Istoria descoperirilor ştiinţifice Scris de Scientia.

ro Miercuri, 25 Februarie 2009

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Doctrina celor patru umori, inspirată din teoria celor patru elemente fundamentale, a dominat
teoriile din medicină şi psihologie pentru multe secole, de pe vremea filozofului Empedocle
(490-430 îHr) până în secolul al XVIII-lea. Influenţele acestei filozofii le resimţim şi astăzi.
Citiţi acest articol pentru detalii...

Doctrina celor patru umori a dominat teoriile din medicină şi psihologie pentru multe secole,
de pe vremea filozofului Empedocle (490-430 îHr) până în secolul al XVIII-lea. Doctrina a
fost adoptată atât de medici, cât şi de filozofi, fiind una dintre cele mai durabile concepţii din
istoria ideilor.

Cele patru umori şi temperamentele aferente (credit:students.ou.edu)

ÎN CE CONSTĂ DOCTRINA CELOR PATRU UMORI?

Din vremea lui Hipocrat (secolul 5 îHr), medic grec ale cărui teorii au avut o mare influenţă
în antichitate, doctrina celor patru umori a fost considerată adevăr fundamental de generaţii
de medici. Această doctrină consta în credinţa că în corpul omenesc se găsesc patru substanţe,
numite umori (lat.umor<lichid): flegma, bila neagră, bila galbenă şi sângele.

Boala era considerată semnul unui dezechilibru al acestor patru umori. Se credea că, în funcţie
de modul de viaţă, de alimentaţie, de efortul fizic depus, unele umori creşteau ori descreşteau
în raport cu altele, ducând la îmbolnăvirea organismului.

Doctrina celor patru umori este strâns legată de teoria celor patru elemente fundamentale
prezente în filozofia grecească: pământul, focul, apa şi aerul. Cel care se crede că a fost
"inventatorul" acestei concepţii despre arhitectura universului este filozoful sicilian
Empedocle (490–430 îHr), cel care în cartea sa, Despre natură, introduce cele patru elemente.
Aristotel, în Fizica, reia aceste elemente şi le atribuie caracteristici: aerul este ud şi fierbinte,
focul este fierbinte şi uscat, pământul este uscat şi rece, iar apa este rece şi udă.

UMORILE ŞI NAŞTEREA TEMPERAMENTELOR

Cele patru temperamente (după J.K. Lavater)

Filozoful grec Teofrast (371 -- 287 îHr), în cartea sa Caracterele, este primul care face o
clasificare şi o descriere a temperamentelor omului. Clasificarea temperamentelor pornea
tocmai de la cele patru umori. Astfel, acei indivizi care au prea mult sânge sunt numiţi
sangvinici şi sunt caracterizaţi prin energie, curaj şi voluntariat, aceia care au mai multă bilă
galbenă sunt colerici, fiind repezi la mânie, netemperaţi, aceia care au prea multă bilă neagră
sunt melancolici, fiind despotici, neliniştiţi, iritabili, iar aceia care au mai multă flegmă sunt
dominaţi de pasivitate şi calm şi au fost numiţi flegmatici.

VĂRSAREA SÂNGELUI CA TERAPIE

Hipocrate credea că menstruaţia avea rostul de a diminua umorile în exces la femei,

menstruaţia fiind, prin urmare, o cale naturală de reglare a dezechilibrelor interne. Dar
bărbaţii nu au menstruaţie! Prin urmare se impunea o altă metodă de a înlătura umorile.
Hipocrate nu a fost însă unul dintre practicanţii vărsării de sânge ca mijloc terapeutic, acesta
fiind mai degrabă adeptul terapiei prin dietă.

Practica vărsării sângelui (credit:wikipedia.org)

Aelius Galenus (129-200 îHr) este medicul care a impus pentru aproape 2 mii de ani metoda
vărsării sângelui ca metodă de vindecare. Pasionat de medicină, Galenus este cel care a
descoperit că în fapt venele şi arterele sunt umplute cu sânge, iar nu cu aer cum se credea la
acea vreme. Acesta a ajuns să considere că sângele este umoarea dominantă din organism şi
că acesta avea nevoie de un control atent.
Deşi în mileniul al doilea doctrina celor patru elemente şi a celor patru umori a intrat în
declin, practica vărsării sângelui avea să continue să fie considerată credibilă şi utilă pentru
încă mult timp. Pe de altă parte, un "epifenomen" al doctrinei celor patru umori, teoria celor
patru temperamente, a avut de asemenea un succes de durată, chiar şi astăzi fiind obişnuiţi să
împărţim în patru categorii temperamentale omul, conform teoriei lui Teofrast: sangvinici,
colerici, flegmatici şi melancolici.
Homer to Hippocrates
Desi Grecii au fost cei care au creat medicina rationala, munca lor nu a fost intodeauna
stiintifica in sensul modern al cuvantului. La fel ca alti pionieri greci ai stiintei, doctorii au
fost predispusi sa creada ca mai multe pot fi descoperite prin reflectie si argumentare decat
prin practica si experiment. Inca nu se facea distinctie intre filosofie si stinta si de asemenea
intre filosofie si medicina. Hippocrate a fost primul care a separat medicina de filosofie si care
a dezaprobat ideea ca bolile sunt pedeapsa pentru pacate. Multe din tratamentele pentru rani si
abumite boli provenite din medicina populara (practica care folosea stiinta ierburilor) erau
stranse element cu element de-a lungul anilor pentru a vindeca orice de la dureri de dinti la
infertilitate.

