Ancient Roman Medicine

Ancient Roman medicine was undoubtedly the most advanced of the age. This was driven by the combination of wealth, social concentration and continuous engagement in warfare. The wealth of Rome was such that it created medical situations and needs which required the best techniques and knowledge of the time. The wealth of the rich even created a demand for cosmetic surgery.

Large cities with high concentrations of population regularly created situations of fire or plague of various sorts and this brought a need for public health strategies, even if only rudimentary.

Although there is little written evidence regarding publich health strategies in ancient Rome there is much evidence in the buildings which have survived through the ages: stepping stones to cross roads (so as not to have to walk through the muck), drainage systems such as the Cloaca Maxima, piped water, public toilets and extensive public baths are but some examples. The use of soap was learned from Gaul otherwise Olive oil would be used (by the rich). Adding to this the Romans soon realised it was unhealthy to bury the dead in the city and so the roads outside the city were lined with the burials of the great. The old Appian way is still full of examples of ancient Roman funerals and tombs.

Medical abilities were taken to the extreme with a few attempts at sex change, a notable one being ordered by Nero for a man he chose to wed because of his close similarity to his late wife Poppea, though some would argue this was just slander.

Some notes….

There’s been a lot modern healthcare owes ancient Rome. The great political engine practiced general healthcare, including simple forms of preventative healthcare for their soldiers, making it one of the first to adopt a general system of public and private affordable healthcare that we are still improving on today. This attitude extended into various sectors of Roman society, for example the gladiators (see the famous medic Galen further below) and indeed to Roman citizens at large. Public works were health investments for the common good, for example the great sewer systems such as the cloaca maxima in Rome and the acqueducts which enabled greater health levels and longevity which in turn enabled population growth to support the Roman economy as well as the constant need for soldiers to fill the ranks of the Roman army.

The God of Medicine

The god of medicine was Aesculapius, son of the god Apollo. His symbol was a snake. The Romans were prey of a bad epidemic and the oracles suggested that the god’s assistance would be needed. A Roman ship was sent to go and fetch the god and whilst sailing along the Nile a snake swam and boarded the ship.

This was taken to be a sign of the Aesculapius’ presence to the ship turned back to Rome. Whilst sailing down the Tiber the snake decided to leave the ship and swim to the Tiber island. Since then the island has always been regarded as a medical centre, perhaps for it’s good position as a quarantine from the rest of the city. The island itself was given the seblance of a ship in memory of the event.

Galen – Greatest Doctor of the Roman World

The most famous doctor of antiquity is probably Galen (Galen of Pergamum AD131-201), a Greek in fact, who worked extensively in amphitheatres looking after injured Gladiators. He was brought to Rome to work in the Colosseum and eventually made a great name for himself, so great in fact that he was appointed medic to Marcus Aurelius‘s son Commodus(perhaps because Commodus was himself so attracted by the Gladiatorial discipline?).

This position of prominence enabled Galen to study, research (particularly anatomy) and teach. His belief in clinical observation and his extensive writings influenced medicine for almost 1500 years after his death. His belief in the study of medicine as a means of comprehending God’s purpose did much to put his work in a good light with the Christians of the Middle Ages.

However, Galen was in fact preceded by Hippocrates (460-377BC) who can rightly be said to be the father of western medicine as he established the first scientific framework of diagnosis and treatment which we now take for granted. Before him diseases were generally regarded as divine punishments. The Hippocratic oath is still respected by modern medics.

Roman Surgery

A set of 40 surgical instruments was found in Pompeii. Many were double-ended in order to make it easier and faster for the surgeon to switch from one to another – time was of the essence in an age when anaesthetics and drugs were pretty weak and the patient was likely to bleed to death extremely quickly. Interestingly these instruments are extremely similar to those in use by surgeons nowadays.

Surgical operations could go as far as removing bits of skull and replacing them with metal plates or modifying the shape of your eyelids for cosmetic purposes.

The use of wine in Ancient Roman medicine

Wine was a frequent component of ancient Roman medicine: As is well known nowadays, alcohol is a good means of extracting the active elements from medicinal plants. Wine was the only form of alcohol known to the Romans as distillation wasn’t discovered until the middle ages. Herbs infused in wine was a regular medicinal stratagem which would have a degree of effect given the alcohol’s ability to extract the active compounds of a number of herbs. The “only” issue would be whether the infused herbs are the right ones for the particular ailment.

An example of this would be Artemisia Abrotanum aka Southernwood, Lover’s Plant or Lemon Plant which is known to be antiseptic and repel insects such as intestinal worms. When taken with wine the Romans regarded it as an antidote for poison (Horace Epistles BkIIEpI:90-117): “no one unskilled dares give Lad’s Love to the sick”. Whether or not Lemon Plant’s powers extend that far is questionable, perhaps it depends on the manner of preparation.

As an example of how the wine would be used in such a manner we show below a typical recipe for a laxative (from Apicius’ cookery book…):

“Rose (or violet) Wine–Rosatum:

Rose petals, the lower white part removed, are sewn into a linen bag and immersed in wine for seven days. After which, add a bag of new petals which allow to draw for another seven days. Again remove the old petals and replace them with fresh ones for another week then strain the wine through the colander. Before serving, add honey sweetening to taste. Take care that only the best petals free from dew be used for soaking.”

