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The earliest account of disease in Greek literature appears in the opening episode of Homer’s
Iliad which was composed sometime in the 8th century BCE. The god Apollo sent a plague
among the Greek army before Troy in punishment for Agamemnon’s insulting the priest Chryses
when he came to ransom his captured daughter. According to Homer, at the onset of the
plague, Apollo only shot his arrows at mules and dogs in the camp and then later at the Greek
soldiers themselves (Iliad I.9ff). What Homer describes is a highly communicable disease with
acute fever, sudden in onset and rapidly fatal, such as easily might attack an army; although no
symptoms are mentioned explicitly, nor are any recoveries. After the Greeks appeased Apollo
with sacrfices and by the return of the girl, they set about cleansing the camp by throwing
“defilements” into the sea. This suggests that part of the disease was a severe dysentery
exacerbated by battlefield conditions. In mythology, the arrows of Apollo and his twin sister
Artemis are often a symbol for the sudden onset of disease. The myth of Niobe illustrates this
point. Niobe was a mortal woman who boasted that she was superior to Leto, the mother of
Apollo and Artemis, because she had borne seven sons and seven daughters as opposed to
Leto’s two children. As punishment for this insult to their mother, Apollo shot all seven sons with
arrows and Artemis shot all seven daughters. Not only was Niobe robbed of the source of her
pride, but she was forced to watch all fourteen die in rapid succession as she tried to shield
them from the deadly allegorical darts with her own body. Arrows not only cause disease, but
heal it as well. In this capacity, Apollo was called by the name Paean, once a distinct god, whom
he absorbed into himself. Apollo was also father of the healing god Asclepius, whose cult was
widespread in the Greek world. In Homer’s Iliad, Apollo is addressed with his epithet Apollo
Smintheus, or “Apollo the Mouse God”. The Greeks associated Apollo with mice and so prayed
to him under that name because they recognized that rodents were vectors of disease, although
they did not realize that it was actually the microorganisms on the fleas on the rodents and not
the rodents themselves that were harmful. They recognized the correlation between plague and
rodent infestation and so prayed to Apollo Smintheus to abate plagues. A famous passage in
Thucydides’ History describes the plague that gripped Periklean Athens during the
Peloponnesian War (II.47.3-54.5). The vivid picture of the plague and the toll it took on its
victims and Athens in general inspired other authors in antiquity who treated similar topics, such
as Sophocles’ Oedipos Tyrannos and Lucretius’ De Rerum Natura (Book V).
Greek myth is often merely an allegory for an historical event. One of the canonical Twelve
Labors of Hercules involved ridding the swampy district of Lernea of a multi-headed serpent
known as the Lernean Hydra. Every time Hercules cut off one of the serpent’s heads, two more
grew in its place. Archaeologists believe this myth actually commemorates an historical plague
which devastated the population of ancient Lernea. The rapid spread of whatever sickness
gripped the region corresponds to the duplicating heads of the serpent.
THE MEDICAL PROFESSION
As a profession, medicine was more highly regarded in Greece than in Rome, however physicians were
basically craftsmen, probably enjoying some esteem among their customers, but not being part of the
socio-political elite. Roman doctors did not fare so well. Many doctors were freed Greek slaves, hence the
social standing of doctors was quite low. Because cure rates were so low, many people were skeptical or
even scornful of doctors. Their skepticism is easily understood. Roman literature contains much which
tells us about the reactions of individuals to medicine and doctors. To listen to the Roman authors is to
hear tales of quackery at all levels of society. Our sources often describe prevalent chicanery:
“Some doctors charge the most excessive prices for the most worthless medicines and drugs,
and others in the craft attempt to deal with and treat diseases they obviously do not
understand.” (Gargilius Martialis, Preface, 7)
There were no licensing boards and no formal requirements for entrance to the profession.
Anyone could call himself a doctor. If his methods were successful, he attracted more patients, if
not, he found himself another profession.
“Until recently, Diaulus was a doctor; now he is an undertaker. He is still doing as an undertaker,
what he used to do as a doctor.” (Martial, Epigrams 1.47)
“You are now a gladiator, although until recently you were an ophthalmologist. You did the same
thing as a doctor that you do now as a gladiator.” (Martial, Epigrams 8.74)
Medical training consisted mostly of apprentice work. Men trained as doctors by following
around another doctor.
“I felt a little ill and called Dr. Symmachus. Well, you came, Symmachus, but you brought 100
medical students with you. One hundred ice cold hands poked and jabbed me. I didn’t have a
fever, Symmachus, when I called you, but now I do.” (Martial, Epigrams 5.9)
Plutarch grumbles that practitioners used all sorts of questionable methods to gain patients,
ranging from escorting the prospective patient home from bars to sharing dirty jokes with him.
DOCTORS AND PATIENTS
Evidence for the public mistrust of physicians is plentiful, including these epigrams from the Greek
Anthology:
“Socles, promising to set Diodorus’ crooked back straight, piled three solid stones, each four
feet square, on the hunchback’s spine. He was crushed and died, but he became straighter than
a ruler.” (Greek Anthology XI, 120)
“Alexis the physician purged by a clyster five patients at one time, and five other by drugs; he
visited five, and again he rubbed five with ointment. And for all there was one night, one
medicine, one coffin-maker, one tomb, one Hades, one lamentation.” (Greek Anthology XI, 122)
“Phidon did not purge me with a clyster or even feel me, but feeling feverish I remembered his
name and died.”(Greek Anthology XI, 118)
Finds of instruments throughout the Roman Empire indicate that the art of surgery had
progressed and proliferated. If any one of the branches of medicine had achieved true
competence in the Empire, surgery is the most serviceable example. Surgery was important in
the training of the conscientious physician, and both Galen and Celsus emphasize it although
they came from divergent medical traditions (Celsus, prooemium VII; Galen, II, 272).
