Greco-Roman Medicine and What It Can Teach Us Today

Nick Summerton

• Editorial: Pen and Sword Archaeology
• Año: 2022
• ISBN:
  9781526752888
• Categoría: Medicine
• Categoría: Medical Theory, Practice & Reference

There can be little doubt that the Romans experienced many of the illnesses that are still encountered today, and individuals have always had to decide how best to deal with their health-related concerns. The Roman Empire was an amalgam of many cultures, often with dissimilar ideas and beliefs. The Greek impact on health was particularly dominant and, therefore, this book focuses on Greco-Roman medicine as it was practised during the Pax Romana, the period between the accession of Augustus and the death of Marcus Aurelius. Drawing on ancient literature supplemented with evidence from archaeology, paleopathology, epigraphy and numismatics the Greco-Roman medical context is carefully examined. A particular focus is on the effectiveness of approaches to both preventing and treating a range of physical and psychological problems. Detailed consideration is also given to the ancient technical and hygienic achievements in addition to the place of healers within Roman society. Uniquely, within each chapter, the author draws on his own clinical and public health experience, combined with modern research findings, in assessing the continuing relevance of Greco-Roman medicine. For example, Galen`s focus on access to fresh air, movement, sensible eating and getting sufficient sleep matter as much today as they did in the past. Our classical forebears can also assist us in determining the best balances between prevention and treatment, centralised control and individual responsibility, as well as the most appropriate uses of technology, drugs and surgery. Some ancient pharmaceutical compounds are already showing promise in treating infections. In addition, practising Stoicism and getting some locotherapy should be considered by anyone struggling to cope with the stresses and strains of modern life.

CHAPTER 1

Introduction

There is a wealth of excellent modern literature exploring various aspects of Greek and Roman Medicine. In writing this book, I have consulted numerous texts and doctoral theses, in addition to a raft of papers in peer-reviewed journals. However, the vast majority of such publications focus on studying ancient medicine for its own sake without considering any practical benefits that might have relevance today.

It is always important to respect the autonomy of the past in terms of the differences in material culture as well as the dissimilar ideas, priorities, hopes and fears of our forebears. But I do not believe that this should be a barrier to drawing inferences, ideas or lessons with a view to examining our current approaches to health and wellbeing. Finding ways to cope with disease, death, disability and distress have been constant concerns throughout all human history.

There can be little doubt that the Romans experienced many of the illnesses that are still encountered today. Individuals would also have had to decide how best to deal with their health-related concerns. Nowadays, some patients might consult their doctor as soon as they experience back pain, but most are more likely to use a home remedy, discuss it with a close friend or relative, visit the pharmacist or even consider a complementary therapist. Similarly, although the range of treatment opportunities would have been different for the Roman patient, individual choice would still have played an important part in determining the type of care selected.

In considering any aspect of ancient medicine, it is crucial not to become blinkered by a modern perspective; health and health care must always be seen in context. For example, a condition considered ‘normal’ in one society (or at one time) might represent a medical problem in other circumstances. Currently in the UK, low blood pressure is generally not treated but elsewhere in Europe the situation is different. Jambes Lourdes is a common condition in France but unrecognised in most other countries. Furthermore, illnesses that warrant the input of a doctor nowadays might, at other times, have been very effectively dealt with by other healers.

In examining Roman medicine, a particular challenge is the enormous time frame. The departure of the last Western Roman emperor, Romulus Augustus, in AD 476 marked over 1200 years since the foundation of Rome. In the east it then continued for another 1,000 years as the Byzantine Empire. A further issue is that there was significant hybridisation of Roman institutions and beliefs with many other ancient cultures. For example, the medicine being practised during the period when the Romans occupied Britain was essentially an amalgam of theories and practices derived from the indigenous inhabitants of Rome, the Etruscans, the Egyptians and the Greeks, combined with the pre-Roman local health beliefs prevalent before they arrived.

