Medicine
Medicine
APICIUS’S RECIPE FOR CAULIFLOWER OR BROCCOLI IN CELERY MINT SAUCE
Diseases Then Unknown. Diseases were common in the ancient world, but, because medical practitioners of these times described symptoms rather than grouping diseases by classification, and because infectious disease-causing microorganisms alter through mutation, many diseases with which we are afflicted were not known or experienced. Some diseases of this period one cannot identify, probably because the organisms causing them mutated or the human immune system became invulnerable to their infections. Likely the Romans were not affected by smallpox, measles, diphtheria (although this malady was possibly described by Aretaeus of Cappadocia, circa 150-200 c.e., but osteological evidence for it is not found), scarlet fever, and influenza. Neither were they afflicted with the ravaging plagues of pandemic diseases, such as the notorious bubonic plague of 1347 c.e. or syphilis, introduced to Europe in the late fifteenth century. The greatest exception came with a plague that arrived in Rome in 170 c.e., supposedly spread by Roman troops transferred from the eastern frontier. Mortality rates were high, but data or even detailed descriptions are lacking. Modern scholars generate various hypotheses as to what type of disease it was—a microorganism ancestor to smallpox and typhus are two leading contenders—but no definitive answer has been forthcoming. Leprosy, identified in biblical and classical texts, is not the disease known in modern times by that name (the organism for which evolved during the Middle Ages). The ancients’ leprosy was elephantiasis in some cases, and other nonfatal skin afflictions as well. Helping to understand why the Romans had a less-restrictive attitude toward sexuality is the fact that they were not subject to potentially fatal venereal diseases. Certainly the Romans were inflicted with pneumonia (in various forms), cancer, typhus, gout (although a cluster of afflictions passed under its name, podagra), tuberculosis, pinta, yaws (the microorganism of which eventually evolved into the one causing endemic syphilis), and malaria, the latter being prevalent. Indeed, one theory for the fall of the Roman Empire was the sustained, corrosive effects of malaria as it sapped lives and energies, especially in the Mediterranean areas. Additionally they had many degenerative chest, skin, and eye diseases. Nothing that we know about ancient Roman medicine indicates that their physicians could have intervened to the extent of curing most major diseases. In those cases, the most that they did was to provide symptomatic relief and comfort.
Medical Knowledge. Two features characterize early Roman medicine: the ideal of the head of the family (paterfamilias) having sufficient medical knowledge to treat his family, slaves, and clients; and the handbook tradition of summarizing empirical cures for written transmission to supplement oral lore. Knowledge passed from father to son, mother to daughter, and wise woman to young woman or man probably accounted for medical therapies that most Romans received, especially those living during the Republic. Supplementary medical knowledge derived from herbalists and other pharmaceutical vendors as they plied their wares. Beginning in the third century b.c.e., Greek physicians established medical practices in Rome and other Latin-speaking areas, and, with them, the face of Roman medicine was altered—not without protest, however, from conservative-minded Romans, such as Cato the Elder and Pliny the Elder. Part of the reason for the Romans’ negative reaction to Greek medicine might be attributed to the fact that early Greek physicians tended to be slaves or freedmen.
Ambivalence to Greek Medicine. Easily, Cato the Elder (234-149 b.c.e.) epitomizes Rome’s love/hate relationship with Greek medicine. On one hand, he warns his sons to beware the Greeks bearing medicine, and yet, in his handbook on agriculture he proudly displays his knowledge of theoretical medicine from Greek authorities. Pliny the Elder exhibited the same ambivalence. Caustically, Pliny charged that the physicians are the only people who can murder with impunity. Greek medicine had some advantages, Cato thought, but the father of a Roman family ought to have enough native intelligence together with experience with illnesses, injuries, and cures to be able to practice medicine effectively. Cato’s only surviving work, De agricultura (160 b.c.e.), contains some of the medical lore expected to be known by a Roman. The older Romans considered the maintenance of good health an individual responsibility. Echoing Cato, Marcus Terentius Varro (116-27 b.c.e.) gave practical advice on farming that included medical and nutritional lore. Varro’s work, De re rustica (37 b.c.e., three books), exemplified the Roman handbook tradition with respect to medicine.