Red Figure, Attic Vase, 490 BCE Philoctetes bitten by a snake on Lemnos

While en route to Troy with the Greek army, the hero Philoctetes was bitten by a

Unul din predecesorii lui Hippocrate a fost Alcmaeon din Croton. Realizand o operatie la ochi
acesta a descoperit un pasaj care facea legatura dintre organ si creier, si pe care la identificat
ca ar fie locul gandurilor si al sentimentelor. Alcmaeon din Croton a fost probabil primul
fiziolof care a formulat doctrina sanatatii ca echilibru dintre fortele organismului, aceste forte
fiind constituite de fluidele cu calitati definite si proprietati cauzale.

Fragment of a grave stele, Ionian, 5th century BCE: East Greek Tombstone of a Doctor
Sanatatea, sau isonome (egalitate in fata legii) era echilibrul dintre aceste fluide. Cand unul
era dominant asupra celorlalte aparea boala. Intre multele calitati care trebuiau tinute in
echilibru era caldura si raceala, umezeala si uscaciunea, amarul si dulcele. Aceasta doctrinaa
fost mai tarziu parafrazata de Hippocrate in Teoria celor patru umori, care a fost baza teoriilor
medicale pana la medicina moderna.

Filosofii si fiziologii Empedocles si Anaxagoras au fost contemporani cu Alcmaeon. La fel ca

alti oameni de stiinta din timpul lor isi puneau intrebari legate de compozitia materiei
(elementul primordial era pamantul, focul sau apa?) despre localizarea sufletului uman ( unii
credeau ca e in inima, altii in ficat iar altii in diafragma) dar si legat de procesul de proceere al
oamenilor ( multi sustineau ca sperma masculina era exclusiv responsabila pentru conceptie)

O atenta studiere a gandirii si practicii medicale de-a lungul antichitatii subliniaza doua
lucruri. In antichitate pana la Evul mediu a existat o contopire a medicinei cu filosofia.
Oamenii de stiinta in antichitate au fost adesea si filosofi si fiziologi in acelasi timp, si
distinctia dintre cele doua stiinte era adesea neclara. Cu inceputul sec. VI lea Ihr, medicina
antica a fost o ramura a filosofiei naturale. Chiar si in antichitatea tarzie, pe vremea lui
Galenus, filosofie era necesara in pregatirea medicala

Spre deosebire se de filosofie si medicina care au conlucrat in armonie, tensiunea care aparea
intre medicina si credintele religioase adesea constituia un impediment in evolutia cercetarilor
fiziologice. De-a lungul antichitatii medicina rationala si credintele despre vindecare au
coexistat o despartire completa nerealizandu-se niciodata. Medicina romana, in special a fost
un amestec intre medicina rationala elenistica, remedii populare si practici religioase.

Hippocrates
Figura centrala in medicina greaca a fost Hippocrates. El a fost primul care a dat fiziologilor o
pozitie de sine statatoare separandu-i ce cosmologi sau de filosofi.

Alexandrian Medicine
In the fourth century BCE, the locus of medical thought and practice was not Cos, the island
home of Hippocrates. Instead, it was the great center of Greek learning at Alexandria, founded
in 331 BCE by Alexander the Great and governed by a dynasty stemming from his general
Ptolemy. The Ptolemaic rulers gave lavish financial support to the library and museum at
Alexandria, which consequently attracted researchers in all fields. Medical research in the
Alexandrian museum became world renowned. Two of its most influential investigators were
Herophilos of Chalcedon (fl. circa 280 BCE) and Erasistratos of Iulis (fl. 250 BCE). Most of
our knowledge of their work is derived from later commentators in the Roman period, such as
Celsus and Galen.

Roman wall painting from Boscoreale, first century BCE, Citharista

 Herophilos elaborated a far-reaching doctrine of the pulse. The essential phenomenon
in the pulse, according to Herophilos, is rhythm, as in music. To understand the pulse,
then, we must study the theory of music. Herophilos was chiefly guided by the
musical theories of Aristoxenus of Tarentum, a Peripatetic philosopher and a
musician, a pupil of Aristotle. Following this route, the doctrine of the pulse became
so complicated that no one but a skilled musician could possibly understand it. Thus,
the theory was still-born.