Technical competence in surgery became better as new shapes were devised for medical tools,
and as new metals and alloys were found to provide sharper edges and cheaper equipment.
Most instruments were made of bronze, or occasionally of silver. Iron was rarely used because,
as in most ancient cultures, it was considered taboo by both the Greeks and Romans, and so
was never used for surgical instruments on religious grounds. The design of many medical
instruments remained unchanged and the quality of manufacture was seldom bettered until
recent times. The full repertoire for Roman surgical equipment is far from completely known,
and newly identified tools include a special forceps for applying caustics.
Bas Relief Fragment, 4th Century CE,
Athens, National Museum
Occasionally instruments not originally manufactured for
surgical purposes were implemented. Galen and Celsus
both mention that the strigil, a curved piece of metal with
a handle used for scraping oil and sweat off the body
after exercise, was often used to get into small openings.
This fragment
shows a doctor
performing an
operation on a
patient's head
while Asclepius
(identifiable by his
superhuman size
and the caduceus
Galen says, “After having heated the fat of a squirrel in a
strigil, insert it into the auditory canal” (Galen, XII, 623).
Surgery was refined as long as the patient had
courage and the doctor had good tools and
experience. The patient’s chances increased if the
head and abdomen were not involved. A cursory
reading of Celsus’ summary of surgical techniques
as they existed in the first century shows a sure
knowledge of human anatomy.
in his right hand) looks on.
Stele from
Herculaneu
Archaeological remains of what appear to be surgeon’s
m, 1st
shops are common enough to indicate physicians
specialized in surgery. Particularly famous is the soCentury
called House of the Surgeon at Pompeii, where most of
BCE
the surgical tools now housed in Naples were found.
Philological evidence seems to support the idea that
there was at least some distinction, even if not a rigid
Surgeon
one, between general practitioner and surgeon.
excising an
Medieval texts distinguish the two positions with
different terms: medicus for a doctor, and magister for arrow from a wounded soldier Both men are
a surgeon.
depicted nude, suggesting that the episode
stems from a mythic tale.
The Romans enlarged upon the variety of instruments available for surgery, and Galen wrote
detailed instructions on their use. The makers of medical instruments are at best shadowy
figures. The well-known relief pictured below is one of the few archaeological finds which helps
clarify the situation. It suggests that some medical instruments were manufactured by specialist
blade makers rather than by craftsmen who specialized in medical instruments. It seems
improbable that there would have been sufficient demand for craftsmen dealing exclusively in
medical instruments and there is as yet no known inscription naming such a specialist. In the
larger cities of the Roman empire, physicians would probably have found craftsmen who could
provide the broad range of medical equipment.
Trajan's column, Rome, dedicated
113 CE: Soldiers aiding their
Before Hellenistic influence, the Roman legion did not contain
wounded comrades
any medical services. The common practice among professional
generals of the Hellenistic world was to campaign in the company
of a personal physician. Literary sources leave us with the distinct
impression that the wounded treated by the physicians present in
the army were of the higher ranks, and there is little indication
that the common soldiers had access to medical care. Instead,
some troops functioned as medical staff as the need arose. It is to
the Romans’ credit that they recognized the need for such a
service, but the solution was not a medical corps whereby trained
physicians became part of the army. The Romans clearly
distinguished between the treatment of the “sick” and the
“wounded”. The wounded were cared for, as far as possible, by
fellow soldiers on the fields, and the transportable sick were
placed in ualetudinaria (hospitals) along with the severely
wounded.
The medici (doctors) treating the wounded on Trajan’s
Trajan's column commemorated
column are dressing superficial wounds and their uniforms
the emperor Trajan's Dacian Wars
are identical with that of the soldiers they are aiding.
which were fought at the
Trajan’s column would thus bear out the general picture: the beginning of the second century
CE. This scene illustrates the
medici were those soldiers of a legion or of an auxiliary
detachment who had demonstrated their capabilities for
treatment of the wounded under
wound dressing and a primitive surgery, but who were not
battlefield conditions. Note that
themselves trained physicians.
the uniforms of the medics
rendering aid do not differ from
those of the regular soldiers.
The Roman poet Virgil (70-19 BCE) composed an epic poem, titled the
Aeneid, about the events leading up to the foundation of Rome. It follows
Wall painting from Casa di
the adventures of the Trojan hero Aeneas who was forced to do battle
Sirico, Pompeii, 1st Century with the native inhabitants of Italy upon immigrating there from Troy. In
one of the climactic scenes at the poem’s conclusion (Aeneid XII.383BCE: Aeneas receiving
440), Aeneas is wounded in the thigh by an arrow shaft hurled by an
anonymous soldier in the enemy camp. After the wounded Aeneas is
medical attention from
helped back to camp, the surgeon Iapyx comes to Aeneas’ aid by using
Iapyx
forceps to remove the arrow. Since the surgeon is unable to withdraw the
shaft, Venus, Aeneas’ divine mother, intervenes. From across the
Mediterranean at Mt. Ida near Troy, she brings dittany, an unknown herb
to heal the wound. Cicero, in the philosophical treatise De Divinatione,
says that dittany was supposed to make arrows fall out of goats’ bodies.
Although he was unable to help Aeneas, Iapyx was given his skill by
Apollo himself to practice ingloriously the “silent arts”, i.e., medicine.
