Research Article Medical practice in Graeco-Roman antiquity L Cilliers Dept, of English and Classical Languages, University of the Free State FP Retief Honorary Research Fellow, University of the Free State Keywords: Hippocratic medical practice Abstract: Curationis 29(2): 34-40 Alexandrian / Hellenistic medical practice The roots of modem medicine can be traced back to the 5th century BC when Hippocratic Roman medical care Military medicine rational medicine originated on the Greek islands of Cos and Cnidos. In this study we Medicine in Roman North Africa Hospi­ examine the way in which practitioners conducted their profession in Graeco-Roman tals in antiquity times, as well as their training. Medical training was by way of apprenticeship with recognized doctors, but no qualifying examinations existed and the standard of practice thus varied enormously. Even in the Roman era the vast majority of medical doctors were Greek and in private practice as itinerant physicians. Civic doctors in the paid service of local communities appeared in Greek society from the 5th century BC onwards, but much later in Rome - probably as late as the 4th century AD. Rome’s unique contributions to medicine lay in public health measures (e.g. their aqueducts, public baths and sewages systems) and an excellent medical service for their armies and navy. Hospitals (valetudinaria) were established for military purposes and for slaves on large Roman estates from the 1st century BC, but civic hospitals for the general public originated as late as the 4th century AD. The Greek medical schools of Cos and Cnidos were eventually superseded by the school of Alexandria in Egypt and towards the end of the Roman Empire by that of Carthage in northern Africa. Its gradual demise in the Christian era lowered the curtain on original medical endeavours during antiquity. Pre-classical Greece Apollo and his son, the physician, (before the 5th Century BC) Asclepius, are involved in the Trojan war, as are Asclepius’s sons (Machaon and The roots of modern medicine can be Podaleirios) who are also doctors. Celsus traced back to the 5th century BC when, (Proem, c.3) later observed that tliey were together with the blossoming of literature, involved in treating battle wounds, but philosophy, arts and science during the not in curing pestilential disease. The Golden Age of Athens, the Greek Iliad does indeed mention 147 war communities at Cos and Cnidos laid the wounds (106 spear thrusts, 17 sword foundation of rational medicine. The slashes, 1 2 arrow wounds and 1 2 sling Hippocratic corpus tells us much about shot wounds) (Porter 1997:51). Correspondence address: the logic and ethics of the new medicine Prof L Cilliers but little about the way in which Faculty of the Humanities practioners conducted their profession. Porter (1997:51) suggests that the Dept of English and Classical Languages In this article we examine the basics of Olympic Games (founded 776 BC) University of the Free State medical practice in antiquity, and the introduced a cult of pride in physique PO Box 339 teaching of influential doctors who led and physical fitness which had an effect Bloemfontein the way during Greek and Hellenistic on healthy living. There are conflicting 9300 times but also the subsequent Roman views on the impact that ancient Egyptian era. medical heritage had on Greek medicine Tel: (051)401-2303 Greek medical history goes back to (Marganne 1993:35-43), which was Fax:(051)444-5803 Homeric times. In the Iliad (1.1 -43ff; 450- practiced by a very heterogeneous E-mail: [email protected] 480; XI.518 and 833) the healing god community of “healers” (demiourgoi). 34 Curationis May 2006 The concept that disease was caused and written by various authors from different rather than iatroi (Krug 1993:194-5; controlled by the gods was generally parts of the Greek world, mostly Godderis 1997:251-3).. accepted; religion and mantic influences completed by the 3rd century BC, but thus played an overriding role. At this some added as late as the Christian era. The bed-side approach recommended in stage medicine was mainly in the hands Knowledge of anatomy was rudimentary, the Hippocratic Corpus shows of priests and magic healers, druggists based largely on the anatomy of animals, remarkable similarity to that of the modem and root cutters (rhizotomoi) (Godderis and physiology was explained on the doctor. In addition to extensive advice 1997:235-237). However, towards the 6 Ih basis of four humours (white bile, black on appropriate dress, demeanour, even century BC a group of philosopher- bile, blood, phlegm) which for good desirable physical features, the doctor is physicians came to the fore who health, had to be in equilibrium with each told that his assessment of the patient significantly influenced the course of other, but also with the four elements should be based on the proper use of his health care development. Among them (earth, air, fire, water) and four “qualities” senses: observation, listening, smell and was Thales