1. ANCIENT ALEXANDRIAN AND ROMAN MEDICINE
Jonathon Erlen, Ph.D.
University of Pittsburgh

2. Before we discuss the Hellenistic medical world, we need to define what we mean by the Hellenistic period, which is 1 of the most intriguing, yet confusing eras in world history.

3. Map of Alexandrian empire
Map of Alexandrian empire. The Hellenistic period was the time from the death of Alexander the Great, 323 B.C., to the death of Cleopatra of Egypt in 30 B.C. During these 3 centuries, there was an outpouring of Greek science and civilization throughout the Near East.

4. Immediately following Alexander's death, quite possible from malaria, in the city of Babylon, his military commanders carved up his empire into various Hellenistic states in the Near East.

5. The state we are most interested in is Alexandria, the Lighthouse of Greek knowledge, which became the center of medical studies during this period.

6. The state we are most interested in is Alexandria, the Lighthouse of Greek knowledge, which became the center of medical studies during this period.

7. The state we are most interested in is Alexandria, the Lighthouse of Greek knowledge, which became the center of medical studies during this period.

8. The state we are most interested in is Alexandria, the Lighthouse of Greek knowledge, which became the center of medical studies during this period.

9. We now come to the establishment of the great medical center at Alexandria in Egypt in the 3rd. century B.C.

10. It was created by Ptolemy I, who sought to establish the greatest center of learning in the known world. As he was the wealthiest ruler at that time, he could afford to and did build the world's largest library in Alexandria, with over 400,000 scrolls, including copies of the Hippcratic Corpus, and to attract many of the world's leading thinkers in a wide range of scientific and other scholarly fields.

11. Many of these resident scholars were housed in the museon
Many of these resident scholars were housed in the museon. This term does not mean museum, but, rather, temple to the muses.

12. In the museon was the world's largest library, with over 400,000 scrolls, including copies of the Hippcratic Corpus.

13. It was in the Alexandrian museon during the 3rd. century B. C. E
It was in the Alexandrian museon during the 3rd. century B.C.E. that we have definite evidence that dissection of the human body was first performed.

14. Although there are some reports of earlier anatomical research, such as the work by Alcmaeon of Croton during the 6th century B.C., who supposedly cut open an eye, are in the literature, it was the documented dissections in Alexandria which are the first we can definitely rely on.

15. It is at the Alexandrian museon during its era of research brilliance in the 3rd century B.C.E. that we encounter 2 of the greatest names in medical history.

16. The 1st. was Herophilus, 335‑280 B. C
The 1st. was Herophilus, 335‑280 B.C., who is regarded by the modern textbooks on the history of medicine as the father of anatomy. Through his anatomical dissections he differentiated between the nerves and the blood vessels. He also began a doctrine still in use today‑the doctrine of pulse counting, for which he used a water clock.

17. Herophilus' fellow researcher in Alexandria was Erasistratus, who lived between 310‑250 B.C.E., and who was renowned as the father of physiology, though not the physiology we study today. He rejected the concept of the 4 elements of Empedocles and the 4 humors. Instead, Erasistratus looked to the body's tissues and organs as the location of diseases, a relatively modern sounding concept. He also believed that the blood provided nourishment throughout the body and that pneuma, which we can define as air, was the substance required for life.

18. Unfortunately we hit a major roadblock in our examinations of the work of these 2 great Alexandrian medical figures because we have none of their original writings. All we have are the commentaries about their work by Galen of Pergamon who lived in the 2nd century AD and other later medical compilers.

19. What we can deduce from these commentaries is that their work was created in an open arena of clinical medical research at the museuon in Alexandria duirng the third century B.C.E.

20. After perhaps this one century of scientific research freedom, outside forces such as religions factors were to create barriers to medical research and education that in some cases lasted into the 19th century in the United States.

21. In Alexandria, Ptolemy Physcon, during the 2nd century B. C. E
In Alexandria, Ptolemy Physcon, during the 2nd century B.C.E., for unspecified reasons, decided to severely limit the academic freedom which had existed under his predecessors at the museon. He ordered the execution of a number of scholars for no apparent reason, and dispersed many more researchers to various points throughout the Mediterranean world.