Apollo’s three realms are music, prophecy and healing. Only in the first
two is the voice used, hence medicine is the silent art. The idea of
obscurity is included because the profession of medicine does not lead to
great fame.
A wounded Aeneas is
carried off the battlefield
and taken to the physician
to remove the dart from his
thigh with forceps.
Drawing of Attic Black Figured Vase, 6th Century BCE, National Museum
Athens: Sthenelos bandaging Diomedes' index finger
The episode portrayed here is not mentioned in any extant saga of the
Trojan War. In the Hippocratic treatise In the Surgery, the author states
bluntly that "he who desires to practice surgery must go to war."
If the work of Hippocrates can be taken as representing the foundation of Greek medicine, then
the work of Galen, who lived six centuries later, is the apex of that tradition. Galen crystallised
all the best work of the Greek medical schools which had preceded his own time. It is essentially
in the form of Galenism that Greek medicine was transmitted to the Renaissance scholars.
Woodcut illustration from a Venetian edition of Galen's
Galen hailed from Pergamon, an ancient
center of civilization, containing, among
other cultural institutions, a library second
works, 1550
Collection Bertarelli, Milan Medicatrina, Clinic Scene
(above) This illustration accompanying Galen’s work
shows the surgical procedures described by Galen--on
the head, eye, leg, mouth, bladder and genitals--still
practiced in the 16th century.
in importance only to Alexandria itself.
Galen’s training was eclectic and although
his chief work was in biology and
medicine, he was also known as a
philosopher and philologist. Training in
philosophy is, in Galen’s view, not merely
a pleasant addition to, but an essential part
of the training of a doctor. His treatise
entitled That the best Doctor is also a
Philosopher gives to us a rather surprising
ethical reason for the doctor to study
philosophy. The profit motive, says Galen,
is incompatible with a serious devotion to
the art. The doctor must learn to despise
money. Galen frequently accuses his
colleagues of avarice and it is to defend
the profession against this charge that he
plays down the motive of financial gain in
becoming a doctor. Galen’s first
professional appointment was as surgeon
to the gladiators in Pergamon. In his tenure
as surgeon he undoubtedly gained much
experience and practical knowledge in
anatomy from the combat wounds he was
compelled to treat. After four years he
immigrated to Rome where he attained a
brilliant reputation as a practitioner and a
public demonstrator of anatomy. Among
his patients were the emperors Marcus
Aurelius, Lucius Verus, Commodus and
Septimius Severus.
GALENISM
Galen, for all his mistakes, remained the unchallenged authority for
over a thousand years. After he died in 203 CE, serious anatomical and
physiological research ground to a halt, because everything there was
to be said on the subject had been said by Galen, who, it is reported,
kept at least 20 scribes on staff to write down his every dictum.
Although he was not a Christian, Galen’s writings reflect a belief in
only one god, and he declared that the body was an instrument of the
soul. This made him most acceptable to the fathers of the church and to
Arab and Hebrew scholars. Galen’s mistakes perpetuated fundamental
errors for nearly fifteen hundred years until Vesalius, the sixteenth
century anatomist, although he regarded his predecessor with esteem,
began to dispel Galen’s authority.
Postage Stamp, 1977
People's Democratic Republic of
Yemen. A testament to Galen's
lasting influence.
GALEN ON THE SOUL
The fundamental principle of life, in Galenic physiology, was pneuma (air, breath), which took three
forms and had three types of action: animal spirit (pneuma physicon) in the brain, center of sensory
perceptions and movement; vital spirit (pneuma zoticon) centering on the heart regulated flow of blood
and body temperature; natural spirit (pneuma physicon) residing in the liver, center of nutrition and
metabolism. Galen studied the anatomy of the respiratory system, and of the heart, arteries and veins. But
he did not discover the circulation of the blood throughout the body, and believed that blood passed from
one side of the heart to the other through invisible pores in the dividing wall. Galen was convinced that
the venous and arterial systems were each sealed and separate from each other. William Harvey,
discoverer of the circulation of the blood, wondered how Galen, having got so close to the answer, did not
himself arrive at the concept of the circulation.
Manuscript Illustration from an edition of the works of
Galen, Lyons, 1528
National Library of Medicine, Bethesda Hippocrates, Galen and
Avicenna As Galen looked back to Hippocrates as his authority,
Avicenna looked to Galen.
GALEN’S PHYSIOLOGY
Galen’s genius was evident in experiments conducted on animals for physiological purposes. The work
On the use of the parts of the human body comprised seventeen books concerned with this topic. To study
the function of the kidneys in producing urine, he tied the ureters and observed the swelling of the
kidneys. To study the function of the nerves he cut them, and thereby showed paralysis of the shoulder
muscles after division of nerves in the neck and loss of voice after interruption of the recurrent laryngeal
nerve. Because his knowledge was derived for the most part from animal (principally the Barbary ape)
rather than human dissection, Galen made many mistakes, especially concerning the internal organs. For
example, he incorrectly assumed that the rete mirabile, a plexus of blood vessels at the base of the brain of
ungulate animals, was also present in humans. In spite of Galen’s mistakes and misconceptions, the
wealth of accurate detail in his writings is astonishing.
Although the Greeks created rational medicine, their work was not always or even fully scientific
in the modern sense of the term. Like other Greek pioneers of science, the doctors were prone
to think that much more could be discovered by mere reflection and argument than by practice
and experiment. For in their time there was not yet a distinction between philosophy and
science, including medicine. Hippocrates was the first to separate medicine from philosophy and
disprove the idea that disease was a punishment for sin. Much of the traditional treatment for
injuries and ailments practiced by the Greeks stemmed from folk medicine, a characteristic
shared by the Greeks with other societies to this day.
