Roman Medicine: We, in our overmedicated and over-modified world, have visions of primitive medical practices in "ancient" Europe. We think of unsanitary curbside surgeries by traveling barbers, poisons distributed as medicines (and vice versa, if you had enemies), herbs and simples with minimal value, bleeding and purging, superstition. There was some of that in the Roman world, but most of the excesses actually came later, when Roman knowledge had been lost.
What did the Romans know, and who did the knowledge benefit? First, a cautionary note: it is often said that Roman life expectancy at birth was about twenty-five years, but that if you got through the dangerous infant and toddler years you could expect to live into your fifties. Modern estimates like those, which are based on small ancient data samples, can not adequately profile the "Roman" populations. ("Roman" is in quotes here, because there was considerable demographic variation across the "Roman" sphere and over a period of more than a thousand years between the founding of Rome and the departure of Constantine for his new eastern capital.) What we really have to "document" Roman life expectancy are anecdotes and sets of human remains, and that's simply not enough to draw statistical conclusions. Nonetheless, there are numerous Internet and hard copy compilations of dubious Roman longevity "statistics".
The first things you come across when researching the history of ancient medicine are the works ascribed to Hippocrates of the Greek Island of Cos. It has never been claimed that Hippocrates invented the practice of "medicine", but, either by accident or because of his fame in his own times, works ascribed to him were saved when others before or after him were lost. His immediate Roman followers, not surprisingly, were called "Hippocratici", but their other common name was more illustrative of their medical philosophy: they were called "dogmatici" or dogmatics, because they didn't question the medical dogmas which were handed down through their founders Thessalus, the son, and Polybus, the son-in-law of Hippocrates (about 400 BC). In the 2nd century, BC a rival school, called the "impirici" arose, and they claimed that their knowledge was derived only from experience. The rivalry between the two schools lasted only about one century (although individuals persisted), because of the rise of a third intermediate group, who called themselves the "methodici". This group synthesized the "best practices" of the dogmatici and impirici. There were later subdivisions in succeeding centuries, but they all were based on the "methodical" synthesis as approached by individual practitioners.
It should be remembered that, although Hippocrates and the various schools that immediately followed him were Greeks, the whole assemblage quickly became part of the "Roman" world and it was mostly the Roman or Romanized medicine that was passed down to posterity as "Western" medicine (even if some of it came through Byzantine or Arab channels.)
Earliest Roman practitioners combined several skills that are now spread among "specialists". In early days, a "medicus" would have to be pharmacist, physiologist, physician, and surgeon. It didn't take long, however, before specialization began, and individuals, while maintaining the full range of skills, could concentrate their efforts on certain aspects of medicine. Celsus, who was esteemed in the time of Augustus, was the preeminent compiler of medical information -- a writer of texts and manuals as well as an accomplished and respected practitioner. Pedanios Dioscorides had a Greek name but was born in Anazarba, Cilicia, in Asia Minor (now Turkey), and was a physician in the Roman army. His text on herbal medicines, written in about 65 AD, was used for more than 1500 years and then was reborn in late-20th-century "alternative" medicine: he was Rome's foremost pharmacist. Galen, whose works codified physiology and preserved surgical knowledge, was born in Pergamus, also in Asia Minor, but came to Rome early in life and established a thriving and popular practice -- popular here meaning popular with the aristocracy who could afford treatment for what ailed them. Galen is credited with systematizing Roman medical practices, and his efforts in this regard are still memorialized in, among other things, the construction of modern medical data-bases in projects that bear his name -- if you search for Galen on the Internet, you will find much more info on modern medical data compilations than you will find on Galen himself.
Roman "medici" were competent manipulators (that is they knew how to press, pull, and tug their patients' bodies and limbs back into proper alignment). They had figured out what medicinal vegetable, animal, and mineral compounds were effective and had a good working knowledge of efficacious dosages. And they were very good surgeons.
It is the last that most awes modern observers, and among the surgical procedures, it is trephination -- cutting holes in the skull to relieve pain and pressure -- that most often steals the spotlight. The process was well known, having been explicated early on by Hippocrates himself. (You can see ancient Roman trephined skulls at the Museo Preistorico ed Etnographico Luigi Pigorini on Piazza Marconi in EUR here in Rome). Other skull procedures were also developed, particularly those concerned with the reduction of depressed cranial fractures -- if your skull was pounded in, it could be fixed.