22. The remaining medical scholars formed 2 bitterly opposing factions of medical thought, with 1 upholding the anatomical doctrines of Herophilus, while the other staunchly supported the precepts of Empedocles and the 4 elements.

23. What emerged from the Hellenistic and Alexandrian medical endeavors were 4 competing schools of medical philosophy, all of which were transmitted, to some degree, to ancient Rome.

24. Dogmatists
The dogmatists, emphasized the study of anatomy, and defended their position by references to Plato, Aristotle, and the Stoic and Epicurean systems of medical thought.

25. Empiricists
The Empiricists, who flatly rejected the idea that a physician could detect the unknown functional origins of the body, or even that such knowledge as might be gained from anatomical observations would benefit the patients' care. Instead, the empiricists placed total reliance on philosophical arguments and were viewed as medical skeptics.

26. Methodists
The Methodists rejected all generalities in medical science, while focusing solely on the individual and his/her health problems. Each individual was a unique medical case; thus, knowledge gained from treating other patients was not useful. This obviously put severe limitations on the study of medicine, as past medical wisdom could not be used by the doctor to treat the patient in front of him.

27. Pneumatists
The Pneumatists were an offshoot of the Dogmatists. Harkening back to the teachings of Aristotle and Erasistritus, the Pneumatists believed that pneuma was the prime necessity for life.

28. PNEUMA
pneuma, what we can call air in a very loose translation, was thought to be the primordial matter upon which all life is based; thus, the cause of all diseases was a disturbance among the body's humors which created an imbalance of the pneuma in the body. This belief that an imbalance of some form of substance or substances within the body caused all diseases was to be a recurring theme in the history of medicine, and would haunt the development of medicine well into the 19th century.

29. Dogmatists Empiricists Methodists Pneumatists
These 4 conflicting medical philosophies were brought to Rome by Greek physicians, the iatros, particularly after Rome incorporated Greece into its empire.

30. Long before this time; however, ancient Romans had developed their own, very different pattern of health care.

31. Early Roman medical beliefs and practices dating back to the 7th century B.C.E. were based on Roman agricultural practices and the religion of the countryside. Disease was understood to be a sign of divine displeasure that everyone would experience from time to time when the gods were angered.

32. Malaria Anthrax Typhus Fever
Common Roman Diseases
Malaria
Anthrax
Typhus Fever

33. Early Roman health care was religio‑magical in nature, and there were no formally trained doctors These early Romans erected prayer altars to the various healing gods they relied on to save them from ill‑health, as well as the use of magical healing amulets-see above.

34. They relied on the pater familias to be the dispenser of the simple remedies used to combat diseases and injuries.

35. The pater familias was the male head of each household
The pater familias was the male head of each household. The basic herbal cures he used within the household were passed on to him from his father via oral tradition, and he in turn would pass them on to his sons.

36. The early Romans adopted the healing gods of their Etruscan forbearers, but were always ready and willing to accept new healing deities when the need arose.

37. Thus when a great plague hit 5th century B. C. E
Thus when a great plague hit 5th century B.C.E. Rome the populace built a temple to the Greek god Apollo, seeking his intervention to end the epidemic.

38. When another plague arrived in Rome in 295 B. C. E
When another plague arrived in Rome in 295 B.C.E. the citizens readily asked for succor from the Greek healing god Asclepius, and built a major temple in his honor on an island in the Tiber River.

39. Dogmatists Empiricists Methodists Pneumatists
Thus when the 4 Hellenistic medical philosophical schools entered Rome in the 3rd century B.C.E., they were met by the well established indigenous medical system of the Etrusco‑Latin religio‑magical medical beliefs and the common sense health care practices of the pater familias based on Roman agricultural experience.

40. The first Greek doctor to supposedly arrive in Rome was Archagathus of Sparta in 219 B.C.E., though there certainly were others who preceded him.

41. Over the following centuries Greek iatroi from the various parts of the Hellenistic world arrived in Rome in ever increasing numbers.

42. At first many of these philosophically trained iatroi came as slaves, as Rome solidified its military hold over the Near East.

43. As Greek medical concepts became more popular, especially among members of the upper class; however, we find efforts in the Empire period to actively attract Greek doctors to Rome.

