Medicine in ancient Rome
Medicine in ancient Rome combined various techniques using different tools, methodology, and ingredients. Ancient Roman medicine was highly influenced by Greek medicine but would ultimately have its own contribution to the history of medicine through past knowledge of the Hippocratic Corpus combined with use of the treatment of diet, regimen, along with surgical procedures. This was most notably seen through the works of two of the prominent Greek Physicians, including Dioscorides and Galen, who practiced medicine and recorded their discoveries in the Roman Empire. This is contrary to two other physicians like Soranus of Ephesus and  Asclepiades of Bithynia who practiced medicine both in outside territories and in ancient Roman territory, subsequently. Dioscorides was a Roman army physician, Soranus was a representative for the Methodic school of medicine, Galen performed public demonstrations, and Asclepiades was a leading Roman physician. These four physicians all had knowledge of medicine, ailments, and treatments that were healing, long lasting and influential to human history. Ancient Roman medicine was divided into specializations such as ophthalmology and urology. To increase their knowledge of the human body, physicians used a variety of surgical procedures for dissection that were carried out using many different  instruments including forceps, scalpels and catheters. Introduction. The Roman Empire was a complex and vigorous combination of Greek and Roman cultural elements forged through centuries of contact. Later Latin authors, notably Cato and Pliny, believed in a specific traditional Roman type of healing based on herbs, chants, prayers and charms easily available to and by the head of household. Greek medicine was introduced into Italy with the establishment and development of military and political contacts between the two regions. It was not until the introduction of the healing god Asclepius in 291 BC and the arrival of the Greek doctor  Archagathus in 219 BC that foreign medicine was publicly accepted in Rome, mainly due to future overall adaptation to the Roman practices. Setting aside some of the broader implications of the Greek influence on Roman society, the effect of Greek medicine, ethnography, and meteorology was particularly pertinent to two fields: architecture and health care. This was particularly important from the perspective of the Roman army, in which there were many medical advances. A medical corpus was established, permanent physicians were appointed, the "valetudinaria" (military hospitals) were established, and in Caesar's time, the first traces of systematic care for the  wounded appeared. The variety and nature of the surgical instruments discovered in Roman remains indicate a good knowledge of surgery. Roman medicine. Roman medicine was highly influenced by the Greek medical tradition. Prior to the introduction of Greek medicine Roman medicine was a combination of religion and magic. The first Roman physicians were religious figures with no medical training or the head of the family. The first professional physicians were Greek physicians. Asclepiades of Bithynia arrived in 124 BCE. He was a popular physician known for his kindness to his patients often prescribing wine, rest and a swinging couch. The  incorporation of Greek medicine into Roman society allowed Rome to transform into a monumental city by 100 BCE. Like Greek physicians, Roman physicians relied on naturalistic observations rather than on spiritual rituals; but that does not imply an absence of spiritual belief. Tragic famines and plagues were often attributed to divine punishment; and appeasement of the gods through rituals was believed to alleviate such events. Miasma was perceived to be the root cause of many diseases, whether caused by famine, wars, or plague. The concept of contagion was formulated, resulting in practices of quarantine and improved sanitation. The Romans established  systems of public hygiene indicating there was an understanding that this was of importance to public health. This can be seen in their practices of burying the dead outside the city walls, their large supplies of water available through aqueducts, public bathing areas and public sewage systems. They also began draining swamps in close proximities the cities. One of the first prominent doctors in Rome was Galen. He became an expert on the human anatomy by dissecting animals, including monkeys, in Greece. Due to his prominence and expertise in ancient Rome, Galen became Emperor Marcus Aurelius' personal physician. In 46  BCE Julius Cesar granted Roman citizenship to physicians when the Roman army had a need for trained surgeons. The Romans conquered the city of Alexandria in 30 BCE, which was an important center for learning; its Great Library held countless volumes of ancient Greek medical information. The Romans adopted into their medical practices many of the practices