They’re known for their roads, military strategy and inventing the book – but what advice might our Roman forebears issue on the subject of staying healthy? Dr Nick Summerton shares six Roman medicine practices…
The Romans attached great importance to preserving health
The second-century physician Galen emphasised that it was a person’s responsibility to take care of their bodies, writing that people must “take it upon [them]selves to preserve health” by following a particular lifestyle (or `hygiene`). He highlighted the importance of taking fresh air and getting enough sleep, in addition to carefully considering diet, exercise and hydration. Galen certainly led by example, writing: “After I reached the age of twenty-eight, having persuaded myself that there is an art of hygiene, I followed its precepts for the rest of my life and was never sick with any disease apart from the occasional fever.”
It was seen as extremely important to tailor the ‘hygienic approach’ to individuals, ensuring that a person was not under-or over-emphasising any specific element as part of their health plan. As Galen explained: “For just as it is impossible for cobblers to use one last for all people, so too it is impossible for doctors to use one plan of life that is beneficial to all. Because of this, then, they say it is most healthy for some to exercise sufficiently every day, whereas for others, there is nothing to prevent them passing their lives wholly in idleness. Also, for some it seems to be most healthy to bathe, whereas for others it does not.”
What were the four humours?
The Romans believed that all matter within the universe – including human bodies – was made from four elemental substances (fire, air, water and earth) and four elemental qualities associated with them (hot, cold, wet and dry). It was thought that the human body contained four corresponding humours – blood (hot and wet); yellow bile (hot and dry); black bile (cold and dry); and phlegm (cold and wet). These four humours needed to be in the correct amounts and strengths for a body to be healthy. The proper blending and balance of the four humours was known as ‘eukrasia’ – whereas imbalance of humours – or `dyskrasia` – led to disease. Illness occurred when there was an imbalance of the four humours in the body. ‘Hygiene’ (which was used in a slightly different sense to its definition today) was about restoring the normal equilibrium of humours and qualities – thereby preventing disease and preserving health.
Eat a healthy diet
Food and fresh air were key to good health
Much like today, a healthy diet was considered part of a balanced health plan. Recent evidence based on an examination of material from several Roman sewers has shed some light on the foodstuffs being consumed by the average Roman. By modern standards, the diet of the population in Herculaneum at the time of the eruption of Vesuvius was extremely healthy and mineral rich, containing high levels of seafood and vegetable protein. (In fact, the residents of Herculaneum probably ate considerably more fish than are consumed by the area’s population today!)
Gardens were also popular with the Romans and, aside from cultivating plants and vegetables, had a much broader role in enhancing wellbeing. In one of his letters, Pliny the Younger described walks along tree-lined pathways and avenues edged by box hedges at his villa in Tuscany. He also commented on the wholesome air with splendid views, cool breezes and sweet aromas.
Choose your doctor carefully
The Romans were wary of placing too much trust in physicians
The Roman historian Pliny the Elder cautioned his fellow citizens about trusting the medical profession – especially the Greeks: “Physicians acquire their knowledge from our dangers, making experiments at the cost of our lives. Only a physician can commit homicide with complete impunity.”
Despite numerous references to ‘physicians’ across the Roman empire, it is often unclear what led to an individual acquiring the title ‘doctor’. There were no examinations, no diplomas, no degrees and no professional licensing procedures in the Roman world; a doctor was simply an individual who claimed the title and carried out treatment for some type of remuneration.
Also, for the Romans, the concept of having a personal professional physician was an anathema. It was at odds with the Roman values of self-sufficiency and looking after your own. On Roman farms the head of the household (pater familias) assumed the role of chief healer with responsibility for the health of his family and any estate workers. As the scholar and agriculturalist Varro explained: “There are two divisions […] in the treatment of human beings: in the one case the physician should be called in, while in the other even an attentive herdsman is competent to give the treatment.”
The exact circumstances when the advice of a physician might be sought are somewhat vague. However one of the writing tablets discovered at Vindolanda, a Roman auxiliary fort just south of Hadrian’s Wall, suggests that the women of military families were expected to deal with the day-to-day health problems that arose in their households. They kept a selection of medicines on hand for this purpose. Paterna, the wife of the garrison prefect at Vindolanda, supplied medicine to her sister, Lepidina: “I shall supply you with two remedies”, she wrote in a letter to her – one of which was for fever.
Unfortunately, for the Roman patient, there were no lists of approved practitioners that could be checked for those wishing to enlist the help of a physician. To get an insight into a doctor’s abilities (and perhaps for entertainment, too), it was not unusual to attend public displays of anatomical skills or to watch medical competitions. In addition, Roman medicine was often practised in public with many folk clustering around the bed of a sick individual, critically scrutinising the care being proffered. Galen outlined how strangers even joined in on house visits: “Boethus seized me and took me along home to see the boy. People who met us in the street, of whom you were one, also came.”
Look after your eyes
Eye problems were a particular concern for Romans
To the Romans the eyes were a privileged body part, and the transition point between the soul and the outside world. Several representations of eyes – in gold, bronze and plaster – have been found at Wroxeter in Shropshire. Such religious votive objects were left in anticipation of a cure or as an offering of gratitude.
