carthage, called the Punic wars.  In the second one, Macedonia, the strongest city-state in Greece at that time, decided to help Carthage.  Romans didn't forget this either, and when Carthage was defeated, the Romans conquered Greece and took many Grecians back to Rome.

Of course many of these people were philosophers and physicians, and thus Rome was introduced to Greek adaptations to these arts. (1, page 114-15) As the Roman Empire spread, so to did Grecian culture.

Greeks taken to Rome became Roman slaves, and many were better educated than their new Roman masters.  So it "became customary for the well-to-do to select for the child's nurse a Greek slave, that a child might acquire the Greek language as naturally as its own," according to historian Harold Johnston.  (7, page 71)

Johnston explains that: (7, page 78)

The Greek language came to be generally learned and Greek ideas of education were in some degree adopted. Schools were established in which the central thing was the study of the Greek poets, and these schools we may call Grammar Schools because the teacher was called grammaticus. Homer was long the universal text-book, and students were not only taught the language, but were instructed in the matters of geography, mythology, antiquities, history, and ethics suggested by the portions of the text which they read. The range of instruction and its value depended entirely upon the teacher, as does such instruction to-day, but it was at best fragmentary and disconnected. There was no systematic study of any of these subjects, not even of history, despite its interest and practical value to a world-ranging people like the Romans.

Of course we must understand that after doing battle against many Greeks during the Punic wars, a prejudice developed among the Romans regarding Greek culture. This might explain Pliney the Elder's statement that Rome "got along for 600 years without physicians." (5, page 72)

He held this opinion while knowing full well Rome had physicians, as he later contradicted himself by claiming the first physician came to Rome in 535 B.C. (3, page 81)

This prejudice might also explain why the Greeks were often disparagingly referred to as "graeculus esuriens of Juvenal," which means "hungry young Greek"  (5, page 72)

We must also understand that the Romans, as might be expected, had their own gods that they believed were responsible for health and sickness.  They had incantations and prayers they'd been using for hundreds of years.  (5, page 97)

They also saw Greek remedies (purging, cupping, bleeding) as harsh, and the fact Greeks kept snakes in their "private houses in pursuance of the Aesculpian cult, did little to make medicine respectable in the eyes of the austere Romans." (5, page 97).

But the medical profession of Rome had it's problems. For one thing, the medicine was primitive in nature, and based mainly on incantations and prayers.  In describing the flaws of the Roman medical system of the time, Bradford quotes medical historian Pierre-Victor Renouard:

In the midst of this overflowing of charlatanism, the health of the citizens was given over to the first imposter who called himself a doctor; for how could the cheat and usurper of the title be distinguished from the man of knowledge and probity, who had acquired it by study? No examination, no legal proof was imposed on any one who wished to practice medicine; there was no security for the sick.''

These weaknesses may have left the door open ever so slightly to the curiosities of some of those who yearned for a remedy that Roman physicians were not providing. Regardless, as Grecian physicians and teachers migrated to Rome, they did so with little encouragement from the Romans. (4, page 96)

Yet as what usually happens, time heals all wounds.  When a person is really sick, when he realizes that incantations and prayers don't heal pain and suffering, he becomes eager to accept new ideas.  And it must have been in this way the Romans were gradually exposed to Grecian medicine, and slowly grew to respect and gain confidence in Grecian physicians.  (4, page 96)

One of the best ways to change the mindset of a people is to impress the king. Even kings are human, and even kings get sick. And kings have the ability to change the mindset of a nation. And it must have been in this way Caesar was exposed to the benefits of Grecian medicine, because in his travels he started taking physicians with him.(4, page 97)

Perhaps it was for this reason that Roman philosopher and orator Cicero (106-43 B.C.) "declared the duty of all men -- a duty particularly incumbant of himself -- to support the dignity of the healing art." (4, pages 96-97)

A Greek physician named Archagathus was among the first to escape the wars of Greece by emigrating to Rome.  When he was born no one knows, although what is known is he was born in Sparta and was later adapted by the Romans, becoming a Roman citizen in the year 219 B.C., around the time that Ptolomy Philopater in Egypt.  He was among the first physicians to emigrate to Rome.

Historian Thomas Lindsley Bradford, in his 1898 book "Quiz questions on the history of medicine," discussed the influence of Archagathus the Executioner upon Greek medicine.