and procedures they found in the Great Library. Augustus gave immunity to physicians from paying taxes and public duties in 10 AD. These incentives to physicians caused physicians to flood to Rome not all were educated physicians some were practicing without the proper  education or training. Many of the those making false claims were claiming to be specialist. These incentives were eventually only offered to a certain number of physicians per region that worked for the public. Greek symbols and gods greatly influenced ancient Roman medicine. The caduceus, pictured right, was originally associated with Hermes, the Greek god of commerce. He carried a staff wrapped with two snakes, known as the caduceus. This symbol later became associated with the Roman God, Mercury. Later, in the 7th century, the caduceus became associated with health and medicine due to its association with the Azoth, the  alchemical "universal solvent". Opposition to Greek medicine in Rome / Pre-Physicians. Cato the Elder despised every aspect of Greek society the Romans decided to mimic including sculptures, literature and medicine. Cato regarded the welcome given in Rome to Greek medicine and physicians as a major threat. In Rome, before there were doctors, the "paterfamilias" (head of the family) was responsible for treating the sick. Cato the Elder himself examined those who lived near him, often prescribing cabbage as a treatment for many ailments ranging from constipation to deafness. He would issue precise instructions on how to prepare the cabbage for  patients with specific ailments. He also used cabbage in liquid form. For example, a mixture of cabbage, water, and wine would be embedded in a deaf man's ear to allow his hearing to be restored. Cato would treat fractured or broken appendages with two ends of a cut reed that were bandaged around the injury. Physicians. Many Greek doctors came to Rome. Many of them strongly believed in achieving the right balance of the four humors and restoring the natural heat of patients. Around 200 BCE many wealthy families in Rome had personal Greek physicians. By around 50 BCE , it was more common than not to have a Greek physician. Physicians were more inclined to study anthropology, biology and physiology because of the great impact that philosophy had on them. The popular belief was that philosophy created interest in medicine as opposed to medicine creating an interest in philosophy. Dioscorides. Pedanius Dioscorides (c. 40–90 CE), was a Greek botanist, pharmacologist and physician who practiced in Rome during the reign of Nero. Dioscorides studied botany and pharmacology in Tarsus. He became a well-known army surgeon for Rome. While traveling with the army, Dioscorides was able to experiment with the  medical properties of many plants. Compared to his predecessors, his work was considered the largest and most thorough in regards to naming and writing about medicines, many of Dioscorides predecessors work was lost. Dioscorides wrote a 5-volume encyclopedia, "De Materia Medica", which listed over 600 herbal cures, forming an influential and long-lasting pharmacopoeia. "De Materia Medica" was used extensively by doctors for the following 1500 years. Within his five books, Dioscorides mentions approximately 1,000 simple drugs. Also contained in his books, Dioscorides refers to opium and mandragora as a sleeping potion that can be used as a natural  surgical anesthetic. Soranus. Soranus was a Greek physician, born in Ephesus, who lived during the reigns of Trajan and Hadrian (98–138 CE). According to the Suda, he trained at the medical school in Alexandria and practiced in Rome. Soranus was a part of the Methodist School of Asclepiades, which fostered the ideals of the Hippocratic doctrine. He was the chief representative of the Methodic school of physicians. Soranus’s most notable work was his book Gynecology, in which he discussed many topics that are considered modern ideas such as birth control, pregnancy, midwife’s duties, and post-childbirth care. His  treatise "Gynaecology" is extant (first published in 1838, later by V. Rose, in 1882, with a 6th-century Latin translation by Muscio, a physician of the same school). He accounts for the internal difficulties that could arise during labor from both the mother and the fetus. He also did work with fractures, surgery, and embryology. Galen. Galen (129 CE – c. 200 or 216 CE) of Pergamon was a prominent Greek physician, whose theories dominated Western medical science for well over a millennium. By the age of 20, he had served for four years in the local temple as a "therapeutes  (attendant" or "associate") of the god Asclepius. Although Galen studied the human body, dissection of human corpses was against Roman law, so instead he used pigs, apes, sheep, goats, and other animals. Through studying animal dissections, Galen applied his animal anatomy findings and developed a theory of human anatomy. Galen moved to Rome