Medicine – Part Four

The Romans

The Romans were on the rise as an expansionist force from around the 3rd Century BC, and cut a bloody swathe across the Mediterranean. The Ancient Roman Empire, at its height, stretched from Hadrian’s Wall in the north west, to the shores of the Caspian Sea, down to the Red Sea in Egypt an across North Africa to the straits of Gibraltar. By 27 B.C. Greece had been fully annexed by Rome. Greek culture and philosophy had a great effect on the Romans, including art, architecture, rhetoric, science, literature, etc. Romans borrowed from this a great deal, and certainly did so in the case of medicine. The Romans invaded Britain in 43 A.D. and brought many of these ideas and technologies with them. Warning: more white people doind stuff

Aqueducts brought in fresh water. They we ingeniously built with a slight slope across the entire length, which enabled water to flow along them. They supplied towns and cities, allowing public and private baths, fountains and toilets, along with irrigation for farming. Most were buried underground. When they had to cross valleys is where we see the arched structure we most readily recognise as an aqueduct. Clean(er), fresh water being brought it for public hygiene was a revolution for most areas of the empire that had relied on rivers, lakes and wells, with the associated issues that stagnant water could bring., and people becoming ill from all using the same water source.

Rich Romans would have water piped in to their homes. This meant they weren’t using the same water supply as others, which meant they were not at risk of catching infections from those using communal water sources. This was a time when many civilisations simply threw waste on to the streets or in to the local river, which was also used for drinking, etc. Aqueducts could avoid this, although poisoning the aqueduct was a favourite tactic for a besieging army.

The Romans were hard headed and practical. They were known for empirical observation. They had noticed that when armies camped by stagnant water and used this the soldiers were more likely to become ill. They also saw that soldiers bitten by flies and mosquitoes near this water also became ill more often. Hence they wrote military instruction manuals that recommended not camping near these places. Hence also wanting aqueducts for fresh water in settlements. This didn’t mean they knew the causes of disease, far from it. But they were using common sense in this case.

Romans knew that a healthy army was more likely to win wars, and that a healthy populace would be able to be more productive, and pay more tax. As such they invested in public amenities for both the public and the military. Roman toilets (latrines) were communal. They also became social meeting places.

A small hole was provided for the necessary. A steady stream of water ran under the latrine to carry waste away. A sponge on a stick was used to clean yourself afterwards. The only problems was that this was communal as well. So while this was a marked improvement on what had gone before, there were still issues.

Another feature of Roman health were the baths, both private and public. These provided a social function as well as being for hygiene. The baths consisted of a number of different rooms. First was the atrium. Here people could exercise, or simply watch. Further inside there were changing rooms. There was then a warm room, known as a tepidarium. This was a preparation for the hot room or hot baths. Next was the caldarium, or hot room, where the temperature was even higher. Here you could open up the pores and sweat out the previous night’s excesses. Often there was a cold pool to finish off before you left, or as an alternative, known as the frigidarium.

The baths were cleverly designed and even had underfloor heating. Furnaces maintained by slaves would heat air and water so they were constantly available. Under the floor of the hypocaust you can see the gaps left between supports for the warm air to circulate. Baths were often highly decorated with mosaics and ornaments.

But where was all the waste and water to go after it was finished with? The Romans also developed sewers. Strabo wrote: “The sewers, covered with a vault of tightly fitted stones, have room in some places for hay wagons to drive through them. And the quantity of water brought into the city by aqueducts is so great that rivers, as it were, flow through the city and the sewers; almost every house has water tanks, and service pipes, and plentiful streams of water…In short, the ancient Romans gave little thought to the beauty of Rome because they were occupied with other, greater and more necessary matters.

So instead of waste rotting in the streets, attracting rodents and other pests, it was sent in to the sewer system. This would help to stop the spread of disease to an extent, especially in large cities like Rome. However, disease was by no means eliminated. Large populations crowded  together will always bring health issues, and the Roman’s lack of understanding of what really caused disease held them back. But the Roman focus on public health was certainly an upgrade on what had come before.

Romans also had doctors. As stated they borrowed much from Greece. Doctors were one feature, and indeed many Roman doctors came from Greece. Doctors were attached to the legions to keep the troops healthy. Many richer households would have a doctor attached. The Emperor had a personal physician. These doctors and their eventual Roman counterparts still heavily relied on the theory of the four humours. Herbal remedies were still highly popular treatments, along with diet and exercise.

Roman doctors could carry out a number of surgical operations. Indeed Julius Caesar was born using caesarean section. Scalpels, forceps, drills, saws, spatulas and even vaginal specula have been found on Roman archaeological sites and literature. Hospitals were set up where slaves and soldiers were treated. This allowed doctors to learn some anatomy, but dissection was still banned for religious reasons. Gladiators taking wounds in the arena also provided doctors with an opportunity to practice techniques. and to see partly what lay within the human body.

The most famous Roman doctor was  Claudius Galen. Galen was from Greece and rose to prominence to become a personal doctor to the Emperor Commodus. He received part of his education at the famous medical school in Alexandria, Egypt, which featured in part 2. He was also a physician to gladiators. Galen developed the theory of the four humours, and added to it the theory of opposites. In its simplest form, this meant if someone was too hot, putting them in cold water. If someone was cold, warm them up, etc you get the idea. Galen contributed much to anatomy via his dissections of monkeys and pigs. Most important was that Galen wrote down his findings in many books. Although he did much good he also made mistakes which he wrote down. Galen was famous and his works disseminated. “Galenism” became very strong. For various reasons these texts went unchallenged for over 1,000 years in the Western world and what remained of the Eastern Roman Empire.. It was not until the Renaissance period that they were challenged. His works took on an almost sacred quality. When some doctors found things that showed Galen was wrong, they assumed it was they who were mistaken and not Galen.

Jonathon Davies, Going Postal

Among Galen’s major contributions to medicine was his work on the circulatory system. He was the first to recognize that there are distinct differences between venous (dark) and arterial (bright) blood. Although his anatomical experiments on animal models led him to a more complete understanding of the circulatory system, nervous system, respiratory system, and other structures, his work contained scientific errors. Galen believed the circulatory system to consist of two separate one-way systems of distribution, rather than a single unified system of circulation. He believed venous blood to be generated in the liver, from where it was distributed and consumed by all organs of the body. He posited that arterial blood originated in the heart, from where it was distributed and consumed by all organs of the body. The blood was then regenerated in either the liver or the heart, completing the cycle.”-Infogalactic

In his work De motu musculorum, Galen explained the difference between motor and sensory nerves, discussed the concept of muscle tone, and explained the difference between agonists and antagonists. Galen was a skilled surgeon, operating on human patients. Many of his procedures and techniques would not be used again for centuries, such as the procedures he performed on brains and eyes. To correct cataracts in patients, Galen performed an operation similar to a modern one. Using a needle-shaped instrument, Galen attempted to remove the cataract-affected lens of the eye. His surgical experiments included ligating the arteries of living animals.-Infogalactic

Romans also had a strand of supernatural medicine. The Greek god Asklepios was incorporated in to the Roman pantheon as Asclepius. Romans also prayed to Salus, and leave offerings at temples. Plagues, disease and famine were often seen as punishments from angry gods. Others blamed bad air, or ironically creatures too small to be seen. Eventually the Roman Empire collapsed, or at least faded away. We are one step closer to being able to survive gargling with novichok, but still so far away. And so we move on to the Middle Ages…

© Jonathon Davies 2018

(Pictures obtained from the Public Domain.)

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