PRACTICAL HEALTHCARE IN THE WESTERN WORLD
Outside of scholarsof medicine, like Galen, most Roman doctors, or medici,were actually slaves (or ex-slaves) capturedas war prizes and then trainedin the practical healing arts. Themediciwere known to be skilled inbone-setting, as well as some surgery (cutting for bladder stones was probably the most common procedure), midwifery, and preparing medical recipes. Such recipes, or early pharmacology, were one aspect of medicine that showed a great deal of overlap between elite and nonelite medicine at this time. Galen’s writings, for example, describe compounddrugs—that is, preparations composed of multiple ingredients assembled according to astandard recipe, but with room for substitutions and modifications.
Galen likely borrowed ideas and recipes of otherGreco-Roman authors (Hippocrates included) incompiling his lists. By then the expandingRoman Empire had accumulated a substantial body of new knowledge fromcross-cultural encounters and exchanges. The compound drug theriac, for
example, was said to have originated in the court of the Persian king Mithridates VI in the first century bce as an antidote for snakebites and other poisons. Mithridates, who was terrified of beingpoisoned, was known to drink theriacevery day.
Jars intended for the storage of mithridatum, which was an antidote for snakebites and otherpoisons .
By Galen’s time,theriac was extremely popular and widely usedas a general tonic (an invigorating substance). Although other Greco-Roman doctors had added to the recipe over time, none did so as
much as Galen, who produced a version of therecipe containing a whopping seventy-nine ingredients. Galenmay have elaborated on his recipe because he wanted to secure a stronger position for himselfand for physicians. Galen “reshapedthe Hippocratic triangle of doctor,patient and illness to ensure thedoctor’s dominance.”
Like his father, Galen valued dreams. He alsoaccepted some aspects of divination, particularly the Greek tradition of bird-divination, in which interpreters skilled in the art wouldobserve patterns in theflight of birds to explain current circumstances and predict future outcomes. Galen accepted bird-divination and ascribed to it a naturalistic cause-and-effectrelationship: changes in weatheraltered the flight of birds, he supposed, and the humoral composition of individuals, which predicted their susceptibilities to disease.
However, Galen opposed astrology as an acceptable part of medicalpractice, despite the fact that it appeared to offer possibilities for the same kinds of naturalistic,weather-based medical indicators thatbird-divination did. The movements of the stars were widely believed toinfluence the weather, and several ofGalen’s medical contemporaries considered astrology a valuable aspect of their practice. Perhapsin part due to his efforts to distancehimself from “magical” medicine,Galen, somewhat arbitrarily decidedto draw the line at astrology.
SLAVE MEDICINE,THE ROMAN ARMY, ANDTHE ORIGINS OF THE WESTERN HOSPITAL(VALETUDINARIUM)
Neither Greek nor Roman societyhad many
institutions devoted to dealing with the sick, whetherrich or poor. One exception to thisin Roman life
Latin termvaletudo(meaning health). Some larger slave-owning householdsset aside special roomscalledvaletudinariafor themedicito take care
of sick slaves, and the Roman military adopted a similar system to care for sicksoldiers.
Archeological evidence suggests that humoral medicine and ideas of miasmatic disease transmission (the ideathat disease was caused by miasmas,noxious vapors from decaying plant or animal matter) strongly influenced the architectural design of militaryvaletudinaria. For instance, there appears to have been a concerted effort to limit the number of patientshoused in any one room and to usebuilding techniques to increase natural light
and improve ventilation wherever possible,which suggests a mindfulness to the dangers of miasmatic airfouling the atmosphere.
Both army and slave valetudinariaprobably retained spiritual aspects ofhealing.28 Modern scholars havefound references to prayers and rituals involving the worship of Asclepiusand other deities in texts and eveninscribed on the walls of archeological ruins.
One aspect of medicalcare at an armyvaletudinariumthat likely differed from other kinds ofmedicine of the time was therange and extent
of surgical procedures performed there. A widerange of brass and copper surgicalinstruments have been unearthed from ancient military sites, and there are some surviving firsthandaccounts of the
was the valetudinarium, a word with its roots in the kinds of procedures surgeons performed. We know, forinstance, that wounds were washed, cleaned,salved (covered with ointment), bled,and dressed by surgeons and thenwatched carefully for signs ofhealing or corruption. A good flow of white-colored discharge—something surgeons referred to as “laudable pus”—at aroundthe fifth day of healing was anexample of good, healthy progress, for instance. On the other hand, the formation of abscesses and gangrene within a similartimeframe was taken as a dire signthat “corruption” of the wound had begun, and that urgent intervention would be required to save thelife of the wounded patient. In casesof wound corruption, surgeons applied hot pitch or turpentine to remove the flesh or would press a heated iron to the corruption in order to cauterize (burn) it away—a technique that was also commonly employedto staunch the flow of bloodfrom a wound.
Ancient Roman surgicaltools found at Pompei
Surgical amputations might also have occurredas part of military medicine in thevaletudinaria,especially since methods for amputation were discussed by several leading scholars of thefirst
century. However,it is difficult to say how commoncertain surgical procedures really were.
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