APICIUS’S RECIPE FOR CAULIFLOWER OR BROCCOLI IN CELERY MINT SAUCE
(Adapted for the modern kitchen: t = teaspoon, equivalent to 6 Roman scruples; T = tablespoon, equivalent to 1 Roman cyathus):
1 cauliflower, cabbage, or
bunch of broccoliFirst Sauce:
1/4 t cumin
pinch of salt
2 T. white wine
1 T. olive oil
Take cauliflower, cabbage, or broccoli, quarter them, and put in a saucepan. For the first sauce, combine the cumin, salt, wine, olive oil, and enough water to steam the vegetables. Add the vegetables, bring to a boil, then simmer gently.
Second Sauce:
1/4 t, ground pepper
1/2 t. celery seed (or lovage)
1/2 t. mint
pinch of rosemary (or rue)
1/4 t. coriander
1/2 c. vegetable stock
2 T. white wine vinegar
1 T. olive oil or butter
Meanwhile, in a mortar, grind pepper, celery seed (or lovage), mint, rosemary (or rue) and coriander. Add to stock, vinegar, and olive oil or butter. Bring to a boil, then simmer to reduce for 25 minutes. Serve over the cooked strained vegetables.
Source: Apicius, The Roman Cookery of Apicius; A Treasury of Gourmet Recipes & Herbal Cookery, translated by John Edwards (Port Roberts, Wash.: Hartley & Marks, 1984).
Surgery. A procedure that ancient physicians considered the last resort, surgery was used only when regimen or drug therapy was deemed not to be effective. Most physicians practiced minor surgery, but, at least in populous areas, there were specialized surgeons—some of whom had reputations for certain procedures. Celsus, in a first century c.e. treatise on medicine, described the ideal surgeon. Surgical instruments found in archaeological sites have familiar functions, such as scalpels, forceps, hooks, and probes, designs similar to those used in modern surgeries. Anesthetics were not totally lacking, although patients must have experienced pain in many instances. Physicians employed plants containing atropine and hyoscyamine to reduce pain, and Dioscorides mentions the Memphis stone that surgeons employed so that
the patients would have no pain during operations. It is not known what that mineral was. Although powerful antiseptics were lacking, surgeons used plant resins to treat wounds and heal sutures, and these had mild antiseptic qualities.
The Humors. By the third century b.c.e. many physicians had adopted an evolving theory of medicine based on humors, or body fluids. Blood, phlegm, yellow bile, and black bile were believed to correspond respectively to the four elements of air, water, fire, and earth.
Schools of Medicine. Medical education in Rome, before and after Hellenistic influences, was achieved the same way as all the craftsmanship skills, namely, with master practitioners training young men as apprentices. A school of medicine, not as the familiar institution for medical education in the late medieval and modern worlds, was a group of like-minded people who shared common perspectives and theories. Despite some measure of agreement, not all physicians accepted the existence of four humors—some espousing the existence of more humors, some fewer, as well as disputing their relative importance. After the great medical researchers Herophilus and Erasistratos, Greek medicine broke up into competing, and often contentious, schools, beginning with the conflict between the Empiricists and the Dogmatists. Empiricists insisted that it was impossible for the physician to penetrate the mysteries of the body and, consequently, viewed each disease as a unique event. They based their therapies on empirical cures and, along the way, rejected anatomy as irrelevant to medical practice. Autopsies could not inform one about a live body, they argued, and, besides, dissections were disgusting. In contrast, the Dogmatists appealed to theory and reason, regarded rigorous study as necessary, especially in anatomy, and believed that ultimately diseases had causes that were ascertainable.
Methodists and Empiricists. Between these two poles of the Empiricists and the Dogmatists, other schools of medicine developed whose influence was felt in Rome and, presumably, throughout the empire. One such school was that of the Methodists, who, like the Empiricists, rejected causation and anatomy but embraced a theory that all illnesses were based on an imbalance of moisture. An affliction caused too great an increase in wetness or dryness, either generally throughout the body or in specific locations. The physician’s duty was to learn
the cause and restore the balance by the administration of diet and/or drugs, according to opposites. Thus, a drying drug would restore an excessively moist condition. Allegedly Thessalus, a leading Methodist, claimed that he could train a full-fledged physician in six months!