Folk medicine uses the knowledge of herbs
and accessible drugs, which humans have
collected piece by piece through the ages to
cure everything from toothaches to infertility.
Stray references in Greek literature give us a
better understanding of folk medicine and
magic in Greek society. In Sophocles’ tragedy
Philoctetes, the hero Philoctetes treats a
snakebite on his foot using an unspecified herb
as a palliative. Elsewhere, the practice of
singing incantations over wounds is mentioned
in Homer’s Odyssey. Odysseus, wounded in
his youth at a boar hunt, is said to have been
skillfully bandaged by the sons of Autolycus,
who stopped the bleeding with incantations
(Odyssey XIX, 455-458).
Red Figure, Attic Vase, 490 BCE Philoctetes
bitten by a snake on Lemnos
While en route to Troy with the
Greek army, the hero
Philocteteswas bitten by a
snake as he participated in a
sacrifice to a minor deity
named Chrse. The wound produced by the
snakebite was so malodorous and caused
Philoctetes to utter such inauspicious cries that
his comrades marooned him on the island of
Lemnos for the duration of the war. Philoctetes
treated his wound with unspecified herbs until
he was finally rescued from Lemnos and cured
by the military doctors at Troy.
One of Hippocrates’ predecessors was Alcmaeon of Croton who operated on the eye and
discovered ‘passages’ linking the sense organs to the brain, which he recognized as the seat of
thought and feeling (followed by Plato but not Aristotle). Alcmaeon was probably the first
physician to formulate the doctrine of health as a balance among the powers of the body, these
powers being constituent fluids with definite qualities and causal properties.
Health was isonome, “equality before the law”, among
these fluids, and illness monarche, the dominance of one
of them. This conception was taken from the observed
century BCE: East Greek Tombstone of a
struggle of factions in politics. Among the many qualities
that needed to be held in balance were heat and cold,
Doctor
moisture and dryness, bitterness and sweetness. This
doctrine was later parlayed by Hippocrates into the
Fragment of a grave stele, Ionian, 5th
Theory of the Four Humors, which provided the basis for
medical theory up until the time of the American
Revolution.
The philosophers/physicians Empedocles and
Anaxagoras were contemporaries of Alcmaeon. Like
other scientists of their day, they inquired about
such quasi-medical topics as the composition of
matter (is the primary element earth, fire or water?),
the seat of the human soul (some believed it to be
the heart, some the liver and still others the
This tombstone is identifable as belonging diaphragm), and the procreative process of humans
to a doctor by the two small cupping
(most held that the male sperm was exclusively
vessels which appear at the top of the
responsible for conception). Modern scientists have
stele. Because the marker is damaged, we grappled with these same problems with only
cannot know whether the figure standing at slightly more success than did the Greeks. We know
right was a patient or assistant.
that atoms constitute matter and that atoms are
further divided into protons, and protons into quarks;
but what smaller constituents await discovery? The
fact that 2,500 years later we are still asking some
of the same questions posed by the Greeks brings
to mind the phrase nihil sub sole novi, that is, “there
is nothing new under the sun” (Eccl.i.9). For every
question we may posit, the Greeks have surely
asked and answered it.
A cursory survey of medical thought and practice throughout antiquity makes apparent two
underlying themes. Throughout antiquity and into the Middle Ages
there was a nexus between medicine and philosophy. Scientists
in the ancient world often were philosophers as well as physicians
and the distinction between the two fields was often blurred. At its
inception in the sixth century BCE, ancient medicine was a mere
branch of natural philosophy. Even in Late Antiquity, when the
philosopher/physician Galen reigned supreme, philosophy was
considered a necessary part of medical training. Unlike
philosophy and medicine, which worked in harmony, the tension between medicine and religious
belief often stifled or impeded physiological research. Throughout antiquity, rational medicine
and faith healing existed side by side, never fully divorcing themselves from one another Roman
medicine especially was an eclectic blend of rational Hellenistic medicine, folk remedies and
religious cult practice. Like so many other aspects of antiquity, medicine was truly
interdisciplinary, influencing and in turn being influenced by art, literature, philosophy, politics
and in no small way, religion.
Greek Manuscript 2144, f
We pass from myth to the opening of history. The central historical
figure in Greek medicine is Hippocrates. The events of his life are
shrouded in uncertainty, yet tales of his ingenuity, patriotism and
compassion made him a legend. He provided an example of the ideal
physician after which others centuries after him patterned their
existence.
10v c. 1342 Bibliotheque
Nationale, Paris
He was associated with the Asclepium of Cos, an island off the
coast of Asia Minor, near Rhodes and with a group of medical
treatises known collectively as the Hippocratic Corpus. Celsus
says: “Hippocrates Cous primus quidem ex omnibus memoria
dignis ab studio sapientiae disciplinam hanc separavit.” He
means that Hippocrates first gave the physician an independent
standing, separating him from the cosmological speculator, or
nature philosopher. Hippocrates confined the medical man to
medicine. At the same time that he assigned the physician his
The father of medicine as
post, Hippocrates would not let him regard the post as
envisioned by a Byzantine
sacrosanct. He set his face against any tendency toward
artist. Portraits of
sacerdotalism. He was also opposed to the spirit of trade-
Hippocrates represent the
unionism in medicine. His concern was rather with the physician’s
physician with a noble face
duties than his “rights”. Hence the greatest legacy of Hippocrates:
and impressive body to
the Hippocratic Oath.
match his intellectual
attributes. Various dignified
ancient busts have been
said to represent
Hippocrates, yet no original
Greek portraits have
survived; hence, our
evidence comes from
Roman copies.