44. Roman emperors granted Greek physicians willing to come to Rome:
high status of Roman citizenship
freedom from military service
no taxation of their incomes

45. Most Romans strongly opposed these "foreign" doctors and their philosophical ideas and clung strongly instead to the centuries‑old indigenous pattern of common sense medicine as handled by the pater familias.

46. Over the following centuries Greek doctors from the various parts of the Hellenistic world arrived in Rome in ever increasing numbers.

47. Although some of the nobility and parts of the lower classes readily accepted these Greek iatroi and their philosophical approach to health care, there was also a sizable part of the Roman populace, probably the majority, who strongly opposed these "foreign" doctors and their philosophical ideas and clung strongly instead to the centuries‑old indigenous pattern of common sense medicine as handled by the pater familias.

48. Cato the Elder in his text, On Agriculture , harshly criticized the “foreign” Greek iatroi and their philosophical medical beliefs.

49. Aulus Cornelius Celsus, in his compendium of native cures entitled, On Medicine, harshly condemned the philosophical approach of the Greek physicians and encouraged the Roman citizenry to reject these outside influences.

50. Aulus Cornelius Celsus, in his compendium of native cures entitled, On Medicine, harshly condemned the philosophical approach of the Greek physicians and encouraged the Roman citizenry to reject these outside influences.

51. Aulus Cornelius Celsus, in his compendium of native cures entitled, On Medicine, harshly condemned the philosophical approach of the Greek physicians and encouraged the Roman citizenry to reject these outside influences.

52. Pliny the Elder, 23‑79 A. D. , who died in the explosion of Mt
Pliny the Elder, 23‑79 A.D., who died in the explosion of Mt. Vesuvius. slides from Pompey from 79 AD also condemned the Greek iatrio and his philosophical concept of disease causation.

53. Ruins of ancient Pompey

54. bleeding cups from ancient Pompey

55. retractors from ancient Pompey

56. spatulae from ancient Pompey

57. forcepts from ancient Pompey

58. vaginal speculum from ancient Pompey

59. speculum from ancient Pompey

60. scalpels and dissectors from ancient Pompey

61. instrument cases from ancient Pompey

62. instruments from ancient Pompey

63. instruments and medical cases from ancient Pompey

64. Perhaps this viewpoint was best stated by Pliny the Elder, 23‑79 A. D
Perhaps this viewpoint was best stated by Pliny the Elder, 23‑79 A.D., who died in the explosion of Mt. Vesuvius, who charged the Greek iatros with being incompetent and false in their medical claims.

65. Pliny the Elder in is major work, Natural History, which is 1 of the greatest of the encyclopedic studies describing early Roman culture and life styles, harshly condemned the Greek iatros and his worthless cures.

66. By the time we come to the age of the great Galen of Pergamon in the 2nd century A.D., we find that much of the philosophical rhetoric of the Hellenistic medical schools had been rejected by the Romans, and that which was retained was merged with the native magical‑religious and common sense elements of health care which previously described.

67. The Romans had taken the best and most useable elements of Hellenistic theoretical medicine and combined this with traditional Roman medicine, folk medicine, and recipes for cures, to fashion a satisfactory, useable style of practical Roman medicine.

68. It was in their practicality and their greatness in large‑scale organization that the Romans made their major contributions to medicine and public health.

69. This point is well illustrated by the massive public works projects during the Roman Empire, undertaken to assure an adequate water supply and acceptable public sanitation.

70. One of the best known efforts at promoting public health were the public baths, which flourished for centuries in Rome and the other major cities of the Roman Empire.

71. One of the best known efforts at promoting public health were the public baths, which flourished for centuries in Rome and the other major cities of the Roman Empire.

72. Although these baths may have fostered some degree of public cleanliness, they also provided ideal locations for the transfer of various communicable diseases such as syphilis.

73. Although these baths may have fostered some degree of public cleanliness, they also provided ideal locations for the transfer of various communicable diseases such as syphilis.

74. Ancient Roman public baths were also a place where venereal diseases was widely spread.

75. Ancient Roman public baths were built in all major Roman cities.

76. An even better recognized symbol of Roman health technology still highly visible today in Europe were the 11 aqueducts, built between 312 B.C. and 226 A.D., to provide Rome with an abundant source of fresh water.