Pneumatist School. Athenaeus of Attaleia (dated variously in the first centuries b.c.e. or c.e.) founded another school, the Pneumatists, but, although influential, none of its early adherents’ works have survived. Closely associated with the Stoic school of philosophy, the Pneumatists postulated the existence of pneuma (literally, “breath”) that gave vital spirits to all forms of animal life. Medicine, as they regarded it, was an essential part of a liberal education. The Pneumatists influenced Roman medicine specifically by an emphasis on diet.
Asclepiadian School. Practicing in Rome for at least part of his career, Asclepiades of Prusias and Mare (first century b.c.e.) developed a corpuscular theory of physiology. He believed that the body functioned through its composition of tiny, fragile corpuscles that moved through ducts. When the free movement was halted through injury or disease, the blockages caused morbid elements. Asclepiades and his followers attempted to employ noninvasive therapies that opened these ducts. Diet, fasting, massage, exercise, and baths were preferred to drugs and were considered the first avenues of address. Drugs could be administered in critical afflictions, however, and surgery was rarely prescribed. Their theme was “To cure, safely, swiftly, and pleasantly.” Needless to say, the Asclepiadian school had some popularity among the Romans.
Cold Baths. A follower of Asclepiades, freedman Antonius Musa (flourishing 20s b.c.e.) achieved a celebrated reputation as a physician. He devised a cold-bath therapy that attained fame when he cured Augustus Caesar in 23 b.c.e. So successful was he with his cold hydrotherapy that he won not only a fortune but also immunity from taxation both for himself and his profession. He wrote on pharmacy, but his work does not survive.
Greatest Medical Authority. Interestingly, Rome’s greatest native writer on medicine in Latin may not have been a physician. A member of the famous Cornelian family, we know that Aulus Cornelius Celsus (flourishing 25 c.e.) wrote a large encyclopedia titled Artes and, as part of it, there were eight books on medicine. The only sections of the work surviving are the medical books. The technical skill with which he presented medicine causes modern scholars and physicians to believe that only a practitioner of medicine could have written with such clinical exactitude. Pointing to the fact that medical learning was expected of Senatorial and Equestrian class Romans, other scholars argue that, despite the sophisticated, practical erudition, Celsus’s work indicates the level of knowledge that at least one well-educated Roman had. Whatever their persuasion on this dispute, Celsus is generally regarded as the best general medical writer in Latin.
History of Medicine. The surviving section of his work is called De medicina (” On Medicine”). After a learned introduction, Celsus gave an extraordinarily valuable history of medicine, especially concerning the Greek Alexandrians, Herophilus and Erasistratus. He had an ambivalent attitude toward the Greeks, among whom “this art [of medicine] has been cultivated much more than in other nations.” In the introduction to his work, however, he asserted that even “the most uncivilized nations have had a knowledge of herbs, and other things to hand for the aiding of wounds and diseases” (1-2). After the introductory historical section, Celsus begins his summary of medicine with general dietetics and discusses pathology, general and special therapies, drugs, surgery, and bone diseases. The work is so well written that some scholars were led to claim that Celsus must have simply translated an unknown, lost work from Greek to Latin. Most scholars now agree that the work reflects no indications of having been a translation and that Celsus was an author of great literary and medical skills.
Greek Medical Writers. Even during the empire, if elite attitudes are indicated from surviving works, the Romans distrusted Greek medicine, and yet, the greatest medical writers of antiquity in terms of influence on later generations lived and practiced medicine in Greece. Most of what we know of Roman medicine comes through the writings of three such persons: Dioscorides, Soranus, and Galen.