THE HIPPOCRATIC OATH
The so-called Hippocratic Oath was unquestionably the exemplar for medical etiquette for centuries, and
it endures in modified form to this day. Yet uncertainty still prevails concerning the date the oath was
composed, the purpose for which it was intended, and the historical forces which shaped the document.
The date of composition in modern debate varies from the sixth century BCE to the fourth century CE. In
antiquity it was generally not considered a violation of medical ethics to do what the Oath forbade. An
ancient doctor who accepted the rules laid down by "Hippocrates" was by no means in agreement with the
opinion of all his fellow physicians; on the contrary, he adhered to a dogma which was much stricter than
that embraced by many, if not by most, of his colleagues.
I swear by Apollo the Physician and Asclepius and Hygeia and Panaceia and all the gods and
goddesses, making them my witnesses, that I will fulfill according to my ability and judgment this
oath and this covenant: To hold him who has taught me this art as equal to my parent and to live
my life in partnership with him, and if he is in need of money to give him a share of mine, and to
regard his offspring as equal to my brothers in male lineage and to teach them this art--if they
desire to learn it--without fee and covenant; to give share of precepts and oral instruction and all
other learning to my sons and to the sons of him who has instructed me and to pupils who have
signed the covenant and have taken an oath according to the medical law, but to no one else. I
will apply dietetic measure for the benefit of the sick according to my ability and judgment; I will
keep them from harm and injustice. I will neither give a deadly drug to anybody if asked for it,
nor will I make a suggestion to this effect. Similarly I will not give a woman an abortive remedy.
In purity and in holiness I will guard my life and my art. I will not use the knife, not even on
sufferers from stone, but will withdraw in favor of such men as are engaged in this work.
Whatever houses I may visit, I will come for the benefit of the sick, remaining free of all
intentional injustice, of all mischief and in particular of sexual relations with both female and
male persons, be they free or slaves. What I may see or hear in the course of the treatment or
even outside of the treatment in regard to the life of men, which on no account one must spread
abroad, I will keep to myself holding such things shameful to be spoken about. If I fulfill this oath
and do not violate it, may it be granted to me to enjoy life and art, being honored with fame
among all men for all time to come; if I transgress it and swear falsely, may the opposite be my
lot.
--Translated by Ludwig Edelstein
The organization of the Hippocratic Oath is clearly bipartite. The first half specifies the duties of
the pupil toward his teacher and his obligations in transmitting medical knowledge; the second
half gives a short summary of medical ethics. It is the second half, the ethical half, which is
inconsistent with the principles and practices of Hippocrates, thus the manifesto was incorrectly
attributed to him.
One immediate inconsistency is the Oath’s prohibition against abortion. The Hippocratic Corpus
contains a number of allusions to the methods of abortion and the use of pessaries. Apparently
the prohibitions found within the Oath did not echo the general feeling of the public. Abortion
was practiced in Greek times no less than in the Roman era, and it was resorted to without
scruple. In a world in which it was held justifiable to expose children immediately after birth, it
would hardly seem objectionable to destroy the embryo.
A second discrepancy between the Oath and general Hippocratic principles is the ban on
suicide. Suicide was not censured in antiquity. Self-murder as a relief from illness was regarded
as justifiable, so much so that in some states it was an institution duly legalized by the
authorities. Nor did ancient religion proscribe suicide. It did not know of any eternal punishment
for those who had ended their own lives. Law and religion then left the physician free to do
whatever seemed best to him.
Pythagoreanism is the only philosophical dogma that can possibly account for the attitude
advocated in the Hippocratic Oath. Among all the Greek philosophical schools, the
Pythagoreans alone outlawed suicide and abortion and did so without qualification. The Oath
also concurs with Pythagorean prohibitions against surgical procedures of all kinds and against
the shedding of blood, in which the soul was thought to reside. The interdiction in the Oath
against the knife is especially out of keeping with the several treatises that deal at length with
surgical techniques and operating room procedures.
It is little wonder that this Oath, although a non-Hippocratic document, has remained steadfastly
the symbol of the physician’s pledge. The prohibition against abortion and suicide were (and
remain) in consonance with the principles of the Christian Church. The earliest reference to this
Oath is in the first century CE, and it may have been appropriated soon after to fit the religious
ideals of the time. The substitution of God, Christ and the saints for the names of Asclepius and
his family is easy enough. It is ironic that the Hippocratic Oath in its present form with its
religious subtext is associated with Hippocrates, the man who first separated medicine from
religion and disease from supernatural explanations.
SURGICAL INSTRUMENTS
The “knotty limb” pattern appearing fairly frequently on surgical instruments resembles the limb or trunk
of a tree. It could be used as a criterion for identifying tools as surgical. It is linked to representations of
Asclepius and in particular, Hercules, which can also be found on the handles of instruments in apotropaic
(i.e., warding off evil forces) fashion. Some scholars claim that the motif is limited to instruments
particularly liable to cause pain. Yet it is more likely that, given the widespread worship of Hercules in
the Roman world, the Hercules motif was adopted by the mainly Greek physicians in order to please their
Roman clients.
THE PHYSICIAN AT WORK
Red figure, Attic Cup, c. 490 BCE
Illustrations of physicians at work are rare in Greek art.