An Egyptian haematite amulet has been found within a Roman context near Welwyn in Hertfordshire. It is inscribed with a representation of the uterus, a scarab beetle and the name ‘Ororiouth’, a protector spirit against women’s diseases.2 At Bath, the presence of the haruspex Lucius Marcius Memor suggests Etruscan influences on medical care. Haruspication involved slaughtering an animal, usually a sheep, and then carefully examining and ‘reading’ the liver and intestines. It was believed that specific aspects of the health of the person bringing the sacrifice could be determined from the anatomy of the animal’s internal organs.3

In Roman Britain and elsewhere, the Greek impact on Roman medicine was particularly dominant and writings by Greek-born physicians such as Galen and Dioscorides continued to be studied and used in Europe for over 1,300 years after the demise of the Western Roman Empire. Also, most doctors recorded on inscriptions from Italy and the Western Latin provinces of the Empire before AD 100 bore Greek names.

Therefore, this book focuses on Greco-Roman medicine as it might have been practised during the Pax Romana, a 200-year period commencing with Augustus and concluding with the death of Marcus Aurelius. Moreover, each main chapter – preventive medicine and the preservation of health, healers and patients, architecture and health, pharmaceutical remedies, psychological wellbeing and holistic care, surgical and physical therapies – is subdivided into two distinct elements.

First, an attempt is made to reconstruct the Roman context drawing on the ancient literature supplemented with evidence from archaeology, paleopathology, epigraphy and numismatics. A second section then reflects on the Roman achievements highlighting some issues that might have continuing relevance today.

Although I have harnessed ancient literature to construct a window into the medical past, questions might be raised about the potential biases of the sources used. The physician Galen was a prolific author but has also been categorised as opinionated, verbose and arrogant. The natural historian Pliny the Elder is sometimes considered insufficiently critical of the masses of information he collected and, in relation to Celsus, it remains unclear whether he was a physician or just a very careful observer. To address such concerns I have avoided, as far as possible, undue focus on a single author or an exclusive concentration on medical writings.

Any attempt to re-construct and interpret the past is also at risk from an author’s selective use of selected sources together with an occasional drift into nostalgia.4 Therefore, in drawing inferences I have largely avoided focusing on precise problems as opposed to considering some broader health care concerns such as the balance between prevention and care, the relationship between healers and patients, trust and regulation, and the role of technology. Only in relation to pharmaceutical remedies does the discussion take a different turn in accordance with the experimental archaeological findings. As pointed out by John Tosh, history presents us with a range of alternatives that might be considered when faced with a particular situation.5 There is always more than one approach to dealing with any predicament so, perhaps, a menu of options from past experiences can help us today.

Clearly there will always be a requirement to continue to exercise extreme caution in drawing any lessons from the distant past. But, by rigidly adopting a twenty-first-century view, it is also all-to-easy to dismiss or denigrate some aspects of ancient medicine and yet to overplay others significantly. How can we be confident that a bronze instrument was an effective surgical tool? Did our medical ancestors make important therapeutic advances or were most of their treatments simply working as placebos? Are aqueducts, drains and bathhouses really a reflection of the Roman concern for the public health? Should we simply dismiss dream therapy or pilgrimages to healing sites as gimmicks? Is there any real value in listening to patients – or even to meet them face-to-face – to make a diagnosis or a prognosis? As we continue to cope with the coronavirus pandemic can we learn anything from the Roman response to their ancient plagues? I hope this book will serve to answer these questions and many more besides.

CHAPTER 2

Preventive Medicine and the Preservation of Health

The Romans and their doctors attached a great deal of importance to following a particular lifestyle (termed ‘regimen’, ‘hygiene’ or ‘dietetics’) with a view to maintaining health. The second-century physician and author Galen made a specific distinction between the preservation of health when it is present (hygiene) and the restoration of health when it is affected by disease (therapeutics).1

Galen’s six books on the preservation of health, De sanitate tuenda (Hygiene), were written around AD 175.2 In addition to drawing from the Greek doctor Hippocrates’ works Regimen in Health, Regimen I, Regimen II, Regimen III and Airs, Waters, Places, Galen also considered the writings of Diocles of Carystus, Praxagorus of Cos, Herophilus of Chalcedon, Erasistratus, Asclepiades of Bithynia and Theon of Alexandria in crystallising his ideas.3