Pharmacy. Nothing is distinctive about the actual drugs that the Romans employed. Generally, the Romans used many of the same drugs that were known by ancient Mediterranean peoples. The various plants, minerals, and animal products were much the same whether found in Greek or Latin texts. Indeed, most of the drugs are the same as those found in the various medical papyri of the ancient Egyptians, some of which date back to the New Kingdom, circa 3000 b.c.e., and various Sumerian, Akkadian, and Assyrian pharmaceutical tablets. Laxatives are one example. Most of the laxatives employed today are the same as those used for four thousand years. Among the drugs the Romans used were almond oil, aloes, ammoniacum, belladonna, calamine, calcium hydrate, castor oil, cherry syrup, cinnamon, copper oxide, coriander, galbanum, galls, ginger, St. John’s wort, juniper, lavender, lead acetate, marjoram, mastic, mercury, olive oil, opium, pepper, pine bark, storax, sulfur, terebinth, thyme, willow bark, and wormwood. Cato the Censor and Pliny the Elder both championed old-fashioned Roman home remedies in preference to the drugs of foreigners, especially Greeks, but in truth most of the drugs were herbs, and most of them were similarly used regardless of culture. The Romans employed drugs primarily to treat symptoms, and they had few drugs that truly were pathological cures. Occasionally new drugs or new uses for known drugs, were discovered. For example, sometime in the Roman period, likely during the Roman Empire, they discovered that the plant autumn crocus cured gout. This plant contains colchicine, the drug currently employed for gout. Colchicine functions to break the chemical chain reaction that leads to inflammation in joint tissue. Many of the drugs the Romans employed came from east Africa, India, and even Malaysia and China, thereby producing an unfavorable balance of trade and causing money to flow out of the empire. The only drug that East Asians imported from Rome was saffron, but soon the Indians and Chinese learned to cultivate it themselves, so it was no longer imported.
Standard Authority. The empirical science of taking certain drugs for specific maladies constituted most of pharmaceutical medicine until Pedanius Dioscorides of Anazarbus (flourishing 50-70 c.e.), a Greek physician, traveled widely in search of new drugs among various ethnic groups. Dioscorides was the author of a five-book work on pharmacy called Pêri hules iatrikes, or, in Latin, De materia medica. So thorough, precise, and authoritative was Dioscorides that his work remained the standard authority on pharmacy through the sixteenth century. While in a medical practice, his keen observational powers, diligence in scholarship, and critical faculties resulted in a study of around one thousand pharmaka, or drugs. Most of the drugs were from the plant kingdom, loosely called herbs, but two sections (part of book 4 and all of book 5) discuss drugs derived from the animal and mineral kingdoms, respectively. His method, as he explained it, was to read in the libraries what every authority had written on the subject of a particular drug, to observe the drug in its environment, in particular habitats and growing conditions, to inquire among the natives of each region where he traveled regarding their use and experiences with the drug, and, finally, to test the drugs himself in clinical trials. Only when a detail had received that level of attention did he have a “fact” to relate. In library research, Dioscorides names some twenty-seven authorities. Each chapter of his work is devoted to a single plant, although he would group related “kinds” or what we would call species or subspecies, within the same genera. He followed (or devised) a method for relating the material that would subsequently be adopted as the format for herbals: (1) picture; (2) name of plant, sometimes with synonyms; (3) botanical descriptions; (4) habitats; (5) drug properties or types of actions, such as “astringent”“drying” and “cooling”; (6) medicinal uses; (7) harmful side effects; (8) quantities and dosages; (9) harvesting, preparation, and storage instructions; (10) adulteration, methods, and tests for detection; and (11) veterinary uses. In his introductory letter, Dioscorides boasted that his work surpassed previous pharmaceutical writings because of his superior organization. He did not explain what his organizing scheme was; thus, it was left to readers to discern. The overall organization is apparent: book one, for example, begins with aromatic herbs, followed by oils, ointments, resins, shrubs, trees, and fruit trees; book two starts with animal drugs, first with specific animals and ending with animal products (such as milk, fats, and blood), then cereals, pot herbs, and sharp herbs. Within each category, however, there appears some order, fore-shadowing the modern scientific binomial classification scheme devised by the Swedish botanist Carolus Linnaeus in the eighteenth century. Dioscorides appeared to have classified plants by linking together related species within the same genus. At other times there are inconsistent interruptions in how the chapters are arranged. Recent scholarship discloses that Dioscorides was arranging his chapters by how the total medicinal uses related to other similar drugs, or, in other words, by drug affinities. This organization explains why there appears some botanical scheme, because related plants tend to have similar chemistries. Because Dioscorides’ scheme was little appreciated or understood by later imitators who otherwise followed his methods, his organizational genius had little subsequent influence.