This scene, on the inside of a dish dating about 490 BCE,
depicting Achilles binding a wound on Patroklos’ arm,
exemplifies two apparent aspects of the prevalent
formality in patient treatment: a prescribed kneeling
position for particular tasks and an overall calmness of
manner. Although the episode portrayed here belongs to
the mythical Trojan cycle, it is unknown to the extant
literature. Ancient mythographers do tell us, however, that
Achilles was trained in medicine by Chiron the centaursage. Although Achilles was invincible in battle, he is
shown here as an inept medic. He is attempting to make a
criss-cross tourniquet which will be at once comfortable
and capable of staunching the wound. However, his
technique is unsuccessful. To judge from Patroklos’
wince, the tourniquet is painful and inexpertly applied
because the two ends will not meet. His work will have to
be unraveled and redone.
THE ORIGINS OF THE MEDICAL CADUCEUS
Snakes are familiar symbols of healing to modern medical personnel because of their
presence on the medical caduceus. The medical caduceus has its origins in WWII, when
medics used it as a symbol for a flag of truce. But its association with medicine goes back
even further than that to ancient Greece where the snake entwined upon a walking staff
Detail,
was one of the accoutrements of the healer-god Asclepius. The Asclepian staff has often
been confused with the caduceus, the herald’s wand used by Hermes. Both were probably Pompeiian
symbols of truce in war-time, but the Asclepian staff entwined by only one snake is
wall painting,
regarded by Classicists as the true symbol of the profession.
first century
BCE
Roman Marble
Statue, 1st Century
The snake has been a symbol of healing since prehistoric times. It was
associated with regeneration (due to the easily observable phenomena of it
shedding its skin) and hence of cure itself. The god Asclepius, shown at left,
often appears accompanied by one or more serpents because they were used in
the healing rites at his temples. Snakes were used not only as part of the
Asklepiad cult in Greece, but also in Italy as part of the private worship within
families. Each household contained a shrine, or lararium, where offerings to
the familial ancestors were placed.
These ancestors, or Lares, were thought to assume the form of snakes, and
they were given credit for the family’s health and prosperity. The detail shown
here is from a lararium uncovered in a Pompeiian household. The god
Bacchus, morphed into a cluster of grapes, is shown pouring a libation to the
household gods and a large serpent is shown receiving the offering of cakes
placed on a small altar.
CE
________________________________________________________________
Source 2
Pliny, in his Natural History, says that the first doctor (medicus) to come to Rome was
Arcagathus, who arrived from the Greek Peloponnese in 219 BCE and was well received.
Arcagathus was accorded the rights of citizenship and a medical shop was set up at state
expense for his use. Prior to this time, Rome had no physicians and only home remedies were
used. Because Arcagathus was an expert wound surgeon (uulnerarius), he immediately became
popular; however his popularity did not last. His vigorous use of the knife and cautery soon
earned him the title “Executioner” (Carnifex). From there it was downhill for the medical cause in
Rome. Over 100 years lapsed before we hear that another Greek physician (Asclepiades of
Bithynia, ca. 100 BCE) had taken up residence in Rome.
Reverse of a bronze medallion of Antoninus Pius (138161 CE), Rome
Tiber welcomes Asclepius in the form of a snake. In
295 BCE a plague ravaged Rome and the Romans
decided to recruit the services of the Greek god of
medicine. No doubt the Romans had heard of the
success of the medical shrines in the Hellenistic world
and hoped some of this power might be transferred to
Rome. A temple to Ascelpius was built on the island in
the Tiber, not inside Rome, and this was a reflection of
the Roman official suspicion of foreign gods. The
pestilence soon went away and the popularity of the
Before the arrival of Arcagathus, early
Roman medicine was agriculturally
based, having its spirit derived from the
farm. Early authors of agricultural
treatises, such as Cato the Elder and
Columella, both from the early second
century BCE, had as much to say about
medicine, or home remedies, as they had
to say about growing seasons, animal
husbandry and slave discipline. In Cato’s
time, the pater familias, or head of the
family, was the dispenser of remedies to
his household because his knowledge of
the farm and its needs qualified him to
deal with matters of health.
Characteristic of early Roman medicine
was a reliance upon one or two remedies.
According to Pliny, the “early Romans
gave wool awesome powers”, confirming
the religious-agricultural context of early
remedies. Unwashed wool, according to
the early traditions, dipped into a mixture
of pounded rue and fat, was good for
bruises and swellings. Rams’ wool,
washed in cold water and soaked in oil,
was used to soothe uterine
inflammations. Wool dipped into a
mixture of oil, sulphur, vinegar, pitch
and soda cured lumbago. Yet for all its
uses, for Cato at least, wool was not the
cure-all that cabbage was. Cato
advocated not only the consumption of
cabbage itself to fend off illness, but the
new cult was assured. The introduction of Asclepius is
the first event of “medical history” in Rome.
consumption of the urine of a person
who has eaten cabbage.
Some of Cato’s cures were applicable to humans as well as to the livestock on the farm:
“If you have reason to fear sickness, give the patient/oxen before they get sick the following
remedy: 3 grains of salt, 3 laurel leaves, 3 leek leaves, 3 spikes of leek, 3 of garlic, 3 grains of
incense, 3 plants of Sabine herb, 3 leaves of rue, 3 stalks of bryony, 3 white beans, 3 live coals,
and 3 pints of wine. You must gather, macerate, and administer all these things while standing,
and he who administers the remedy must be fasting. Administer to each ox or to the patient for
three days, and divide it in such a way that when you have administered three doses to each,
you have used it all. See to it that the patient and the one who administers are both standing,
and use a wooden vessel.”