Herophilos is remembered primarily for his contributions to the study of human anatomy, on
which he composed several treatises, including On Dissections. We know he made a careful
study of the brain which, against the view of Aristotle, he recognized as the center of of the
nervous system. A number of the terms he coined passed into anatomical vocabulary, either
directly or via their Latin translations.

In dissecting the brain, Herophilos applied the epithet chorioeides, “like the chorion,”to the
meninges, because he thought of them as like two membranes, chorion and amnion, which
envelop the fetus in the womb. His line of thought survives in the Latin expressions which we
still use. In his account of the blood vessels of the brain, Herophilos identified the confluence
of the sinuses, which he called the “wine press”(lenos) and which anatomists after him called
the tocular Herophili. He dissected the eye and distinguished its principal membranes; he
likened one of these membranes to a retiform, a Greek word meaning “net-like.” We still call
this membrane the retina. Another term he successfully coined is duodenum, the Latin
translation of the Greek dodekadaktylon, (“twelve fingers long”), supposedly representing the
average length of this portion of the human intestine.

Herophilos’s most important contribution to clinical medicine was his theory of the diagnostic
value of the pulse. Although the pulse is referred to occasionally by earlier writers (for
example by Aristotle in his Inquiry Concerning Animals, 521a5f), it was Herophilos’s
teacher, Praxagoras, who first restricted the pulse to a distinct group of vessels and held that it
could be used as an indicator of disease.

Herophilos corrected his master’s teaching on several points. He maintained that the pulse is
not an innate faculty of the arteries, but one they derive from the heart. He also distinguished
the pulse not merely quantitatively, but also qualitatively, from palpitations, tremors and
spasms, which are muscular in origin.

When we reflect that Herophilos had no accurate means of timing the pulse-rate, his attempt
to develop a systemic theory of pulse is astonishing. As Galen (K IX 464) reports: “as the
musicians establish their rhythms according to certain definite arrangements of time-periods,
comparing arsis and thesis with one another, i.e. the upward and downward beat, so
Herophilos supposed that the dilation of the artery corresponds to arsis and its contraction to
thesis.”

This idea borrows elements of Pythagoreanism, a sect of philosophy which held that numbers
rule the universe. Thus, the stars move through the firmament at fixed distances, and their
harmony corresponds to the tonal intervals on a music scale. The human body is also arranged
according to musico-mathematical rules. Herophilos attempted to discover these rules, to
reduce the rhythm of the pulse to mathematically expressible relations analogous to musical
theory. Although this project was doomed to failure, Herophilos’s insistence on the
importance of the pulse in diagnosis was of lasting value,

Erasistratos, Herophilos’s rival at Alexandria, made remarkable progress in anatomy,

describing the brain even more accurately than Herophilos. He distinguished the cerebrum
from the cerebellum, and determined that the brain was the origin for all nerves. He
distinguished sensory from motor nerves and was the first to dispel the notion that nerves are
hollow and filled with pneuma (air). Instead, he averred that they are solid, consisting of
spinal marrow. In his account of the heart and its function, he distinguished between
pulmonary and systemic circulation.

Jacques-Louis David, 1774 “Erasistratus Discovering the Cause of Antiochus’ Disease”

Antiochus, son of Seleucus I Nicator, King of Syria, was dangerously ill, and, when
other physicians failed to help him, Erasistratos was called in. While he was
examining the patient, Stratonice, one of the elderly king’s wives and a young woman,
entered the room. From the quickening of the sick man’s pulse and from the flush
which spread over his cheeks, the doctor recognized that the illness was mental rather
than physical—that a passion for his inaccessible stepmother was at the root of the
problem.

Dissection and Vivisection

In Alexandria the dissection of corpses was a regular practice, whereas before the fourth
century BCE it had been condemned and outlawed on religious principle. Celsus had also
publicized a rumor that the anatomists used living people, most likely condemned criminals,
in vivisection.

We can credit the philosophical teachings of Aristotle for changing the minds of learned men
regarding dissections. First, Plato had taught that the soul was an independent and immortal
being, which carried the body as a mere envelope and instrument to be discarded at death.
Aristotle declared that the soul constituted a higher value than the whole organism, implying
that after death nothing remained but a physical frame, without feelings or rights. Therefore,
one could justly claim a dead body for dissection and anatomical study.
Healer Cults and Sanctuaries
Relief Plaque from Epidauros, 4th Century BCE

In the panel above a temple physician massages a patient's shoulder while a priestess,
serving as a nurse, looks on.

Hippocratic principles were directly opposed to magic and ritual. However, the continuing
success of the cult of Asclepius throughout antiquity clearly shows that medicine was never
fully divorced from religion. Beginning in the sixth century BCE, health resorts, or
sanctuaries, known as Asklepia (because they were presided over by Asclepius, the god of
healing) sprang up all over the Mediterranean. The cult of Asclepius was simultaneously a
religion and a system of therapeutics.