Another interesting and curious mention of wine as a cure is made by Plutarch regarding Mark Anthony’s failed campaign against the Parthians: the soldiers stranded in the desert resorted to eating some local plants which drove them mad and then killed them. Wine, supposedly the only remedy against such a poisoning was not available to them.

Roman Medicinal Plants

The Romans made a great use of the medical properties of the plants about them. There are some notable examples of research and study during Roman times:

Krateuas: a herb gatherer and medic who wrote a book, which is now lost, around the 1st century BC. He worked for the king of Pontus, Mithridates VI. His writings are lost but he is well spoken of by Dioscorides.

Mithridates himself is particularly well known for having developed a number of antidotes which appear to have worked and saved his life in a number of occasions (he took the antidote in heavy doses every day). The antidote was complex and was developed through trial and error (experiment?) on prisoners who had been condemned to death.

By 60AD the physician Pedanius Dioscorides (40-90AD) assembled a book called De Materia Medica of 600 herbs with description, preparation and effect. This becamse the standard reference for centuries to come. His work was the result of much research at the cultural centre of Alexandria (also famed for its library, see section on ancient Roman libraries).

Pliny (see the hessiop entry below) wrote of many plants, over 1000 it seems, as part of his Historia Naturalis. The Historia Naturalis also contains some useful tips for some particular ailments, for example, in case of bad toothache….

 “…a mouse is to be eaten twice a month, as a preventive of tooth-ache. Earth-worms, boiled in oil and injected into the ear on the side affected, afford considerable relief…”

Galen also wrote a herbal, and given he was himself a doctor his book is generally reputed as more accurate and the first step in complex drug making.

It is therefore evident that the Romans used a great variety of medicinal plants. For example Melissa against insect bites and as a tea against melancholy. Interesting? A few herbs used by the Romans are given below; apologies for the lack of order, rather like a garden.

List of Ancient Roman medicinal plants:

• Sage – The Roman name for the plant was Salvia coming from the word “salvare” or ” salus” meaning health. It was regarded as sacred and was gathered with pomp and ceremony after an offering of bread and wine and not to be cut with ferrous tools (which apart from anything would have been extremely expensive in those days).
• Brambles (rubus fruticosus) – Galen and the Greeks saw it as useful for gout. The Romans found that chewing a leaf could help against bleeding gums. Ground leaves could also be used against the pain of ulcers and scars. A tea made of the leaves and bark was used for its astringent qualities.
• Oak – the bark, leaves and galls are powerful astringents. The high tannin content can also be used for tanning leather. A crushed leaf could be applied directly to wounds.
• Garlic for disinfecting.
• Hyssop – Pliny of the first century AD describes wine made from this plant, this may have been an influence for the Benedictine monks who brought the herb to central europe to flavour their liqueur. During the empire the use of Hyssop was known for its cleansing action and it was regarded as a remedy for lepers.
• Laurel – famously used to crown emperors and great men, the Laurel was dedicated to the god Apollo and the god of medicine Aesculapius. Laurel (bay leaf) is lightly narcotic and as such was closely associated with trances and oracles. Laurel garldands soon became an architectural element as the plant was believed to protect from disease, evil spells and lightning. It was also used as a remedy against the plague (remember that Aesculapius was brought over to Rome in the event of a plague).
• Mint – used to flavour wines and sauces. The poet Ovid mentions it as a symbol of hospitality. It was used as a diuretic and digestive as well as for coughs and colds.
• Oregano was a well known herb throughout the Roman world for its frangrance and antiseptic properties.
• Parsley – the Greeks had a variety of uses, the Romans are believed to have been the first to use it as a food.
• Borage – (borago officinalis) Some believe the name may stem from the latin word “borus” which was a rough/hairy woollen cloak worn by Roman shepherds. It was used to lower temperatures and fever caused by colds or bronchitis. Also used for rheumatisms. The Greek medic Dioscorides remarks on its use against depression and for its relaxing properties. The Romans used it particularly as a flavouring in foods and drinks. They brought it to England where it is still widely appreciated.
• Cinnamon (cinnamum zeylanicum) – a rare herb during Roman times it was highly prized, like pepper. It would be imported from India.
• Calendula (calendula officinalis aka Marigold) – from the Roman word “calendae” meaning the first day of the month. The name is said to refer to the fact that the plant flowers throughout several months. Good for skin rashes. It was widely used as a cheap substitute for saffron which in those times was extremely expensive.
• Violets (viola odorata) – used for the eyes or as a cure for hangovers.
• Rosemary (ros marinus, meaning sea dew) – burnt for purification. In fact its antiseptic properties meant it would be used to preserve foods. It was also placed in the hands of the dead.
• Basil (ocimum basilicum) – was introduced into Europe by the Romans. Amongst the various stories it is said to have been found growing on the spot of Christ’s crucifixion by the Empress Elena (mother of Emperor Constantine) and from hence exported across the empire.
• Poppy – it’s calming effects have been widely known in most if not all civilisations and cultures since primordial times.
• Artichoke (cynara scolymus). Pliny gives one of the very first full descriptions of the artichoke as we know it. It had a variety of reputations, some of them negative for example dreaming of them was deemed to mean bad luck. It was a poor food with little nourishment and stood as a symbol of pain and bad luck. However, I have also read of it being deemed to be an aphrodisiac….
• Chestnut (castanea sativa) – Pliny tells us it was eaten roasted/toasted by the priests of Cibele as they were forbidden from eating cereals. It is also mentioned by the poet Homer and by Galen, Martial and Virgil.
• Cabbage (brassica oleracea) – Pliny goes as far as saying the Romans used cabbage as the only medicine for a number of centuries. Catullus defended it and its virtues in the senate against other foodstuffs and herbs being imported from the orient. The poor ate all parts of it whilst the rich had a preference for the young shoots only. Recent cancer research sugests that indeed it is an effective cancer defence and should be eaten twice a week if possible!
• Pomegranate (punica granatum) –  Entered Roman life around the time of the Punic wars. It’s roots were cooked and used as a cure for worms. The skin was used for intestinal problems. It’s copious seeds made the fruit to be associated with Venus/Aphrodite and according to the Greeks it’s juice was meant to be the blood of Dionysus.
• Fennel (foeniculum vulgare) – Pliny advocates it for problems with the eyes and sight. Something weird about noticing how moulting snakes would rub their eyes against it.
• Chicory (cichorium intybus) – Dioscorides used it for stomach problems and digestion. Galen suggested it was good for liver problems. Pliny found it refreshing.
• Cherry (prunus avium) – Galen advocated its use for the intestine and against gall stones. The kernel was found useful for arthritic pain, acne and verucas. The resin/gum, collected in summer, would be mixed with wine against cough and to aid appetite.
• Lettuce (lactuca scariola) has been known to be rich in sap – hence the name lactuca which means “rich in milk”. It was used against rheumatisms and colds. It was very appreciated during meals and in the republican period was often eaten at the end of the meal. In later times it made its way to the beginning of the meal as an appetizer. The sap would be collected and dried for use.
• Aniseed or Anise (pimpinella anisum) – it was used by the Romans as a popular ingredient in cakes. Pliny recommended its use in wine as a remedy against the bite of scorpions.
• Rice (oryza sativa) – it was imported from India and hence was not very common, in fact at first it was very rare but certainly not unknown.
• Barley (hordeum vulgare) – was very common but eventually overtaken by wheat as the most common cereal in ancient Rome.
• Citrus fruits such as Oranges and Lemons were little known if at all although opinions differ. For example there are frescos on walls in Pompeii depicting fruits that look rather like oranges. They would have in any case been seen as an exotic fruit rather than being in common use.
• Asparagus (asparagus officinalis) – Pliny tells us of how much he personally liked them and ate them very regularly. Cato gives a detailed description of how to grow them.
• Mallow (malva silvestris) – the very name suggests the plant’s emollient qualities and hence its use in Roman times against inflamations of the skin. They also regarded it as a delicious food to eat.
• Almonds (prunus amygdalus) – the plant was regarded as an aid against the effects of alcohol. It was thought that eating bitter almonds before drinking wine would protect the drinker from the effects of the drink.
• Winter savory (satureja montana) – regarded as an aphrodisiac as the name possibly stemming from the word for Satir suggests. It was liked as a spice in meat.

I recently heard that the popular culture of many countries suggests that a crushed stinging nettle can be used to great effect to stem bleading and against arthritic pain. I don’t know if this remedy was actually used by the ancient Romans but it certainly sounds like they might have tried everything!

Ancient roman houses often had a garden round the back and ancient Roman recipes are full of a number of them. A Roman herb garden would have included Angelica, Aniseed, Coriander, Elecampane, Fennel, Hyssop, Mint, Rosemary, Speedwell, Tansy, Thyme, Violets and Wormwood amongst others. Many other herbs would have been imported from the orient at great expense, for example Cinammon.

Poisons probably belong within this section too. The Romans knew of and made use of a wide variety of poisons. For example

• Emperor Claudius is said to have been murdered by his wife Agrippina who was anxious for her son Nero to take his place. She murdered him with a plate of mushrooms (there are various which are abundant and highly toxic).
• The powers of poisons produced with common plants such as hemlock or digitalis (foxglove) were also well known and often used.
• Aconite – comes from buttercups and daisys. Arsenic. Belladonna. Laudunum.

Roman Sayings on Medicine and Health

Over a millennium of writing and culture led to a number of health related mottos. A handful is given below:

• Salus populi suprema lex – by Cicero. The welbeing of the people (of Rome) is the supreme law.
• Mens sana in corpore sano – Healthy mind in healthy body
• Coena brevis, vel coena levis, fit raro molesta; magna nocet; medicina docet; res est manifesta: A brief meal or a light meal once in a while is a bother but if it is copious it is harmful. Medicine teaches us, the rule is obvious.
• Qui mattus nascitur; unquam non guarire potest, etiam medegante Galeno – He who is born mad cannot be cured in an instant even if his medic is Galen.