© 1999 Robert A. Freitas Jr. All Rights Reserved.

Robert A. Freitas Jr., Nanomedicine, Volume I: Basic Capabilities, Landes Bioscience, Georgetown, TX, 1999

1.2.1.6 Ancient Roman Medicine

Roman tradition held that one was better off without doctors. According to Cato (234-149 BC), citizens had no need of professional physicians because Romans were hale and hearty, unlike the effete Greeks. Apparently Romans enjoyed bad-mouthing Greek physicians. Thus the Romans despised medicine as a profession but this did not prevent them from making use of Greek physicians or even of the services of their own slaves. Galen of Pergamum (130-200 AD) tells us that in his time, large cities such as Rome and Alexandria swarmed with specialists who also travelled about from place to place. Martial (40-104 AD) mentions some of them in an epigram: "Cascellius extracts and repairs bad teeth; you, Hyginus, cauterize ingrowing eyelashes; Fannius cures a relaxed uvula without cutting; Eros removes brand marks from slaves; Hermes is a very Podalirius for ruptures." Under the Empire, military medicine was highly organized -- every cohort had its surgeon, and surgeons of a higher grade were attached to the legions as consultants. Army surgeons ranked as noncombatants and enjoyed many privileges.

In the Roman empire, the earliest scientific teacher was a Greek, Asclepiades of Bithynia (124-40 BC). Asclepiades ridiculed the Hippocratic expectant attitude as a mere "meditation on death," and urged active measures that the cure might be "seemly, swift and sure." Though outside the mainstream, his medical practice is interesting as a modification of the atomic or corpuscular theory, according to which disease results from an irregular or inharmonious motion of the corpuscles of the body. His pupils were numerous,constituting the Methodical school, but his available therapeutic tools were few -- he trusted mainly to changes of diet, friction, bathing, exercise, and occasionally emetics, bleeding, and wine. He was also the first to use music in the treatment of the insane.

Back in the mainstream, Galen of Pergamum (130-200 AD) provided the final medical synthesis of antiquity and the effective medical standard for the next 13 centuries. His first medical appointment was as surgeon to the Roman gladiators. He later traveled to Rome and wrote extensively on anatomy, physiology and practical medicine. His fame is due in part to his prolific pen some 350 authentic titles ranging in topic from the soul to bloodletting polemics survive, about as much as all Greek medical writings together. Galen was a flamboyant character. One of his party tricks, revealing his genius for self-advertisement as well as experiment, was to sever the nerves in the neck of a pig. As these were severed, one by one, the pig continued to squeal; but when Galen cut one of the laryngeal nerves the squealing stopped, impressing the crowd.

Galen justified venesection in terms of his elaborate pulse lore. Written in the early 170s, his sixteen books on the pulse were divided into four treatises, each four books long. In one of these treatises, he explains how to take the pulse and to interpret it, raising key questions, for example: How was it possible to tell whether a pulse was full, rapid, or rhythmical? Such questions he resolved partly from experience and partly by reference to earlier authorities. Galen developed a characteristic physiological scheme that remained in vogue until the 17th century. It supposes three types of so-called spirits associated with three types of the activity of living things. These were the natural spirits formed in the liver and distributed by the veins, the vital spirits formed in the heart and distributed by the arteries, and the animal spirits formed in the brain and distributed by the nerves. Galen's system was an admirable if factually flawed working hypothesis, based on much experimental evidence, and he presented his work as "perfecting" the legacy of Hippocrates.

As in Greece, medicine remained personal in Rome. No medical degrees were conferred or qualifications required. In the absence of colleges and universities, the private face-to-face nature of medical instruction encouraged fluidity and diversity, Students attached themselves to an individual teacher, sitting at his feet and accompanying him on his rounds. Many different sorts of medical care were available, and self-help was universal. Celsus' On Medicine was written for a non-professional readership as willing to wield the scalpel as the plough. Disease explanations changed little. Public authorities still ascribed famines and pestilences to the gods, and Galen was silent on contagion. The essential trilogy of classical medicine remained dietetics, exercise, and drugs, accompanied by light surgery.

Last updated on 5 February 2003