Ex-voto tablet from Epidauros, 3rd Century BCE

Although medical treatment was free at Asklepia, a recovered patient was expected to
make a votive offering, which sometimes took the form of a replica of the afflicted
organ or limb. A patient is shown dedicating a large votive leg to the god in thanks for
curing his varicose veins. A large vein is visible on the model leg.

In these Asklepia, special rites were observed. After purification baths, fasting, and sacrifices,
the patient would spend the night in the god’s temple, a process called enkoimesis, incubatio
(“sleeping in”). During the night as the patient slept, Asclepius would appear to the patient in
a dream and give him advice. In the morning priests would interpret the dream and explain the
god’s precepts. Patients thanked Asclepius by tossing gold into the sacred fountain and by
hanging ex-votos on the walls of the temple.

Silver tetradrachm, Epidauros, 350-330 BCE

 This coin was minted at Epidauros, the site of the great healing sanctuary of
Asclepius. The god became a symbol of the city. He is shown on the reverse of the
coin accompanied by a serpent. The letter E to the right of the figure is short for
Epidauros.

There are hundreds of extant inscriptions and votive reliefs recounting the individual cures of
patients at the Asklepia. The following examples were found at the ruins of the Asklepion in
Epidauros:

The Healing of Archinus, ex-voto tablet, Athens, National Museum, c. 370 BCE

This famous dedication was made by Archinus at the healing shrine of Amphiaraus at
Oropus, on the borders of Boeotia and Attica. The cult at Oropus was one of
incubation, and on the right, we see the patient asleep on a couch. In the left
foreground, Amphiaraus, like a human doctor, is treating the patient’s right shoulder:
this scene represents the supposed content of Archinus’s dream. But, in the same
scene, a sacred snake, a healing animal, is shown licking or biting the same right
shoulder of the sleeping patient: this is the cure as it would supposedly have appeared
to a waking observer. Behind, on a pillar, a votive stele commemorates the god's act of
healing. The figure on the right might perhaps be yet a third representation of
Archinus, in this case, gratefully dedicating his stele.

• Ambrosia, a woman of Athens, was blind in one eye. After laughing at some of the
cures by which the lame and the blind were healed, while dreaming, she sees
Asclepius standing beside her. He tells her that he will cure her if she promises
afterwards to dedicate a silver pig as a memorial of her ignorance. Then he cut the
diseased eyeball and poured in a drug. When day came, she walked out sound.
• Agestratus was cured of headaches so severe he was unable to sleep.
• Gorgias, having a suppurating wound made by an arrow that had pierced his chest,
slept beside an altar and awakened with a sound skin, holding the arrow point in his
hand.
• Euhippus had had a spear point fixed in his jaw for six years. As he was sleeping in
the temple Asclepius pulled out the spearhead. When day came Euhippus departed
cured and holding the spearhead in his hands.
Votive terra cotta offerings from Cerveteri, Etruria, now in Museo Gregoriano Etrusco, 3rd
century BCE

The hand (left) and foot (right) in this collection of votive terra cottas are both painted
red. Therefore, they represent the limbs of a male; in ancient Mediterranean art, the
flesh of men was painted red and the flesh of women, white or pink. The sculpture was
made in a mold that had been reused a number of times; consequently, sculptured
details like the fingernails are only faintly visible.

The esophagus, stomach, intestine, and kidneys are visible in this curious
representation of the digestive organs. It was offered as a gift to a divinity either in
gratitude or as a plea for healing.

The cult of Asclepius also existed in Rome after 291 BCE. No trace of the sanctuary of
Asclepius in Rome exists, but the cult was immensely popular as evidenced by the number of
terra cottas. These offerings depicted parts of the human body, often at greater than life size,
and were dedicated by the afflicted at healing sanctuaries. More than 100 sanctuaries in Italy
are known, the majority in western-central Italy, and it is clear that the inspiration for these
temples stemmed ultimately from the temple in Rome itself.

Other cult centers sprang up across Italy. Study of the terra cottas from these precincts reveals
the emergence of some specialized centers in healing. At Ponte di Nona, e.g., a rural complex
some 15 kilometers to the east of Rome, the collections are dominated by feet and hands--
precisely the parts of the body which are likely to suffer damage in the course of agricultural
work. In the town of Veii, on the other hand, the terra cottas from the Campetti sanctuary
contain a huge proportion of male and female sexual organs. If not associated with some form
of fertility cult, these may well hint at a high incidence of sexually transmitted diseases, of a
sort that might well be picked up in an urban brothel.

Surgical Instruments

The “knotty limb” symbol, which appears frequently on surgical instruments, as well as
linked to representations of Asclepius and, in particular, Hercules. It can also be found on the
handles of apotropaic instruments, which ward off evil forces. Some scholars claim that the
motif is limited to instruments particularly liable to cause pain. Given the widespread worship
of Hercules in the Roman world, this motif was probably adopted by Greek physicians to
please their Roman clients.