He was the first of all the Greeks who attempted to introduce their kind of physic (medicine) into Italy. At first his coming was very agreeable to them, and many marked distinctions were paid him, but when he came to the cutting and burning part they changed their opinion, and conceived such an aversion to him that he was compelled to leave the city. He was called executioner on account of the too frequent use of the actual cautery and the knife. He was also called Vulnarius and Carnifex. He was honored by the Senate." (8, pages 27-28)

Bradford must have obtained much of his wisdom about Archagathus from the writings of Pliny the Elder, who wrote  about 150 years later:

He obtained Roman citizenship and was extraordinarily popular on his arrival, but very soon, gained the nickname of the "executioner." (9)

Regardless, Roman physicians were slowly gaining the respect and confidence of the Roman people, and the man given credit for this was Asclepiades of Bithynia. He was born in Rome at the time of Pompey in 106 B.C., and then was educated at the school of Alexandria and practiced in Athens before moving back to Rome. (4, page 99-101)

Please note that, despite his name, Asclepiades has no ties with the Asclepiate temples that rose in Ancient Greece and Rome. (8, page 28)

His opinions and remedies were based on the Atomist philosophy of medicine devised by Democritus, and were the opposite of the Hippocratic doctrine.  Since he believed in a different hypothesis as Hippocrates, he also had different remedies which included fresh air, light diet, hydrotherapy, massage, clysters, local application of some external medicines, and sparing use of internal medicine.  (5, page 72)(8, page 28-29)

This new medical philosophy, coupled by his "good bedside manner," made Asclepiades a very popular physician in Rome.  He was so well accepted that after his death other physicians took on his name hoping to take advantage of his fame.  (6, page 83)

Asclepiades basically believed Romans had a negative view of Greek medicine because their dogmatic remedies appeared to make the sick  worse before gettingt better.  And considering most people probably thought those who got better would have done so regardless of the harsh treatment, Greek medicine was viewed skeptically.  (4, page 99)

Asclepiades believed it was perceived as a "crude and unfeeling practice." He took advantage of this and smoothed out the edges by not using medicine that "offended the stomach" and using hygienic remedies instead. His techniques were so well accepted he became famous and wealthy. He wrote a book on General Remedies, and started the first school of medicine in Rome. (4, page 99)

Bradford said:

He does not seem to have followed any course of medical study, but owing to his fashion of catering to the patient and avoiding everything that was painful and disagreeable, he soon gained a large practice.  He eschewed emetic and purgatives, though he practiced blood-letting.  He also relinquished the religious ceremonies which had held so large a place in medical practice...  His treatment was mainly dietetic and hygienic.  He advocated exercise, bathing, music, and even declamation as a means of curing disease." (8, pages 28-29)

He was revered by some as the greatest physician ever, aside from Hippocrates. Others claimed he was no more than a philosopher and charlatan. Even Galen "charged him with many absurdities, and with having but little knowledge of the great fathers of the profession, whom he affected to ridicule." (4, page 98)

Yet Caesar liked him and approved of his work, and that may have been all that was needed.  Asclepiades died in 48 B.C. "and is said to have been killed by a fall from a ladder in his extreme old age." (4, page 101)

So perhaps more so than the physicians themselves, it was a combination of both the politics, philosophy and public relations of the physicians, coupled with the approval of various emperors, who improved respect and confidence in Grecian medicine.  It is because of them Grecian medicine survived the test of time.

John Watson said: (4, pages 97-98)

Caesar, after reaching the summit of his power, in order to attract men of science to the capital, and to improve the condition of those already there, decreed that all who practiced physic at Rome, and all the masters of the liberal arts therin residing, should enjoy the privilege of citizenship.  And Augustus, after having been relieved of a dangerous illness by his freedman, Antonius Musa, loaded this physician with wealth; raised him, by consent of the Senate, to the equestian rank; erected a bronze statue to his honor near that of Aeslepius; and, at his instigation, conferred important privileges on the whole body of the profession then residing in the city... These privileges afterwords confirmed by... later emperors." (4, pages 97-98)

Bradford said:

Before the consolidation of the Roman empire in 31 B.C. there were no established medical laws.  The Greek system of training seems to have been in vogue.  Everyone who was liberally educated was instructed in philosophy of medicine. which explains why all the philosophers of the old days were also to some extent teachers of medicine. But the physician was expected, in common with his medical knowledge, to be familiar with the grammar of his own language, with rhetoric, arithmetic, geometry, dialectics, moral philosophy, astronomy, and even architecture. (8, page 53)

The benefactors of all this education were, of course, all those who became sick or injured.