Magical connotation is clear from the continual use of three of each ingredient. The greater part
of this remedy consists of foodstuffs from the pantry. Possibly the standing position is a remnant
of psychological factors pointing to an earlier time of medicine man or shaman. The insistence
upon a wooden bowl shows this recipe to be an ancient one.
The Romans inherited some of their ideas of anatomy and medicine from their Etruscan
ancestors and adapted them to the practice of the official state religion, specifically in the
practice of hepatoscopy, or reading the divine signals in animal livers. Models of bronze livers
which were used by priests to interpret omens within the liver have been unearthed in Etruria.
Hepatoscopy had its origins in Near Eastern practice and was not performed by anyone except
state-appointed priests.
Thus Roman medicine can be divided into three distinct areas: (1) the “practical” medicine of the
pater familias, that is, home remedies based upon an agricultural context; (2) the state religion
as handed down from the Etruscans; and (3) the private practitioner using Greek medical
principles.
The opposition of Cato the Elder and other traditionalists to the introduction of Greek medicine
in Rome by Arcagathus was the result of several factors: political strife in the Roman nobility,
hostility against Greek culture, fear of Arcagathus’ surgical and pharmaceutical treatments and
loathing for the mercenary character of the medical profession, which was regarded as a sign of
luxury. In Cato’s day, that is the period following the Second Punic War in the early second
century BCE, sumptuary laws were passed to combat conspicuous consumption. The
introduction of Greek doctors into the households of the Roman nobility was seen as a
degenerative sign of the Romans succumbing to Greek culture and practices.
Horace said “Graecia capta ferum victorem cepit”. He understood that political domination, the
occupation of territory by armies, does not necessarily mean real conquest. Horace’s statement
applied to medicine as to other branches of culture.
_______________________________________________________________
Source 3
syllabus
The History of Ancient Medicine Some links to useful materials Professor
NH Demand e-mail: [email protected]. Notice: This material ...
www.indiana.edu/~ancmed/syllabus.HTM - 7k - Cached - Similar pages
HIPPOCRATIC USE OF DRUGS
(Translations are from the Loeb Hippocrates series)
There is no book devoted solely to pharmacology in the Hippocratic Corpus, and few of the
treatises provide directions for treatment. The books dealing with general medicine that do
discuss treatment rely generally on diet as a therapy; in those that do specify other treatment,
these seem to develop out of, and to be used in conjunction with, dietary measures.
In fact, the author of Ancient Medicine attributes the discovery of medicine to experiments in
treating natural products to make them more suitable for human consumption, by "steeping,
winnowing, grinding and sifting, kneading, baking ... combining the weaker components so as to
adapt all to the constitution and power of man." (III, tr. W.H.S.Jones) Regimen in Acute
Diseases gives detailed instructions for various forms and uses of gruel (which, despite its
innocuous sound, also has its dangers -- the doctor warns that untimely use of gruel without first
purging the patient, or use of unstrained gruel, can be fatal) (XVI, XVII)
Hippocratic treatment was based upon the principle that all foods have properties that react on
the body. Some cool, others heat, some are soothing, and some offer dramatic evidence for
their "effectiveness" (purges, emetics). For example, Diseases III, 17 gives numerous recipes
for ardent fever, first advising: "...they have many effects, some are diuretic, others laxative,
others both, and others neither, merely cooling as if some one were to pour cold water over a
vessel of boiling water, or were to move the vessel itself into the cold air. Give different ones to
different patients, for the sweet ones do not benefit everyone, nor do the astringent ones, nor
are all patients able to drink the same things." (tr. Paul Potter)
In most cases, drugs, when they appear, are mingled with dietary suggestions, and it seem that
the Hippocratic doctor saw little distinction, since all have properties and effects on the body.
Thus Internal Affections 1 suggests, "...give him for breakfast fine cereals and main dishes of
the heartiest kinds, have him drink the same wine. Also, give him roots effective against tears:
grate centaury over wine; grate dragon arum [shavings] over wine, too, and give it. For the
cough, grate dragon arum into honey, and give this to the patient to take." (tr. Paul Potter) In
Epidemics VII.80 a fever is said to have come down from "the drink made from coarse barley
meal, sometimes from apple and pomegranate juice and juice from toasted lentils, cold." (tr.
Wesley Smith) In the recipe given in Internal Affections 6, only silphium juice (because of its
rarity) would probably not qualify as an everyday nutrient: "...early in the morning let the patient
drink in the fasting state silphium juice, to the amount of a vetch, in melicrat or in wine and
honey, eat garlic and radishes, and on top of that take dry white or dark wine unmixed with
water; let him again take these things with his meal and after it." (tr. Paul Potter)
On the other hand, a few books are more therapeutically oriented. For example, Diseases III
prescribes a number of non-foods as expectorants, including, "...equal amounts of white
hellebore, thapsia, and fresh squirting-cucumber juice....Alternatively... give a cheramys each of
cuckoo-pint, dauke and stinging nettle, good pinches of mustard and rue, and silphium joice in
the amount of a bean; mix these in sweetened vineagar and water, sieve, and give warm to the
fasting patient." (tr. Paul Potter)
Uses of these plants from The Pla nt Tracker: link

White hellebore, one of two hellebore plants, probably unrelated: "analgesic, anthelmintic,
cathartic, emetic, errhine, expectorant, hypnotic and sternutatory. The root is very poisonous, with
a paralyzing effect on the nervous system, and is scarcely if ever used internally."

Thapsia, deadly carrot: diuretic, emetic and purgative; strongly rubefacient, producing blisters and
intense itching.

Squirting-cucumber: juice is antirheumatic, cardiac, purgative; used in treatment of oedema
associated with kidney complaints, heart problems, rheumatism, paralysis and shingles. Excessive
doses can cause gastroenteritis and even death. Abortifacient.