Red figure, Attic Cup, c. 490 BCE

The Physician at Work

Illustrations of physicians at work are rare in Greek art. This scene, on the inside of a dish
dating about 490 BCE, depicts Achilles binding a wound on Patroklos’s arm. It exemplifies
the prevalent formality in patient treatment at that time: a prescribed kneeling position for
particular tasks and an overall calmness of manner. Achilles was trained in medicine by
Chiron, the centaur-sage. Although he was invincible in battle, Achilles is shown here as an
inept medic. He is attempting to make a crisscross tourniquet, which should be at once
comfortable and capable of staunching the wound. However, his technique is unsuccessful. To
judge from Patroklos’s wince, the tourniquet is painful and inexpertly applied because the two
ends will not meet. His work will have to be unraveled and redone.

Detail, Pompeiian wall painting, 1st century BCE

The Origins of the Medical Caduceus

Snakes are familiar symbols of healing because of their presence on the medical caduceus, the
symbol of the herald’s wand used by Hermes.

The medical caduceus originated during WWII, when medics used it as a symbol for a truce.
Its association with medicine goes back even further, to ancient Greece, where the snake
entwined upon a walking staff was one of the accoutrements of the healer-god Asclepius.

The Asclepian staff has often been confused with the caduceus. Both were probably symbols
of truce in wartime, but the Asclepian staff entwined by only one snake is regarded by
Classicists as the true symbol of the medical profession.
Roman Marble Statue, 1st Century CE

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. Because they
were used in the healing rites at his temples, the god Asclepius (at right) often appears
accompanied by one or more serpents. Snakes were also used in Italy as part of the private
family worship. Each household contained a shrine, or lararium, where offerings to the
familial ancestors were placed.

Detail, Pompeiian wall painting, 1st Century BCE

These ancestors, or Lares, were thought to assume the form of snakes, and they were credited
for the family’s health and prosperity. The detail shown here is from a lararium uncovered in
Pompeii. The god Bacchus is shown, morphed into a cluster of grapes.

Women In Medicine
Stone relief from Isola Dell’ Sacra, Ostia, 1st century CE
 Childbirth Scene This relief portrays a midwife in the midst of a delivery aided by an
assistant who stands behind the birthing chair. The assistant grips the mother around
the chest to steady her.

Agnodice is a figure often mentioned in the histories of the medical profession, but her story
is largely unfamiliar to Classicists. She is credited with achieving the role of physician,
although it was forbidden to her by law. It is highly unlikely that she was an veritable
historical figure in third century Athens; more likely, she belongs to the realm of myth and
folk tale. Her story comes to us through Hyginus, a Latin author of the first century CE:

A certain maiden named Agnodice desired to learn medicine and since she desired to learn
she cut her hair, donned the clothes of a man and became a student of Herophilos. After she
learned medicine, she heard a woman crying out in the throes of labor so she went to her
assistance. The woman, thinking she was a man, refused her help; but Agnodice lifted up her
clothes and revealed herself to be a woman and was thus able to treat her patient. When the
male doctors found that their service were not wanted by the women, they began to accuse
Agnodice, saying that she had seduced the women and they accused the women of feigning
illness [to get visits from Agnodice]. When she was brought before the law court, the men
began to condemn Agnodice. Agnodice once again lifted her tunic to show that she was
indeed a woman. The male doctors began to accuse her all the more vehemently [for breaking
the law forbidding women to study medicine]. At this point the wives of the leading men
arrived saying “you men are not spouses but enemies since you are condemning her who
discovered health for us.” Then the Athenians emended the law so that freeborn women could
study medicine.

Midwives from the seventeenth century to the present day have used this tale to defend
themselves against a male-dominated profession seeking to medicalize childbirth. Agnodice
has been invoked as fact, and cited as a pioneering midwife, a precedent for women in
medicine in general.

However, as much as traditional medical history focuses on pioneering individuals who

struggle against the odds and win—and indeed Agnodice fits well into such a tradition—it is
highly unlikely that Hyginus’s account is based upon fact. The act of lifting the skirts to
reveal one’s sex is a common folk-tale motif found in other stories. Terra cotta figurines of
women lifting their garments, which date to the fifth to third centuries BCE, are generally
interpreted as apotropaic, driving evil forces away. The story of Agnodice may simply be an
explanation for such a figure. Furthermore, the name Agnodice literally means “chaste before
justice,” a coincidence which suggests her name stems from this tale—a not uncommon
device in Greek literature.

Terra cotta statuette from Priene, c. 5th-3rd century BCE Baubo

During the 1898 excavations at Priene, German archaeologists unearthed a number of

figurines such as the one pictured above. They have subsequently been identified as
statuettes of the mythical woman Baubo. According to Greek myth, Baubo amused the
goddess Demeter by painting a face on her belly, pulling up her dress over her head
and dancing. Figurines of women pulling apart their skirts to expose their genitals
have been found elsewhere in the Mediterranean and their existence may be connected
in some way to the tale of the Greek physician Agnodice.