References:

1. Suter, Joanne, "Fearon's World History," 1994
2. "Ancient Rome Geography,"  mariamilani.com, http://www.mariamilani.com/ancient_rome/Ancient%20Rome%20Geography_.htm
3. Watson, John, "The Medical Profession in Anciet Times: an anniversary discourse delivered before the New York Accademy of Medicine November 7, 1855, New York, Baker and Godwin
4. Watson, ibid, pages 97-98, in reference to Seutonius, Octav, August, cap. lix.
5. Garrison, Fielding Hudson, "An introduction to the history of medicine: with medical chronology, Bibliographic data and test questions," 1913, Philadelphia and London, W.B. Saunders company
6. Withington, Edward, "Medical history from the earliest times: a popular history of the healing art," 1994, London
7. Johnston, Harold, "The Private Life of the Romans," 1908
8. Bradford, Thomas Lindsley, writer, Robert Ray Roth, editor, “Quiz questions on the history of medicine from the lectures of Thomas Lindley Bradford M.D.,” 1898, Philadelphia, Hohn Joseph McVey 
9. Pliney the Elder, "Natural History,

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320-400: Oribasius preserves Galen's work

Figure 1 -- Julian

In 320 A.D., Oribasius was born in Pergamum, the hometown of Galen, and perhaps it's for this reason he fell in love with the writings of the former. Through his voluminous writings he may be partially responsible for Galen becoming a medicinal god to medieval physicians.

This is especially important because the physicians that immediately followed Galen, including Serenus Sammonicus (died 211 A.D.) and Marcellus Empiricus (4th or 5th century), wrote nothing of Galen, said historian John Watson.  (8, page 173)

Constantine (272-337) was Roman Emperor from 306-337, and during his reign he declared the national religion was Catholicism. This was good in a way, because it helped to clean up some of the problems that ailed Rome.  It encouraged people to develop morals and values that were necessary to clean up the fabric of life. It encouraged people to be humble, and to be happy living a simple life with little, or remote, opportunity for advancement.

The Christian Bible encouraged each man to marry one woman, and to be faithful to that one woman.  We could debate the intent of this, although for our purposes it was probably partly for hygienic purposes to prevent the spread of disease.  It was also done because people probably realized that children are more likely to grow into productive members of society in stable families with both male and female role models.

Basically, Christianity encouraged purity and cleanliness in an attempt to prevent the spread of disease.  It was also an attempt to encourage each person to be kind and generous to their neighbors. It likewise encouraged businessmen to be honest in their dealings.

Yet this happened at the expense of wealth and opportunity.  It came at the expense of philosophy and medicine.  The Christian priests believed that wisdom and wealth were the antithesis of faith, and instead people were encouraged to work hard and to live humbly and to appreciate poverty and depravity as a gift from God. The reward for such hard work and humility was eternal life with Jesus in Heaven. All that was needed to maintain health and order was faith in the Lord. He was the King, and He was the Healer.

Figure 2 --Zeno

In 337 A.D. Constantine died, and Julian came to the throne.  Julian wanted to end the reign of Christianity in Rome, and to do this he hired the services of the physician Zeno. Of this, medical historian Thomas Bradford wrote:

After Constantine had declared Christianity the true religion, came Julian who attempted to overthrow its teachings and re-establish paganism. One of the first of his imperial acts was to endeavor to revive the ancient institutions of Alexandria. This mission was entrusted to a physician of Cyprus, named Zeno (at Alexandria). He went thither, but most of the inhabitants were Christians, and instead of proclaiming his mission, he kept himself quiet, and being really an illustrious member of the medical profession, was soon able to surround himself with numerous disciples, among whom were Jonicus and Oribasius. Zeno (who lived in the 4th century) left certain treatises, but they are lost. He is described as being the most famous teacher and practitioner of that time, though his fame seems to have originated in being able to have educated such illustrious pupils.(6, page 45)

Jonicus went on to become a very skilled physician in the 4th century.  He became very knowledgeable of anatomy, and "so great was his knowledge of pharmacology that it was said that none its secrets were withheld from him."  (6, page 45-46)

Yet it was Oribasius who would have the greatest impact on medicine.   He was a pagan and a sophist, "descended from parents of good condition.  He made quick progress of the liberal arts, which greatly conduce to virtue," wrote a good friend of his, Eunapius. (3, page 387)