Gynecology. During the period of the writings attributed to Hippocrates, circa 460-330 b.c.e., there were several gynecological works produced. They were written by men and were mostly compilations of midwife practices. During the Roman Empire, a writer on gynecology truly elevated the art of women’s medicine. In the words of Owsei Temkin, Soranus of Ephesus (flourishing early second century c.e.) was “one of the most learned, critical, and lucid authors of antiquity.” He wrote on many medical subjects, such as acute and chronic diseases, causes of diseases, medicaments, surgery, bandages, ophthalmology, and, more philosophically, on the soul. None of those works survived except for portions preserved in the texts of later writers. What survived was influential—a masterful treatise on gynecology, called Gynaecia, in four books. Details of his life are few: we know that he practiced in Rome during the reigns of Trajan and Hadrian and that he received some medical training in Alexandria. Indirect evidence indicates that he learned medicine also in Ephesus. Clearly he subscribed to the Methodist School, but he was not dogmatic in applying its theoretical constructs when he saw clinical evidence pointing elsewhere. Soranus used some theoretical constructs derived from the Alexandrian physiologists and anatomists as a basis for his observations.
Women’s Health. Book one defines the ideal midwife (sober, literate, displaying integrity, free from superstition, knowledgeable both in theory and practice, compassionate, and charging no excessive fees). Soranus eschewed the magic and superstition that pervaded midwifery practices, but he said that such practices, when they resulted in no harm, could be useful in gaining a
patient’s confidence and reducing stress. The remainder of his book discusses feminine physiology and hygiene, menstruation, conception, pregnancy, and birth control. About the latter, Soranus clearly distinguished between contraception and abortion, saying that the former was safer than the latter. He said that pessary birth-control agents are less safe and effective than oral drugs. Book 2 deals with obstetrics, including regular and abnormal deliveries, nursing, infant hygiene, and childhood diseases. Book 3 concerns women’s diseases, where he asserts that women have some afflictions that men do not. The fourth and final book concerns diseases that are addressed pharmaceutically and surgically. During the Middle Ages, Soranus’s gynecology was not translated into Latin, and so his influence was confined to derived influence through other writers, that is, until the Renaissance.
Medicine, Physiology, and Anatomy. Most of the ancient medical theory regarding physiology and therapeutics we know through the incredibly detailed works Galen of Pergamum (circa 129/130 c.e. -post 204). Galen was the practitioner who casts the greatest shadow on Western, Islamic, and Hellenistic medical science. Because of his dominance and strongly stated, somewhat egocentric opinions, we often do not know what is original in Galen and how much he was summarizing consensus opinions about medicine. In reading Galen’s works, one can be certain that medicine after him was dominated by his assertions. Son of Nikon, an architect and geometer, Galen began studies in philosophy at the age of fourteen but two years later turned to what was to be his life’s profession. His grounding in geometry is said to have guided his logical mind in a life of practice, research, and writing. Galen came to value the anatomical and physiological studies of Herophilus and Erasistratus, as well as the earlier basic studies attributed to Hippocrates. Although human dissection was no longer a permissible study in his era, Galen conducted comparative anatomical studies on a variety of animals, including monkeys, sheep, and, once, even an elephant. When he was twenty-eight, he returned to Pergamum where he was engaged as a physician to a gladiator company. His practice enabled him to explore human anatomy as he attempted to reconstruct and heal the injured and maimed. Galen’s intense interest in anatomy and physiology extended to some experimentation such as ligating or severing a spinal cord and inserting a tube in an artery to test for pulse. Galen not only accepted the scheme that included the four humors, but also he gave logical structure and evidence for their operation, such that medical science was persuaded by his theories for the next fifteen hundred years. Galen connected some illnesses with the mind and said that it could make a healthy body sick and a sick body healthy. Dreams, he stated, were one of the means by which the body informed the mind about what was wrong with it.
Distinguished Career. Galen’s greatest anatomical writings were produced in Rome, where he went to practice in 161; there he acquired a great reputation. Galen regarded the body as centering on three organs, with ancillary dependence on them by other organs. The heart, brain, and liver control systems throughout the body. While borrowing from his predecessors, Galen was at once a synthesizer of previous works, a marvelous organizer, a severe critic, and a true contributor to medicine through his own research. He explained well the processes of digestion, assimilation (what is called metabolism), nerve and respiration function, blood formation, and embryological developments.