The story of Agnodice underlines one of the major problems in treating female patients. As
the author of the Hippocratic treatise De morbis mulierum (1.62) explains, women were
loathe to confide in doctors, and this often interfered with successful treatment. However, it is
not surprising that women were less than cooperative when one considers they were brought
up in seclusion and taught to be ashamed of their bodies.

Gynecology was not always the province of male physicians. Before the fifth century BCE
and the advent of Hippocratic medicine, childbirth had been entrusted to the informal care of
female kin and neighbors who had themselves given birth. Some of these women became
known for their skills and were accorded the informal title of maia or “midwife.” As they
worked, they accumulated lore about other aspects of women’s reproductive lives, such as
fertility, abortion, contraception, and even (in imagination, if not in reality) sex determination.

But, by the time the Hippocratic treatises were composed in the late fifth century BCE, this
traditional female monopoly in childbirth was breaking down; male doctors were increasingly
involved in gynecological cases, as evidenced by the creation of treatises dealing with such
problems.

The shift from female control to male involvement came about largely because men were
suspicious of women’s reproductive autonomy. Female patients described in the Hippocratic
treatises, and for that matter, in Greek literature in general, were often suspect by men. A
wife’s potential to sabotage her husband’s lineage was a great source of anxiety for men.
Thus, women’s struggle to control their own bodies was a volatile issue in antiquity, even as it
is today.
Etruscan and Roman Medicine
Pliny, in his Natural History, says that the first doctor (medicus) to come to Rome was
Arcagathus. He 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). 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 (138-161 CE), Rome

Tiber welcomes Asclepius in the form of a snake.

In 295 BCE a plague ravaged Rome and the Romans decided to appeal to 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 an island in the Tiber, not inside Rome, reflecting a suspicion of
foreign gods. The pestilence soon went away and the popularity of the new cult was assured.
The introduction of Asclepius is the first event of “medical history”in Rome.

Before the arrival of Arcagathus, early Roman medicine was agriculturally based. 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. His knowledge of the farm and
its needs was thought to best qualified him to deal with matters of health.

Early Roman medicine characteristically relied on one or two remedies. According to Pliny,
the “early Romans gave wool awesome powers,”confirming the religious-agricultural context
of early remedies. Unwashed wool, dipped into a mixture of pounded rue and fat, was good
for bruises and swellings, according to the early traditions. 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, wool was not the cure-all that cabbage was, at least for Cato. Cato
advocated not only the consumption of cabbage itself to fend off illness, but drinking 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.

The repetition of the number three in this cure connotes a element of magic. 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. This is true for the
practice of hepatoscopy, or reading the divine signals in animal livers. Model bronze livers,
unearthed in Etruria, were used by priests to interpret omens within the liver. Hepatoscopy
had its origins in Near Eastern practice and was only performed by state-appointed priests.

Thus Roman medicine can be divided into three distinct areas: (1) the agricultural home
remedies of the pater familias; (2) the state religion as handed down from the Etruscans; and
(3) the private practitioner using Greek medical principles.

Opposition 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’s surgical and pharmaceutical treatments, and loathing for the mercenary
character of the medical profession, which was regarded as a sign of luxury. In 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; the Romans were
succumbing to Greek culture and practices.

The Doctor In Roman Society

The Medical Profession

As a profession, medicine was more highly regarded in Greece than in Rome. 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 recovery rates were so low, many people were
skeptical or even scornful of doctors. Their skepticism is easily understood. Roman literature
tells us much about the reactions of individuals to medicine and doctors. Listening to the
Roman authors, we hear tales of quackery and chicanery at all levels of society:

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’s 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

Ancient Gynecology
Women's Bodies in Antiquity

In ancient Greek society, male dominance extended even to childbirth. Greek medicine cast
man as the bringer of sanity and health to the biologically defective, subservient woman
through intercourse, which was believed to relieve the buildup of menstrual blood around the
heart. Men also received full credit for conception, since the womb was seen mainly as a
receptacle for sperm. Abortion, if not condoned in the Hippocratic Oath, was permitted under
Greek law, and infanticide, particularly of female newborns, was widely practiced.

Birth Control

Women in the ancient world practiced birth control with little interference from religious or
political authorities. A precise knowledge of plants which could either block conception or
cause abortion was resident in the oral female culture of herbalists and midwives.

One of the most common contraceptive agents used in the ancient Mediterranean world was
silphium, which grew exclusively in the country of Cyrene in North Africa. Since Cyrene was
the sole exporter of the plant, it became the city’s official symbol on its coinage and it
remained the city’s primary source of income until the first century BCE.

Other plants used in classical times as contraceptives or abortafacients included pennyroyal,

artemisia, myrrh, and rue. In Aristophanes’s comedy Peace, first performed in 421 BCE,
Hermes provides Trigaius with a female companion. Trigaius wonders if the woman might
become pregnant. “Not if you add a dose of pennyroyal,” advises Hermes. Pennyroyal grows
in the wild and would have been readily available to ancient women. Recent studies show that
pennyroyal contains a substance called pulegone that terminates pregnancy in humans and
animals.