Oribasius was also a "precocious" student during the reign of Constantine and his son Constantius (who was close to the age of Oribasius).  He studied at the school of Alexandria, and it was here he became physician and good friend to the future emperor Julian.  (1, page 175)

Oribasius would also go on to become one of the most famous philosophers of his time.  (6, page 46)

Oribasius and Julian had a lot in common.  As they became close friends early in life, they "were of similar taste, and were both devoted to the ancient religion (which was paganism)." (6, page46)

The two friends would go on to greatly benefit one another.  Many believe Oribasius taught Julian philosophical skills that were later necessary to be king. And Julian encouraged his friend to write a synopsis of the works of Galen. (1, page 175)

Oribasius ended up spending the next several years enveloped in research regarding ancient physicians, particularly on the works of Hippocrates and Galen. He ended up writing a 70 book synopsis (some say it was 72 books) on the writings of both physicians, and much of his works were plagiarized from their works. Time has destroyed three quarters of his work, yet what remains is "of great historical value." (4, page 129)(6, page 46)

Rather than call him a plagiarizer, historian Fielding Hudson Garrison, in his book, "An Introduction to the history of medicine...  (5, page 111)

...preferred to describe him as a torch-bearer of knowledge rather than as an original writer, but his compilations are highly valued by scholars in that he always gives his authorities, and, so far as is known, quotes them exactly.  (5, page 111)

In other words, if it were not for the works of Oribasis, many of the works he copied would have been lost. (5, page 111)

Julian, in his 277 A.D. Letter to Athenians, according to Wilmer Cave Wright...

...refers to a 'certain physician" who had been allowed by Constantius (see figure 3) to accompany him to Milan when he was summoned there to be made Caesar. Oribasius went with Julian to Gaul, and there is preserved by Photius a letter from him to Julian mentioning their sojourn there together; but we do not know whether he went on the expedition to Persia.  When Eunapius says that Oribasius "made Julian Emperor," he probably means not so much that Oribasius was an accomplice in the plot to put Julian on the throne, though he does in fact, in his Life of Maximus, speak of Oribasius as the Caesar's "accomplice," but rather that the physician, by his virtuous teachings, had fitted Julian for the position. The historians at any rate are silent as to the connivance of Oribasius. It was probably in 358 that Julian wrote his extant letter to Oribasius, when the latter was editing an epitome of GaFen. Oribasius was with him in Antioch on the way to Persia, and is no doubt one of the seven persons whom Julian mentions in Misopogon 354 c as newcomers to Antioch, and out of sympathy with its frivolous and ungodly citizens. (7, pages 337-338)

Julian at one point named his friend Oribasius "quaestor (public official who managed financial affairs of the state) of Constantinople", and was later with Julian as his personal physician as the Emperor traveled into Persia. (6, page 46)

In 363 Julian was killed in a war with the Parthinans, and he died, of his mortal wounds, in the arms of his best friend Oribasius.  (2, page 214) (6, page 46)(3, page 387)

Perhaps due to his opposition to Christianity, Christian emperors who took over the reigns of the empire exiled Oribasius, spared him death for being a pagan, and exiled him to live among the Barbarians (it is unknown who the Barbarians were).(3, page 387)(6, page 46)

Much of what we know about Oribasius (much of what is written above) comes from his friend, and fellow exiled pagan physician Eunapius. It is believed that Eunapius was born in 347 A.D. in Sardis, studied there under the pagan sophist (Greek teacher of philosophy, rhetoric and arts) Chrysanthius (of the 4th century), and went to Athens to learn rhetoric from Prohaeresius (272-367).  Like Julian and Oribasius, he was also a Pagan, and was opposed to Christianity, and this theme was emphasized in his writings.