in 162. There he lectured, wrote extensively, and performed public demonstrations of his anatomical knowledge. He soon gained a reputation as an experienced physician, attracting to his practice a large number of patients. Among them was the consul Flavius Boethius, who introduced him to the imperial court , where he became a physician to Emperor Marcus Aurelius. Despite being a member of the court, Galen reputedly shunned Latin, preferring to speak and write in his native Greek, a tongue that was actually quite popular in Rome. He treated Roman emperors Lucius Verus, Commodus, and Septimius Severus. In 166, Galen returned to Pergamon but went back to Rome for good in 169. Galen followed Hippocrates' theory of the four humours, believing that one's health depended on the balance between the four main fluids of the body (blood, yellow bile, black bile, and phlegm). Food was believed to be  the initial object that allowed the stabilization of these humours. By contrast, drugs, venesection, cautery and surgery were drastic and were to be used only when diet and regimen could no longer help. The survival and amendment of Hippocratic medicine is attributed to Galen, who coupled the four qualities of cold, heat, dry, and wet with the four main fluids of the body, would remain in health care for another millennia or so. Galen wrote a short essay called; "The Best Doctor Is Also A Philosopher", where he writes that a physician needs to be knowledgeable about not just the  physical, but additionally logical and ethical philosophy. He writes that a physician "must be skilled at reasoning about the problems presented to him, must understand the nature and function of the body within the physician world, and must practice temperance and despise all money". The ideal physician treats both the poor and elite fairly and is a student of all that affects health. Galen thought that eleven years of study was an adequate amount of time to make a competent physician. He references Hippocrates throughout his writings, saying that Hippocratic literature is the basis for physicians' conduct and treatments. The  writings of Galen survived longer than the writings of any other medical researchers of antiquity. Galen also wrote an astrological doctrine, "De diebus decretorus ("Critical Days Book III), in which he describes the importance of astrology in prognosis and diagnosis. Asclepiades. Asclepiades studied to be a physician in Alexandria and practiced medicine in Asia Minor as well as Greece before he moved to Rome in the 1st century BCE. His knowledge of medicine allowed him to flourish as a physician. Asclepiades was a leading physician in Rome and was a close friend of Cicero. He developed his own version of  the molecular structure of the human body. Asclepiades' atomic model contained multi-shaped atoms that passed through bodily pores. These atoms were either round, square, triangular. Asclepiades noted that as long as the atoms were flowing freely and continuously, then the health of the human was maintained. He believed that if the atoms were too large or the pores were too constricted, then illness would present in multiple symptoms such as fever, spasms, or in more severe cases paralysis. Asclepiades strongly believed in hot and cold baths as a remedy for illness; his techniques purposely did not inflict severe pain  upon the patient. Asclepiades used techniques with the intent to cause the least amount of discomfort while continuing to cure the patient. His other remedies included: listening to music to induce sedation, and consuming wine to cure headache and a fever. Asclepiades is the first documented physician in Rome to use massage therapy. Others contributing to Roman medicine. Aulus Cornelius Celsus. Celsus (25 BC–AD 50) was a Roman encyclopedist who wrote a general encyclopedia about many subjects. His exact place of birth as well as when he lived are unknown; however, it is known he lived during the reigns  of Augustus and Tiberius. The only surviving work from his larger encyclopedia is De Medicina. This work contains eight volumes, two of which are on surgery. De Medicina provides some of the best accounts of Roman medicine during his time. Its contents proved to be valuable even into the 15th century after Pope Nicolas V rediscovered it, becoming the first medical book to be published in 1478 AD. It is still debated if he practiced medicine himself or just compiled the works of the time, much of it from greek sources. This is important because at the time Greeks were  looked down upon by the Romans and thus so was the work of doctors. In his book he discussed the two different schools of thought at the time relating to medicine he calls ‘Empirics’ and ‘Dogmatics.’ Empirics followed empirical observation while dogmatics needed to understand the theory behind how a treatment works. Celsus is also credited with writing on four of the five characteristics of inflammation, redness (rubor), swelling (tumour), heat (calor), and pain (dolor). Galen would write about the fifth, loss of function (functio laesa). Hospitals. The Roman medical system saw the establishment of the first hospitals; these were  reserved for slaves and soldiers. Physicians were assigned to follow armies or ships, tending to the injured. In Rome, death was caused by a combination of poor sanitation, famine, disease, epidemics, malnutrition, and warfare that led to high Roman mortality rates. The development of health services was prolonged by the unsympathetic attitudes of the Romans towards the sick, superstition, and religious beliefs. The earliest known Roman hospitals of the Roman Empire were built in the 1st and 2nd centuries AD, in the reign of the emperor Trajan. The army's expansion beyond the Italian Peninsula meant that the wounded could  no longer be cared for in private homes. For this reason the "valetudinarium" was established. The "valetudinaria" (plural of "valetudinarium") were field hospitals or flying military camps and began as a small cluster of tents and fortresses dedicated to wounded soldiers, that provided insight into how the doctors managed the different wounds and diseases which allowed for the awareness into which herbs were good for certain medical uses. Over time, the temporary forts developed into permanent facilities. The original hospitals were built along major roads, and soon became part of Roman fort architecture. They were usually placed near the outer  wall in a quiet part of the fortification. The hospital building. A standard valetudinarium was a rectangular building consisting of four wings, connected by an entrance hall that could be used as a triage center. Each legion's hospital was constructed to accommodate 6% to 10% of the legion's 5,000 men. The building also included a large hall, reception ward, dispensary, kitchen, staff quarters, and washing and latrine facilities. Surgical instruments. Surgery was typically used as a last resort because of the risks involved. When surgery did happen though, it was usually limited to the surface of the body  because doctors recognized that injuries regarding the body's most important physiological functions (brain, heart, spine, etc.) could not usually be treated. A variety of surgical instruments are known from archaeology and Roman medical literature, very similar to our current day medical instruments, including: The ancient Roman medical instruments and their qualities and appearance were made by special manufacturers up to the standards of the surgeon and his future implementations. Medicines. Diet. Correct diet was seen as essential to healthy living. Food was perceived to have a healing effect or a causative effect on disease, determined by its impact on  the humors; as well as preventing disease. Some of these foods included rice, chic-pea, olive and fig which were widely used by the Roman military. At an archeological site, other plants were found that were used for medicinal purposes such as lentils, garden peas and figs. A variety of meats were also discovered at the site which were believed to be used for sick individuals. Poultry, eggs and oysters were used as a diet for those with health issues. Moderation of foods was key to healthy living and gave rise to healthy eating philosophies. When diet no longer promoted  health, drugs, phlebotomy, cautery, or surgery were used. Patients having control of their lives, managing their own preventative medical diets, and the freedom to seek physicians, indicates that patient autonomy was valued. Herbal and other medicines. Roman physicians used a wide range of herbal and other medicines. Their ancient names, often derived from Greek, do not necessarily correspond to individual modern species, even if these have the same names. Known medicines include: Statues and healing shrines were sites of prayer and sacrifice for both the poor and the elite, and were common throughout the Roman Empire. Reverence for shrines and  statues reflected a search for healing, guidance, and alternatives to ineffectual human physicians and drugs. In 2013, Italian scientists studied the content of a Roman shipping vessel, known as the "Relitto del Pozzino", sank off the coast of Populonia, Tuscany around 120 BC, which was excavated during the 1980s and 90s. The vessel had a medicine chest with pyxides inside, which contained medicinal tablets or pills full of a number of zinc compounds, as well as iron oxide, starch, beeswax, pine resin and other plant-derived materials, all probably served as some sort of eye medicine or eyewash. Treatments. Stab  Wounds. Roman physicians tried their best to help treat battlefield wounds. Celsus describes treatments early Roman doctors used for battlefield abdominal wounds. Celsus describes that doctors should first observe the color of the intestines to see that if they are “...livid or pallid or black…” in which case treatment is impossible. If