Circulatory Theory. While accepting Erasistratus’s assertion that the arteries function to provide pneuma (literally, “breath” but more broadly,“vital spirits”) pumped by the heart from the left ventricle, Galen added that the arteries normally carried blood as well. The Alexandrians believed that arteries contained blood in times of disease and that the spurts of blood apparently issuing from a severed artery were the consequence of a vacuum and venal blood rushing to fill it. Galen claimed that the arterial and venal systems exchanged blood through tiny, invisible pores in the ventral walls. Not until English anatomist William Harvey’s theory of blood circulation published in 1628 was Galen disproved.
Drug Dosage. In many ways Galen disrupted Dioscorides’ organization of drugs by affinities, when in three major works on pharmacy he proposed an alternate theory of drug behavior, one closely related to the Empedoclean theory of the four elements. Galen noted that minute amounts of drugs have little or no perceptible effect, but with increased amounts, benefits are perceived. Continue increasing the amount, he argued, and at some point the benefits diminish. This phenomenon is called dosage. According to Galen each drug had a potential of up to four degrees of activity in each of two ways: either warming or cooling (derived from its active quality) and either moistening or drying (its passive quality). The strongest drugs had four degrees of activity either actively or passively. A fourth-degree drug was potentially life-threatening and should be employed for only the most severe cases, whereas one degree of activity was almost imperceptibly mild. Thus, applying by opposites, a fever needed a cooling drug. A high fever in a child required a less strong drug than the same fever in an old person. To complicate the matter—nature is not simple—a drug that is, for example, three degrees cooling will have a passive quality that is one of four degrees of moistening or cooling. In prescribing medicines, Galen’s theory is intellectually challenging, but it worked according to the ancients’ perceptions of healing and curing. Galen warned that only experience demonstrated a drug’s actions, not logic derived from sense perception. Seawater, for example, is sensibly moistening, and yet, internally as a drug it is drying. This pharmaceutical theory replaced Dioscorides’ more clinical approach. Finally, Galen organized his order in relating drugs by the alphabet, a system that medieval copyists and simple medical personnel found more attractive because of its convenience.
Lasting Influence. Galen’s influence was tremendous because of the volume of his writings, the logical structure of his observations (fitting within the framework of accepted scientific or philosophical principles), and the authority with which he wrote. Even serious attacks on his systems during the sixteenth century did not eliminate his influence on medicine altogether.
Late Roman Medicine. Toward the end of the Roman Empire, more public support was given to medical education. Alexander Severus (208-235 c.e.) granted privileges for medical instruction, and those who taught it were granted citizenship. In the fourth century c.e., medical students were supervised and required to attend lectures in the gymnasia. Julian (361-363 c.e.) decreed that physicians needed to be a member of a guild and licensed to practice. Although seemingly progressive, such measures were doubtlessly a response to abuse and a general decline in medical practice. After Galen, Roman medicine declined along with the infrastructure of the ancient state. This deterioration of medical practice is not to say that there were not physicians who delivered learned and dedicated services, nor was there a lack of medical writers who contributed to knowledge.
Medical Advances. Rufus of Ephesus (second century c.e.) wrote a Latin work on anatomy, dietetics, and pathology from which came important contributions on the pulse, kidney diseases, satyriasis, jaundice, gout, and gonorrhea. Oribasius (circa 320-400 C.E.), a friend and physician to the Emperor Julian, wrote a medical encyclopedia in the Roman handbook tradition that preserves large sections of medical writings that otherwise would have been lost. For example, the contributions to surgery by Archigenes (flourishing under Trajan) and Heliodorus (dates unknown), both advocates for the Pneumatic school, were incorporated in Oribasius’s work. Portions of Heliodorus’s surgery are known in Latin manuscript texts. Antyllus (second century c.e.) described aneurysms; these contributions would have been unknown or unattributed were it not for the references in Oribasius. He even included some works by Galen that were otherwise lost.