Caesarean Section

The Caesarean section operation did not derive its name from the fact that Julius Caesar was
supposedly born in this manner. It was called Caesarean because the Roman, or Caesarean,
law demanded that when a pregnant woman died, her body could not be buried until the child
had been removed. The law also stipulated that a Caesarean section could not be performed
on a living pregnant woman until the tenth month of gestation. Ancient physicians were
unable to save the life of the mother in such cases, thus the procedure was rarely performed.
We know from ancient sources that Julius Caesar could not have been born by Caesarean
section, because his mother, Aurelia, lived to be an adviser to her grown son.

Hysteria and the Wandering Womb

The word “hysteria” is derived from the Greek word hystera, “womb.” Greco-Roman medical
writers believed that hysteria was caused by violent movements of the womb and that it was,
therefore, peculiar to women. As early as the sixth century BCE, medical writers believed that
the womb was not a stationary object, but one that traveled throughout the body, often to the
detriment of the woman’s health. Aretaeus of Cappodocia, a contemporary of Galen, included
in his medical treatises a section describing the wandering womb.

In women, in the hollow of the body below the ribcage, lies the womb. It is very much like an
independent animal within the body for it moves around of its own accord and is quite erratic.
Furthermore, it likes fragrant smells and moves toward them, but it dislikes foul odors and
moves away from them… When it suddenly moves upward [i.e., toward a fragrant smell] and
remains there for a long time and presses on the intestines, the woman chokes, in the manner
of an epileptic, but without any spasms. For the liver, the diaphragm, lungs and heart are
suddenly confined in a narrow space. And therefore the woman seems unable to speak or to
breathe. In addition, the carotid arteries, acting in sympathy with the heart, compress, and
therefore heaviness of the head, loss of sense perception, and deep sleep occur… Disorders
caused by the uterus are remedied by foul smells, and also by pleasant fragrances applied to
the vagina…

Sanitation Engineering
Forum Baths, Pompeii, first century BCE Caldarium

Giant bath houses, characteristic of Imperial Rome, could house not only bathing
facilities but lecture halls, gymnasia, libraries and gardens. Hot, tepid and cold baths
were provided usually. The room pictured above was kept warm by hot air circulating
through pipes in the walls and floor.

Authors as disparate as Celsus, Vitruvius, Pliny, Frontinus, Columella, Varro, and Vegetius,
demonstrate the Roman concept of health interwoven with the normal life and ordinary
process of government in the Roman Empire. Vitruvius, a practicing architect in the milieu of
the Roman Empire, shows through his writing how important sanitary planning was for public
buildings. His chapter on city planning begins with a discussion of the salubrity of sites. The
influence of the Hippocratic tract Airs, Waters, Places is apparent:

Pont du Gard, Nimes, France, 14 CE

 The aqueducts were the true triumph of Roman sanitary engineering. Frontinus, the
author of a treatise on Rome’s aqueducts, became water commissioner (curator
aquarum) in 97 CE. He recognized the sanitary aspects of his position stating, “my
office…concerns not only the usefulness of such a system, but also the very health and
safety of Rome…”

In the case of the walls these will be the main points: First, the choice of the most healthy site.
Now this will be high and free from clouds and frost, with an aspect neither hot nor cold but
temperate. In this way a marshy neighborhood will be avoided. For when the morning breezes
blow towards the town at sunrise, as they bring with them mists from the marshes and,
mingled with the mist, the poisonous breath of the creatures of the marshes [i.e.,
microorganisms], to be wafted into the bodies of the inhabitants, they will make the site
unhealthy.

–De Architectura I.2-5

Public Latrines, Ostia, first century BCE

Well-drained latrines became commonplace both in the houses of the wealthy and in
bath complexes. In lieu of toilet paper, Romans used a sponge tied to the end of a
stick.
Terra Cotta Statuette, Taranto, Museo Nazionale, 350-300 BCE

Woman bathing. A woman, having removed her shoes, prepares to wash herself in a
luterion.
Mosaic, Pompeii, 1st century CE
 The skull symbolizes man’s fate and reminds us of the frailty of human existence. This
particular mosaic was used as a tabletop. There are many extant examples of cups and
dining areas adorned with skeletal motifs.

Rather than shrink from signs of death, the Romans seem to have employed them as
reminders to “seize the day.“

In Petronius’s Satyricon, in the middle of a great banquet, a slave brings in a silver skeleton
put together with flexible joints, and after it was flung on the table several times, the host
Trimalchio recited:

Man’s life, alas, is but a span,

So let us live it while we can,
We’ll be like this when dead.

Despite the advanced state of sanitation engineering in the Roman world, the average life span
was only 30-40 years.