Thoracic surgery was rarely attempted, except for procedures to remove arrows and other projectiles and to close abdominal wounds. Roman practitioners could surgically reduce limb fractures when non-surgical methods failed, and they knew about (but rarely attempted) tracheal procedures to restore breathing and reconstruct tracheal openings. Roman surgeons did internal and external suturing and tied ligatures around blood vessels and used cauterization to stop bleeding. This was particularly important in amputations, which might be carried out to prevent spread of infection, tumors, gangrene, or in the case of industrial accidents, or war injuries. An ancillary profession, the construction of limb prostheses, was soon established
It was war injuries, of course, that really advanced Roman surgery. If you were lucky, your military unit would have a good medicus/chirurgus who could patch you up before you bled to death, and if you were really lucky he might retire to the same colonia that you were pensioned off to. (Chirurgus was really a corruption of the Greek word for surgeon, which transliterates into English as "cheirourgos". The pure Latin phrase for surgeon was actually "medicus vulnerarius", which means, literally, "wound doctor".) Roman military surgeons were, in fact, only rivaled by specialist arena surgeons, who repaired valuable gladiators.
Roman surgeons were also adept at several forms of minor plastic surgery. They did facial and other repairs, removed growths, etc. The most common operation appears to have been male de-circumcision. Reversal of genital mutilation, which might have been the result of religious observance or mischance, was an important procedure which one would seek in order to avoid embarrassment when appearing naked at the baths or in the gymnasia.
An interesting sidelight: even though they knew nothing about "germ theory" and the spread of disease, Roman surgeons, drawing on the practices of the impirici handed down through the methodici, always boiled their surgical tools and vessels before starting an operation.
As always, we need to ask ourselves whether there was anything distinctly "Roman" in Roman medicine. Weren't they just borrowing from neighboring Mediterranean societies? Did they have anything new to contribute? We know that the Romans adapted medical and surgical practices from the Greeks (some of it through the Etruscans), and that the Greeks, in their turn, got most of what they knew from the Egyptians. In fact, most "Roman" practitioners were imported (often enslaved) experts or the progeny of foreigners who preserved family or community skills and practices. It is sometimes said that what the Romans really contributed was their penchant for writing manuals -- we gather from modern analyses that the Romans were more interested in widespread propagation of knowledge than were their neighbors. The Romans didn't think of knowledge as something to be hoarded, confined by professional or family loyalties. But even this may be a false impression. The Egyptians also had medical texts, and so did the Greeks (and Persians). But because the copies of Greek and Egyptian works that have come down to us were found in "restricted" areas -- temples and tombs and private libraries of the very rich and important -- their finders (modern archeologists and historians) are inclined to think that their circulation was severely restricted. Roman texts, on the other hand, have been found in "public" libraries and were written by popular authors of their times. What we don't know, however, is what access the general Roman populace really had to Roman and earlier texts. The upper crust would have access, but did the "average" Roman, who would, of course, be a member of the slave or unskilled worker classes, ever go to the library or borrow medical texts from those who had them? These are probably unknowable things, but I'd guess that they would not. Even today, despite the vast amount of freely available information, how many of us know anything about modern medicine other than "what we read in the newspapers"?
Less important than what you knew was what your medicus knew -- and, of course, whether you belonged to the upper class minority that could afford treatment or whether you were important or valuable enough that someone in that minority might foot your bill.
The classical medical works are available in Italian and in Latin in bookstores here in Rome and in English through on-line book sellers. Some texts are available on line in English and Latin. (http://www.ea.pvt.k12.pa.us/medant/hyprtxts.htm is one useful starting point.
Some other Internet sites used in the preparation of this article are:
http://www.med.virginia.edu/hs-library/historical/antiqua/anthome.html (lots of links) and
http://www.mic.ki.se/West.html (even more links) and
http://www.ukans.edu/history/index/europe/ancient_rome/E/Roman/Texts/secondary/SMIGRA*/Medicina.html and http://www.ukans.edu/history/index/europe/ancient_rome/E/Roman/Texts/secondary/SMIGRA*/Medicus.html
and http://www.dl.ket.org/latin1/mores/medicine/index.htm and
http://www.utexas.edu/depts/classics/documents/Life.html (One of several sites that give admittedly unreliable statistics on Roman life expectancy) and,
http://www.cirp.org/library/restoration/rubin/ (a graphic explanation of Celsus's de-circumcision procedure)
Go to http://www.mmdtkw.org/Veneto2002.html for articles on other subjcts.