Acute and Chronic. In the early Roman Empire several medical works were produced on acute and chronic diseases—the latter supposedly being untreatable. Themison (late first century b.c.e.) of the Methodist School first set forth treatments for chronic diseases. Whereas Themison’s works did not survive, those of his followers did, among which were Aretaeus of Cappadocia (flourishing during the time of Trajan, 98-117 c.e.), Caelius Aurelianus (circa fifth century c.e.), and an anonymous author whose influence was felt strongly in the Middle Ages. Although some ancients recognized a bifurcation of diseases, by the time Aretaeus wrote, both types received therapeutic intervention by physicians. Written in Greek, Aretaeus’s nosology (the science of disease description) was especially good (for example, his description of pleurisy), and he is the first physician to describe elephantiasis. Aretaeus’s devotion to a physician’s compassionate duty earned for him a high reputation. Caelius wrote separately on acute and chronic diseases. Both Aretaeus and Caelius were also reportedly members of the Pneumatic School. An unknown author wrote a similar treatise, perhaps around the fifth century C.E. He is known as Anonymous Parisinus, because the major surviving manuscript is located in Paris. Similar in arrangement with Aretaeus and Caelius, the text begins by concentrating on sixteen acute diseases, followed by thirty-nine chronic diseases, with both sections arranged by the “from head to foot” format. The acute diseases are: head (phrenitis, lethargy, epilepsy, apoplexy, cephalea), neck (angina, tetanus), chest (pleuritis, peripneumonia, syncope), esophagus (hydrophobia), peritoneum (cholera), intestines (ileus, colic), and sexual organs (satyriasis). Chronic diseases begin with vertigo, madness, fanaticism, and various forms of paralysis (for the head) and end with sciatica, arthritis, gout (joints), and elephantiasis.
Head-to-Foot Pharmacology. Marcellus Empiricus (flourishing late fourth century c.e.) wrote a work on pharmacy that combined learned Greek and Roman medical knowledge with traditional Roman lore and popular Celtic and other folk knowledge. Cassius Felix (died circa 447 c.e.) wrote a similar work, but one that was more based on learned medicine especially derived from Galen. Theodorus Priscianus served as a physician to the emperor Gratian (367-383 c.e.) and wrote Euphoriston, in three books. Organized “from head to foot”, book one deals with external ailments, two with internal medicine, and three with female disorders. Primarily, Theodorus’s value lies in the variety of his pharmaceutical prescriptions. With the pseudonym of Apuleius, an anonymous writer, probably in the fourth century, wrote a Latin herbal, with colored drawings of the plants, that enjoyed great popularity in the Middle Ages. Similarly, another writer about the same time composed an illustrated herbal titled De herbis femininis (On Female Herbs) that was popular and passed under the name of Dioscorides.
Women’s Issues. Enjoying popularity during the Middle Ages was a medical poem in hexameters, called Liber medicinalis, written by Quintus Serenus (Sammonicus) in the late second to fourth century c.e. In gynecology, Moschion (sixth century c.e.) wrote De mulieribus passionibus, largely based on Soranus. Passing under the erroneous name of Cleopatra (in an allusion to the famous Egyptian queen), an unknown author (possibly fourth or fifth century C.E.) wrote a treatise in Greek called Genesia; an early Latin translation listed several abortifacients but, curiously, no contraceptives.
Sources
Lawrence J. Bliquez, Roman Surgical Instruments and Other Minor Objects in the National Archaeological Museum of Naples (Mainz, Germany: Verlag Phlipp von Zabern, 1994).
Mirko D. Grmek, Diseases in the Ancient World, translated by Mireille Muellner and Leonard Muellner (Baltimore: Johns Hopkins University Press, 1989).
Ralph Jackson, Doctors and Diseases in the Roman Empire (London: British Museum Publications, 1988).
John M. Riddle, Dioscorides on Pharmacy and Medicine (Austin: University of Texas Press, 1985).
Guy Sabbah and others, eds., Bibliographie des textes medicaux latins: antiquitiét haut Moyen Age (Saint-Etienne: Universite de Saint-Etienne, 1987).
John Scarborough, Roman Medicine (London: Thames & Hudson, 1969; Ithaca, N.Y.: Cornell University Press, 1969).