of Miletus and his pupil (heat, cold, dryness, dampness). Disease palpation. He must inform himself of all Anaximander, followed by the remarkable was explained as imbalances of this possibly relevant information, inter alia Pythagoras (570-489 BC) from Croton in system, and although quite unscientific through discussions with relatives or Southern Italy. Besides his enormous as measured by modem knowledge, it friends. Examination of the patient would contributions in mathematics and was nevertheless “rational” insofar as include observation of the patient’s physics, he (possibly in association with superstition and religion played a very position in bed and general attitude, the his pupil, Alcmaeon) formulated the small role in their argumentation (Retief breathing, condition of the abdomen, theory of four body humours as the basis & Cilliers 2000:10-14). The admirable code pulse (in Hippocratic times not yet an of human physiology - a theory, which of ethical conduct contained in the extensive science), chest (including although quite wrong, remained dogma Corpus was never enforced on the auscultation with the ear against the for more than two millennia (Major profession, and we do indeed have ample thoracic wall: pleural rubs and 1954:110-116). It is evident that as early evidence also of bad medicine practised succussion splashes were recognized), as the 6 th century BC there were centres by Greek physicians of the day urine and other excreta. The overall of medical education at Croton, Cyrene (Hippocrates, Law c.l; Van der Eijk assessment did not lead to a diagnosis, (Northern Africa) and Cnidos (Nunn 1999:70-71). Public comment affirmed but to the formulation of a prognosis and 19%: 12). this, as well as satire in the theatre appropriate treatment (to address the (Godderis 1997:249-250) and stinging patient’s assumed humoural imbalance). The assertion made by the Greek criticism from philosophers like Plato, There were three levels of therapy, of historian, Diodorus Siculus (12.13.4), that who condemned ignorant folk healers which the first was dietetics, comprising as early as the 7th century BC the state (Republic 364 b-c) as well as incompetent not only dietary measures, but also had already appointed salaried civic doctors (Charmides 156e). In the 4,h procedures affecting life style like doctors, is not generally accepted century BC the physician Diodes of exercise and fitness programmes. When (Nutton 1988:11), but Herodotus’s claim Carystus, a pupil of Aristotle, contributed additional treatment was indicated, (3.13Iff.) that Democedes (one time much to the Hippocratic tradition, but of medicaments were prescribed. The third reluctant court physician to the Persian his writings only a few fragments therapeutic level comprised surgery and King Darius) became a salaried doctor in survived (Van der Eijk 1997:70). Aristotle cautery, which was only used as a last Aegina in 530 BC (later also in Athens and his Peripatetic School contributed resort. However, the Hippocratic Corpus and Samos) seems more credible (Nutton extensively to medical knowledge (inter does contain extensive advice on aspects 1988:12). This was then possibly the first alia anatomy and embryology) (Major of surgery and orthopaedics in particular, recorded example of physicians 1954:1390140). and one gets the impression that the employed by the state to render a pre­ average physician was expected to handle determined service to the populace. The Hippocratic doctor treated patients all therapeutic modalities (Edelstein from all sections of the community, 1987:87-8,91-102; Schlesinger 1999:95- Classical Greece (5th and although Godderis (1997:252-3) suggests 99). Diocles’s prescriptions on dietetics that the rich probably received more and maintenance of normal health are so 4th Centuries BC) attention than the poor. Training was detailed and intricate that only the During the 5th century BC and as part of acquired through apprenticeship to a advantaged rich could afford such a life the Golden age of Athens, a system of physician - for the fortunate ones this style. Plato (Republic 403e ff.) was quite rational medicine (technê iatrikê) in which happened at the schools of Cos and critical about such regimes. The ethical religion and supernatural factors played Cnidos. No professional registration was code which accompanied Hippocratic a minimal role was developed, mainly by needed and training standards must have medicine was an important conditioning the Greek medical fraternity on the island been extremely variable and inconsistent. factor in health care, containing classical of Cos under the inspiration of Most physicians were men (iatroi) but admonishments such as: “Practice two Hippocrates. In this evolutionary there were also woman doctors (iatrinai), things in your dealing with disease : try process, earlier physicians like midwives (maiai) and even iatro-maiai. to help but do not harm the patient” Anaxagoras and Empedocles made Nurses in the modern sense were (Epidemics 1:11).