the large intestine is found to be cut he says treatment is unlikely to be successful but suggests suturing the intestine. Treatment of abdominal wounds should occur quickly and for fear exposed intestines would dry out. Celsus suggests adding water to the intestines to prevent this. The Romans  also knew about the delicate care needed for such complex wounds. Assistants with surgical hooks were used to stitch up large abdominal wounds. They were used to help separate the margins of the abdomen because both the inner membrane and the surface skin needed to be sutured with two sets of stitches because it could be broken easily. The Romans applied a variety of ointments and dressings to these wounds. Celsus describes 34 different ones. Healing sanctuaries. A physician's overall goal was to help those afflicted by disease or injury as best as they could; the physician's credibility  rested on their successful cures. Of course they could not reliably cure ailments; sometimes the best they could hope for was that their treatments did not worsen their patients' problems. Many physicians were criticised by their peers for their inability to cure an apparently simple illness. Gaps in physician-provided care were filled with several types of supernatural healthcare; the Romans believed in the power of divine messages and healing. There have been descriptions of many gods from multiple religions that dealt with destruction or healing. For example, in 431 BCE, in response to the plague running rampant all over  the country of Italy, the temple of the Apollo Medicus was accredited with an influence of healing. Scattered across Greco-Roman and Egyptian history are descriptions of healing sanctuaries dedicated to the various healing gods. Sick or injured Romans would often flock to temples dedicated to Asclepius, the god of healing, as it was believed that the god actually inhabited the sanctuary and would provide divine healing to supplicants. The process itself was simple: the sick person would give a specified donation to the temple, and then undergo a process called "incubation" in which they would relocate to a special  room where the god would be able to contact them, often through dreams in which the god would either prescribe care or provide it themselves. Often the type of cure prescribed would be rather similar to the actual medical practices of physicians of the time. This type of supernatural care did not conflict with mainstream healthcare. Physicians would often recommend that patients go to a healing sanctuary when they were afflicted by an illness that the physician could not cure. This allowed the reputation of the physician to remain unharmed, as it was seen more as a referral than as  a failure. Colostrum. Colostrum is the first form of milk produced by lactating mammals. Both Greek and Roman medical texts prescribe the use of a variety of substances, of varying medical and religious significance. Several substances, such as sulfur, asphalt and animal excrement, were associated with the practice of human purification. The practice of using a woman's breast milk as a medicine has very early roots in Egyptian medical texts. In several such texts there are references to the use of the milk of a woman who has given birth to a male child. This practice is said to  be based on depictions in several statues of the goddess Isis breastfeeding her son, the god Horus. Both Egyptian and Greek texts state that the milk used for medicinal purposes should be strictly from a woman who has borne a male child. The treatments using breast milk differed vastly between Greek and Roman culture. In Greek medicine, milk was very rarely actually consumed. Instead, it was used in recipes for ointments and washes that would treat burns and other skin-related maladies. These treatments were exclusively given to women, as women's bodies were viewed as "polluted" in some sense . In stark contrast, the Roman use of colostrum was more widespread and varied. Stories suggest that adults drinking breast milk was viewed as socially acceptable, but was not common unless used for treatment. The milk was instead ingested by the patient, and the treatment was given to both men and women, which then allowed the views of the female body to be viewed as analogous compared to their male peers, rather than as the opposites they have been for centuries before. In general, while not every single fear about the changing medical views of female physiology went away, the Romans  then seemed less concerned about the so-called "pollution" of a woman's body and therefore need to have the women have special requirements needed for "purification." It has been shown in modern times that having patients ingest mother's milk (or colostrum) is actually a rather effective treatment due to the benefits associated with it. For example, the use of colostrum has been shown to prevent the growth of "Staphylococcus" bacteria, which are a known