Prior to Galen, several Greek philosophers including Empedocles of Acragas developed the doctrine that all matter within the universe – including human bodies – was a mixture of four elemental substances (fire, air, water and earth) and four elemental qualities associated with them (hot, cold, wet and dry). Linked to this, it was determined that the human body contained four humours – blood (hot and wet), yellow bile (hot and dry), black bile (cold and dry) and phlegm (cold and wet).4

It was believed that the four humours needed to be in the correct amounts and strengths for a body to be healthy. The proper blending and balance of the four humours was known as ‘eukrasia’. Imbalance of humours – or ‘dyskrasia’ – led to disease. In general, illness was about the excess or the lack of a specific humour or the exacerbation of one quality over another (hot or cold; dry or wet).5

Importantly, humours were not considered to be present in equal quantities in everyone. Therefore, a physician wishing to re-balance an individual’s humours had to consider a number of factors such as a person’s lifestyle, age and temperament in addition to the season.6

To the Greeks and the Romans, health was something that existed in its own right and was not simply the absence of disease. According to Galen, health was ‘that state in which we neither feel pain nor are impeded in the functions pertaining to life’. And ‘That which is in accord with nature. Disease is that which is contrary to nature.’7

In ‘accord with nature’ was taken to mean a situation in which the body was in perfect balance in relation to seven ‘naturals’.8

1. The four elements – air, fire, earth and water

2. The four qualities – hot, dry, cold and moist

3. The four humours – blood, yellow bile, black bile and phlegm

4. The different parts (members) of the body divided into

a. The fundamental (brain, heart, liver)

b. The subservient (nerves, arteries, veins)

c. The specific (bones, membranes, muscles)

d. The dependent (stomach, kidneys, intestines)

5. The faculties (energies) – natural, spiritual and animal

6. The spirits – natural, vital and animal

7. The functions (operations) of the body – hunger, digestion, retention, expulsion

Galen also recognised that ‘the range of health is very wide and not exactly the same for all of us’,9 adding that ‘one must not determine those who are healthy and who are diseased simply on the basis of the strength or weakness of the functions; one must apply the term “in accord with nature”’.10 In addition, he made the important point that a problem affecting the body might be ‘so small and imperceptible as not to disturb those who have it’.11

Hygiene was about seeking to restore the status quo thereby preventing disease and preserving health. In a book written for Thrasybulus, Galen proposed that hygienic measures should be targeted at three groups: those who appear healthy already, those who are recovering from an illness and those who are in an intermediate state between heath and illness (e.g. the elderly or individuals experiencing fatigue).12

The priority was to identify the factors under some degree of human control that could facilitate or obstruct the power of nature (sometimes referred to as the ‘non-naturals’).13 For example, the first century philosopher Seneca wrote that:

it is quite contrary to nature to torture one’s body, to reject simple standards of cleanliness and make a point of being dirty, to adopt a diet that is not just plain but hideous and revolting. In the same way as a craving for dainties is a token of extravagant living, avoidance of familiar and inexpensive dishes betokens insanity.14

The medical hygienist’s goal was to maintain the normal equilibrium of humours and qualities by recommending the correct kind and amount of, for example, food, drink, sleep, wakefulness, sexual activity and exercise. In Ars medica (The Art of Medicine) Galen o...

Índice

• Cover
• Title
• Copyright
• Contents
• List of Plates
• Acknowledgements
• Preface
• Chapter 1 Introduction
• Chapter 2 Preventive Medicine and the Preservation of Health
• Chapter 3 Healers and Patients
• Chapter 4 Architecture and Health
• Chapter 5 Pharmaceutical Remedies
• Chapter 6 Psychological Wellbeing and Holistic Care
• Chapter 7 Surgical and Physical Therapies
• Chapter 8 Conclusion
• Appendix 1: The Hippocratic Oath (tr, WHS Jones, 1923)
• Appendix 2: Titles and Translations of Greek and Roman Literary Sources
• Notes
• Bibliography
• Plate section