Cuckoo-pint, Arum maculatum: Root and leaves edible when dried or cooked. Medicinal uses:
root is diaphoretic, expectorant, vermifuge.

Dauke, wild carrot: "an aromatic herb that acts as a diuretic, soothes the digestive tract and
stimulates the uterus. The whole plant is anthelmintic, carminative, deobstruent, diuretic,
galactogogus, ophthalmic, stimulant.... The root is also used to encourage delayed menstruation. It
can induce uterine contractions and so should not be used by pregnant women."

Stinging nettle: "A tea made from the leaves has traditionally been used as a tonic and blood
purifier. The whole plant is antiasthmatic, antidandruff, astringent, depurative, diuretic,
galactogogue, haemostatic, hypoglycaemic and a stimulating tonic. An infusion of the plant is
very valuable in stemming internal bleeding. It is also used to treat anaemia, excessive
menstruation, haemorrhoids, arthritis, rheumatism and skin complaints, especially eczema.
Externally, the plant is used to treat arthritic pain, gout, sciatica, neuralgia, haemorrhoids, hair
problems, etc."

Mustard: "The seed is antibacterial, antifungal, appetizer, carminative, diaphoretic, digestive,
diuretic, emetic, expectorant, rubefacient and stimulant....cathartic.... seldom used internally as a
medicine. Externally it is usually made into mustard plasters (using the ground seed), poultices or
added to the bath water."

Rue: "especially valued for its strengthening action on the eyes. The plant contains flavonoids
(notably rutin) that reduce capillary fragility, which might explain the plants reputation as an eye
strengthener. Some caution is advised in its use internally, however, since in large doses it is toxic
and it can also cause miscarriages. The whole herb is abortifacient, anthelmintic, antidote,
antispasmodic, carminative, emetic, emmenagogue, expectorant, haemostatic, ophthalmic,
rubefacient, strongly stimulant, mildly stomachic and uterotonic."

Silphium: a giant fennel (Ferula), now extinct, prized in antiquity as a condiment and cathartic.
The more pharmaceutically-oriented books include the two major gynaecological works, Diseases of
Women, and On the Nature of Women. These include many recipes for remedies, which may be written
records of previously orally transmitted folklore, much of it passed along by women in their treatment of
illnesses in the household, and focussed especially on women's concerns. Control of the menses was
obviously of importance, since the Greeks saw their blockage as presenting both a mortal threat to women
and a risk to their companions (sufferers might seek to strangle themselves or murderously attack others).
Therefore emenogogues (drugs to bring on the menses) were frequently prescribed. Many of these could
also have been used to speed a slow or inadequate labor, or to end an unwanted pregnancy. We often
cannot tell how they were intended to be used, but many such "multi-purpose" recipes appear in the
gynaeocological works. John Riddle has done much interesting research on the ingredients of these, many
of which -- rue, pennyroyal (one of the family of mints), pomegranate seeds, ivy, belladonna (a member
of the nightshade family) -- have properties that would have made them effective in the right dosages (and
possibly fatal otherwise).
A number of other members of the nightshade family, which we would classify clearly as drugs,
were used as well, about half the time for their narcotic effect. Opium makes 21 appearances in
the gynaecological treatises, mostly in drinks to be used for the Wandering Womb or other
uterine troubles.
Another characteristic of the gynaeocological treatises is their use of "excrement therapy."
Heinrich von Staden has drawn attention to the fact that ninety-nine percent of all references of
the use of such materials occur in the gynaecological works. He suggests that this constitutes
an element of Hippocratic continuity with ritual: "Here the Hippocratic healer of the womb
partially resembles those very 'purifiers' and magicians' whom the celebrated author of On
Sacred Disease excoriates." (von Staden, 20).
In conclusion, we can say, with the author of Affections 45, that Hippocratic therapy was, with
some notable exceptions, based on effects that were empirically determined and in harmony
with rationalized beliefs about the workings of the body and the causes of illness: "About
medications that are drunk or applied to wounds it is worth learning from everyone; for people
do not discover these by reasoning but by chance, and experts not more than laymen. But
whatever is discovered in medicine by reasoning, whether about foods or about medications,
you must learn from those that have discernment in the art, if you wish to learn anything." (tr.
Paul Potter)
Hippocratic Treatise On Fractures
By Hippocrates (ca. 400 B.C.E.)
Translated by Francis Adams
Part I In treating fractures and dislocations, the physician must take the extension as straight as
possible, for this is the most natural direction. But if it incline to either side, it should rather turn to that
of pronation, for there is thus less harm than if it be toward supination. Those, then, who act in such
cases without deliberation, for the most part do not fall into any great mistake, for the person who is to
have his arm bound, presents it in the proper position from necessity, but physicians who fancy
themselves learned in these matters, are they who commit blunders. There is no necessity of giving the
longer directions on this subject, because I know physicians who have the reputation of being skilled in
giving the proper position to the arm in binding it up, while in reality they are only showing their own
ignorance. But many other things in our art are judged of in this manner, for people rather admire
what is new, although they do not know whether it be proper or not, than what they are accustomed to,
and know already to be proper; and what is strange, they prefer to what is obvious. I must now state
what the mistakes of medical men are, which I wish to unteach, and what instructions I have to say
regarding it, will apply to the other bones of the body.
Part 21 The swellings which arise in the ham, at the foot, or in any other part from the pressure,
should be well wrapped in unscoured and carded wool, washed with wine and oil, and anointed with
cerate,