While Oribasius was still alive, Eunapius published a book, "The Lives of the Sophists," honoring the world's 23 greatest philosophers, of whom, according to Eunapius, Oribasius was one. (3,page 387)

Eunapius said that Oribasius was also "the most skillful in medicine, and the most amiable in conversation."  (6, page 46)(7, pages 533, 537)

Eunapius explained that while in exile... (3, page 387)

...he (Oribasius) exhibited proofs of his abilities restoring some to health from long and grievous sicknesses, and recovering others from the very gates of death. Whereby, in a short time, he gained great esteem with the barbarian kings, and was revered with almost divine honours. The Romans were very desirous of his presence with them; and the emperors, changing their former counsels, gave him leave to return; which he was very willing to do out of regard to his native country. (3, page 387)(7, page 535)

Eunapius said Oribasius married a rich woman, had four children, "had his estate restored to him out of the public treasury, the emperors revoking their former sentence against him as unjust."  (3, page 387)(6, page 46)(7, page 535)

Eunapius said Oribasius then "recovered his original fortune from the public treasure."  (7, page 537)

His legend lived on through his voluminous writings. He was partially responsible for keeping the works of Galen in the minds of medieval physicians, as his works were referenced by future physicians, including many who would go on to write about asthma and other respiratory disorders.

Because of his association with Julian, and later due to his skills as a physician, "Oribasius and his family lived a very comfortably; if he met with some difficulties, as Eunapius intimates, they could not be for any long duration... it hence appears that Oribasius reached a good old age."  (3, page 387)

He died sometime around 400 A.D.

There is one more thing I'd like to say about Oribasius and the era of which he lived.  While he and Julian tried to draw Rome back to its Pagan roots, "the majority of the people of the Roman empire were Christians, and the laws were favourable to them," said radBradford (3, page 387) 

People who claimed that "diseases had a real cause" were ignored, and those who practiced medicine were persecuted, said Bradford (6, page 48-49)

Figure 3 --
Marble bust of Constantine.
His father was Constantius, who lived from 250-306,
and was Roman Emperor from 293-305.
Constantine lived from 272-337,
and was Roman Emperor from 306-337.
He was the father of the next Constantius,
also known as Constantine II,
who lived from 316-340,
and was Roman Emperor from 317-340.
Julian lived from 331-363,
and was Roman Emperor from 355-363.

All the temples of Aesculapius, the Asclepions, since they were no longer needed, were "abolished" by Constantine, said Bradford.  Of these, Bradford said:

They were replaced by hospitals and asylums placed under the care of the church. These were richly endowed with lands and money... The empress—mother of Constantine—Helena, was foremost in this charitable work, and was assisted by many high-born ladies. Orphan asylums, foundling homes and abodes were organized for the poor. There were also parabolani, out-door visitors to the sick poor, especially in time of pestilence. But noble as was this great charity of the church, it labored under the defect that in place of the skillful physicians of the Asclepions, they were now only well meaning but unskillful priests, who really knew nothing about disease. The sick were really under the care of nurses; and hence, to hide their inability and ignorance, these nurse priests proclaimed that prayer and relics of saints and other ceremonials were better for thecure of the sick than the skill of the earthly physician. Those having charge of the hospitals were called the nosocomi... With the Asclepions closed, the schools of philosophy prohibited, learning branded as magic and punished as treason, philosophy driven into exile, and as a class exterminated" (6, page 49)

Bradford likewise explains that knowledgeable and skillful physicians "were replaced by well meaning but unskillful priests."  (6, page 49)

Diseases were no longer caused by an imbalance of the humors, so knowledge of anatomy, pathology, and philosophy were no longer needed.  Instead of  the sick seeking the cures of physicians, they sought the miracles of priests. (6, page 49)

Regardless, Paganism became extinct.  Oribasius was, therefore, the last of the Pagan physicians.  (4, page 129)

References:

1. Lawson, Russell M, "Science in the ancient world: an encyclopedia," 
2. Temkin, Owsei, "Hippocrates in a World of Pagans and Christians, 
3. Lardner, Nathaniel, transcribed by Andrew Kippis, "The works of Nathaniel Lardner in five volumes," 1815, pages 386-388
4. Withington, Edward, "Medical History from the earliest times," 1894
5. Garrison, Fielding Hudson, "An introduction to the history of medicine," 1921, Philadelphia and London, W.B. Saunders Company
6. Bradford, Thomas Lindsley, writer, Robert Ray Roth, editor, “Quiz questions on the history of medicine from the lectures of Thomas Lindley Bradford M.D.,” 1898, Philadelphia, Hohn Joseph McVey
7. Philostratus (the Athenian), Eunapius, "Lives of the Sophist," translated by Wilmer Cave Wright, 1922, London, G.P. Putnam's Sons
8. Watson, John, "The Medical Profession from the Earliest Times: an anniversary discourse delivered before the New York Academy of Medicine November 7, 1855," 1856, New York, Baker & Godwini

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