77. These structures were erected across valleys and rivers for the reasons that underground lead‑piping was too weak and bronze piping too expensive, along with the fact that it was much easier to repair an exposed water delivery system than 1 that was buried.

78. These structures were erected across valleys and rivers for the reasons that underground lead‑piping was too weak and bronze piping too expensive, along with the fact that it was much easier to repair an exposed water delivery system than 1 that was buried.

79. These structures were erected across valleys and rivers for the reasons that underground lead‑piping was too weak and bronze piping too expensive, along with the fact that it was much easier to repair an exposed water delivery system than 1 that was buried.

80. Within Rome itself, many of the homes of the wealthy had the sanitary convenience of well drained latrines, something that would fall into disuse in Western civilization until the end of the 19th century.

81. Within Rome itself, many of the homes of the wealthy had the sanitary convenience of well drained latrines, something that would fall into disuse in Western civilization until the end of the 19th century.

82. Ancient Roman public latrines found in all major Roman cities.

83. Throughout the city of Rome, Roman engineers, renowned for their massive projects, devised a tremendous system of underground sewers to remove excrement from the city.

84. Throughout the city of Rome, Roman engineers, renowned for their massive projects, devised a tremendous system of underground sewers to remove excrement from the city.

85. Roman technical and hygienic public health achievements clearly surpassed any purely medical advances made in this period, and this fact can at least be partially attributed to the Roman belief that it was far more important to maintain one's good health than to depend on medicine’s ability to cure disease.

86. Although there were large hospitals, called valetudinaria, created to service the Roman legions in their military campaigns, there were no secular hospitals built in Rome.

87. Although there were large hospitals, called valetudinaria, created to service the Roman legions in their military campaigns, there were no secular hospitals built in Rome.

88. Personal health was still seen within the ancient framework of the household.

89. The average Roman citizen distrusted the philosophical pronouncements of the Greek iatros and put his/her faith in the hands of the pater familias.

90. John Scarborough, a leading ancient Roman history of medicine scholar, cites numerous quotes that show how the ancient Romans made fun of the iatros and his supposed healing skills.

91. Quackery was very wide spread, particularly the practice of concocting and selling fraudulent drugs. These useless, and even dangerous preparations were sold by traveling quacks, not only to the sick, but also to local doctors, who, in turn, passed them on to their patients in hopes of their curative powers.

92. Medicine=Trade
The practice of medicine at this time was actually a trade, not a profession as it is today, and doctors actively competed with one another for patients by giving public lectures and any other means of enticing potential paying customers.

93. Because of this fact, many physicians refused to treat seriously ill patients, fearing that if these individuals died, word would spread of the doctor’s incompetence and the doctor would loose potential future business.

94. When we evaluate the effectiveness of official medicine in Roman society we need to note the prodigious influence of magic and traditional forms of religious medical practices, such as amulets, votive offerings, and the like, on both the doctors and their patients.

95. Hippocratic Corpus
In final summation we can credit Roman medicine with successfully, for their time, synthesizing some of the best medical aspects from the classical Greek traditions, particularly the Hippocratic Corpus

96. With the short‑lived Alexandrian experimental medical science housed in the museon

97. With the Roman aristocrats' learned, simple health cures followed by the pater familias as set down by the encyclopedists such as Cato the Elder and Pliny the Elder

98. Roman society demanded that its physicians serve also as "friends" upon whom they could call for solace, if not actual medical help, during their illnesses, similar to the image of the general practitioner in early 20th century America. The best doctors relied more on rest and diet than on drugs and harsher forms of therapy for their patients.

99. Most health care practices were performed in the home under the direction of the pater familias, who relied on oral tradition and common sense, along with a long list of potential healing gods to see his family through all medical matters.

100. Doctors, either the Greek philosophically oriented iatros or the old fashioned Roman healers, were seen as a last ditch effort at medical assistance to be tried only after everything else had failed.

101. Despite this rather grim picture of traditional Roman medical care and the Roman and Greek physicians who carried it out, there was 1 great medical figure to emerge from this era.

102. Galen of Pergamon, ??? A.D., would have a major influence on the development, or lack of development of medical science in Western Europe for well over a thousand years.