Galen
If the work of Hippocrates represents the foundation of Greek medicine, then the work of
Galen, who lived six centuries later, is the apex of that tradition. Galen crystallised the best
work of the Greek medical schools which had preceded his 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 works, 1550
Collection Bertarelli, Milan Medicatrina, Clinic Scene. 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.

Galen hailed from Pergamon, an ancient center of civilization, containing, among other
cultural institutions, a library second in importance only to Alexandria’s. Galen’s training was
eclectic. Although his chief work was in biology and medicine, he was also known as a
philosopher and philologist. Training in philosophy was, in Galen’s view, an essential part of
the training of a doctor, not merely a pleasant addition.

His treatise entitled That the best Doctor is also a Philosopher provides 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 of healing. The doctor must learn to despise
money. Galen frequently accused his colleagues of avarice. In order to defend his profession
against this charge, he downplayed the motive of financial gain associated with becoming a
doctor.

For his first professional appointment, Galen served as surgeon to the gladiators in Pergamon.
In this tenure, he undoubtedly gained much experience and practical anatomical knowledge
from the combat wounds he treated. After four years, he emigrated to Rome where he earned
a brilliant reputation as a practitioner and a public demonstrator of anatomy. The emperors
Marcus Aurelius, Lucius Verus, Commodus, and Septimius Severus sought his care.

Galenism

Galen, for all his mistakes, remained an unchallenged authority in his lifetime, and his work
established a legacy that continued for over a thousand years. In his day Galen said everything
there was to be said on anatomy. According to reports he kept as many as 20 scribes on staff
to write down his every dictum. When he died in 203 CE, serious anatomical and
physiological research ground to a halt.

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 acceptable both to the
fathers of the church and to Arab and Hebrew scholars. Galen’s mistakes perpetuated
fundamental errors for nearly fifteen hundred years. Later, Vesalius, the sixteenth century
anatomist, began to dispel Galen’s authority, although he regarded his predecessor with
esteem.
Galen on the Soul

Postage Stamp, 1977

People's Democratic Republic of Yemen. A testament to Galen's lasting influence.

The fundamental principle of life, in Galenic physiology, was pneuma (air, breath). Pneuma
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) in the heart, center
of blood flow regulation and body temperature; and natural spirit (pneuma physicon) residing
in the liver, center of nutrition and metabolism (both animal and natural spirit are known as
pneuma physicon).

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 in the body, and he 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
gotten so close to the answer, did not himself arrive at the concept of circulation.

Galen’s Physiology

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, so Avicenna looked to Galen.

Galen’s genius was evident in the physiological experiments he conducted on animals. The
work On the Use of the Parts of the Human Body comprised seventeen books concerning 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 of
voice loss 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 in ungulate animals, was also present in humans. In spite of
Galen’s mistakes and misconceptions, his writings reveal an astonishing wealth of accurate
detail.

Military Medicos
Trajan's column, Rome, dedicated 113 CE: Soldiers aiding their wounded comrades

Trajan's column commemorates the emperor Trajan's Dacian Wars, fought at the
beginning of the second century CE. This scene illustrates the treatment of the
wounded under battlefield conditions. The medici (doctors) treating the wounded are
dressing superficial wounds and their uniforms are identical with that of the soldiers
they are aiding. This leads us to believe that the medici were simply soldiers who had
demonstrated their capabilities for wound dressing and primitive surgery, not trained
physicians.

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 these physicians 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.

Wall painting from Casa di Sirico, Pompeii, 1st Century BCE: Aeneas receiving medical
attention from Iapyx
 A wounded Aeneas is carried off the battlefield and taken to the physician to remove
the dart from his thigh with forceps.

Before Hellenistic influence, the Roman legion did not offer any medical services. It is to the
Romans’ credit that they recognized the need for such services, but their solution was not a
corps of trained physicians The Romans clearly distinguished between the treatment of the
“sick” and the “wounded.” The wounded were cared for, as much as possible, by fellow
soldiers on the fields, and the transportable sick were placed in ualetudinaria (hospitals) along
with the severely wounded.

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 the adventures of the Trojan hero
Aeneas who was forced to do battle with the native inhabitants of Italy upon immigrating
there from Troy.

Drawing of Attic Black Figured Vase, 6th Century BCE, National Museum Athens: Sthenelos
bandaging Diomedes' s 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.”

In one of the climactic scenes at the poem’s conclusion (Aeneid XII.383-440), Aeneas is
wounded in the thigh by an arrow shaft hurled from the enemy camp. After the wounded
Aeneas is helped back to camp, the surgeon Iapyx attempts to remove the arrow with forceps.
When he is unsuccessful, Venus, Aeneas’s 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 of practicing the “silent
arts,” i.e., medicine, by Apollo himself. Of Apollo’s three realms— music, prophecy, and
healing—it is only healing in which the voice is not used, hence medicine was known as the
silent art. This phrase also invokes the idea of obscurity, as the profession of medicine was
not thought to lead to great fame.