cause of several types of infection. Colostrum is about half as effective as some antibiotics prescribed to patients today. Colostrum is also effective against  the bacterium chlamydia. Chlamydia is a sexually transmitted disease in which some subtypes of it can cause trachoma, which is a major source of cause for severe sight impairment, if not blindness. Colostrum was a reasonably effective treatment for Chlamydia in the absence of other antibiotics. Diagnostic methods. Dreams. The interpretation of dreams was another avenue for treatment of illnesses by physicians. Often the interpretations of a patient's dreams would actually determine what treatment they received. A Hippocratic work called "Regimen" details much of the principles outlined by Galen: specifically the humors and examples of how they could be  used to prescribe treatment. The theme of this method is knowing the patient. To know how to treat a person, the physician must become familiar with and interpret the important aspects of their lives: the climate, their food intake, how much they sleep, how much they drink, any injuries. They would then draw conclusions about the patient and what must be done to set them back to equilibrium. The fourth book of the "Regimen" is the earliest mention of the topic of dream medicine. Dreams were used by physicians in diagnosis. They added another layer of depth to the physician 's investigation of the patient. The soul was thought to serve the purpose that the brain has been discovered to serve. Sensation, pain, motion and other physiological concepts were thought to be the work of the soul. It was also thought that the soul continues the work of bodily upkeep even when a person is sleeping. Thus, dreams would show what ailed a person. There were two types of dreams associated with medicine: prophetic and diagnostic. Prophetic dreams were divine in origin and foretold good or bad tidings for the future. Diagnostic dreams were a result of the soul telling  what afflicted the body. If the dreams were of normal everyday events, their body was healthy and in equilibrium. The farther from the norm, and the more chaotic the dreams were, the more ill the patient was. The treatments that were recommended addressed what the dreams showed, and attempted to set the body right through consumption of food that carried the correct humor characteristics. Astro-medicine. Galen wrote a treatise on diagnosis and prognosis by celestial movement. This ancient medical practice associated that disease and parts of the body were affected by the movement or location of the sun, moon  and planets. This is similar to horoscopic astrology and the notion of astrological signs. These celestial signs were only a part of the process in his work Critical Days Galen also includes that the patients' feces, urine, sputum should be examined for diagnosis. He states that examination of the excrement could indicate a disease of the respirator system, urinary tract or vascular system. Many physicians at the time believed in the association of astrology and medicine. Book III of Galen's writing he correlates the lunar phases which cause changes in the tides to also cause changes the fluid humors  in the body. He also makes reference to "medical months" which are based on the two periods of the moons which are about two calendar months. There were also days that were considered critical including day seven, fourteen and day twenty which were considered favorable for a medical crisis to occur. Textual transmission. Galenic medical texts embody the written medical tradition of classical antiquity. Little written word has survived from before that era. The volume of Galen's extant written works, however, is nearly 350 – far surpassing any other writer of the period. Prior to Galen, much of medical knowledge  survived through word of mouth. The tradition of transmission and translation originated with the "De Materia Medica", an encyclopedia written by Pedanius Dioscorides between 50 AD and 70 AD. Dioscorides was a Roman physician of Greek descent. The manuscripts classified and illustrated over 1000 substances and their uses. "De Materia Medica" influenced medical knowledge for centuries, due to its dissemination and translation into Greek, Arabic, and Latin. Galen wrote in Greek, but Arabic and Syriac translations survived as well. He referenced and challenged written works by Hippocratic physicians and authors, which gave insight into other popular medical philosophies. Herophilus, known  for his texts on anatomy through dissection, and Erasistratus, also known for anatomy and physiology, survive through Galenic reference. Galen also referenced the written works of Soranus, a physician of the Methodic school known for his four-book treatise on gynecology. His synthesis of earlier medical philosophies and broad range of subjects produced the textual legacy that Galen left for the medical community for the next 1500 years.