Inadequate hygiene and dusty roads would have contributed to the large numbers of individuals with eye problems. A military strength report of the First Cohort of Tungrians from Vindolanda specifically categorises the 31 soldiers signed off as unfit into three distinct groups: aegri (sick – 15); volnerati (wounded – 6); and lippientes (eye troubles – 10).
Two dozen oculist (or collyrium) stamps have been discovered in Britain – including two at Wroxeter. These small green stones were used for impressing the name of the maker as well as the nature and purpose of an eye treatment onto a hardened block of medication (collyrium). The stamps usually consist of small thin square blocks, generally with an inscription on each of the four edges. In a few instances the stone is oblong with two inscribed sides and in one from Wroxeter, it is circular. The letters are cut in intaglio form and written from right to left so that when stamped on the collyrium they make an impression that reads from left to right.
In his De Medicina, the first-century writer Celsus devoted a whole chapter to eye care and provided a very clear description of cataract surgery:
“He is to be seated opposite the surgeon in a light room, facing the light, while the surgeon sits on a slightly higher seat; the assistant from behind holds the head so that the patient does not move: for vision can be destroyed permanently by a slight movement…
“Thereupon a needle is to be taken pointed enough to penetrate, yet not too fine, and this is to be inserted straight through the two outer tunics at a spot intermediate between the pupil of the eye and the angle adjacent to the temple, away from the middle of the cataract, in such a way that no vein is wounded.
“The needle should not be, however, entered timidly… When the [correct] spot is reached, the needle is to be sloped…..and should gently rotate there and little by little guide it [ie, the lens with the cataract] below the region of the pupil.”
Eye couching needles to undertake the procedure have been found at Carlisle and Piddington Roman Villa, Northamptonshire.
Secure expert wound care
The survival rate of Roman soldiers after battle was better than that of their opponents
Slashing and cutting wounds from long swords would have been particularly common injuries for Roman soldiers battling across Britain. Other weapons used by the local tribes included spears, knives, axes, stone sling shot and, less commonly, arrows. The consequences for some unfortunate Roman soldiers were fractures, head and eye injuries – in addition to penetrating abdominal or chest wounds.
All cuts and abrasions needed cleaning and dressing: some others required stitching too. Occasionally, more complicated surgery was necessary to remove bone fragments, stop bleeding or to extract spear points.
Traumatic wounds were at particular risk of getting infected and honey dressings were frequently used by the Romans. The military physician Dioscorides wrote that “honey is cleansing, opens pores, and draws out fluids. Boiled and applied it heals flesh that stands separated”.
A lot of basic wound care would have been provided by fellow soldiers, some of whom – the capsarii – were trained first aiders. The capsarii were under the control of a doctor with the rank of a centurion, such as Anicius Ingenuus, medicus ordinarius of the first cohort of Tungrians from Housesteads, on Hadrian’s Wall.
The repair of a simple flesh wound was the most performed surgical procedure undertaken by individuals such as Anicius Ingenuus. Basic surgical kits consisting of probes, hooks, forceps, needles, cautery tools and scalpels were readily available, and many items have been discovered in excavations at Roman sites across Britain.
Stitching cuts with a needle and thread was not dissimilar to the approach used today, but if there were any concerns about infection or inflammation the fibulae technique was often preferred. This entailed passing copper-alloy skewers through the wound and then looping threads around them in a figure-of-eight fashion. The Roman medical writer and thinker Celsus wrote that “fibulae leave the wound wider open […] in order that there may be an outlet for any humour collecting within”.
Focus on overall wellbeing
To the Romans, physical and mental health were closely linked
Looking after the psyche – or the soul – was viewed as integral to the care of the body and it was a key element of keeping in shape alongside exercise, fresh air, sleep and diet.
Many Romans citizens sought a philosophy of life and one approach popularised by the likes of the emperor Marcus Aurelius was Stoicism. The overriding aim was to replace negative emotions such as grief, anger and anxiety with positive emotions such as joy.
Other individuals, such as the emperor Caracalla, frequented healing sanctuaries. These focused on providing holistic care (including psychological wellbeing) by offering a broad range of treatments, as well as enlisting the assistance of healing deities including Aesculapius.
Across Britain several inscriptions to Aesculapius have been discovered in addition to two healing sanctuaries at Lydney, in Gloucestershire, and Bath, dedicated to Nodens and Sulis Minerva respectively. The site at Lydney has been comprehensively excavated revealing a temple, a guest house, a well-equipped suite of baths and a long narrow building containing many cubicles (abaton).
The abaton was where visitors would have been taken to experience ritual temple sleep and dream healing – termed incubation. During this process priests circulated among the sleepers with serpents or dogs, the curative dreams being augmented by licks from the animals.
At Lydney numerous representations of sacred Irish wolfhounds have been found, in addition to a mosaic decorated with fish and sea monsters bearing the inscription: D M N T FLAVIUS SENILIS PR REL EX STIPIBUS POSSUIT O[PITU]LANTE VICTORINO INTERP[RE]TIANTE (translated as “for the god Mars Nodens, Titus Flavius Senilis, superintendent of the cult, from the offerings had this laid; Victorinus, the interpreter (of dreams), gave his assistance”).
Individuals visiting healing sites would have been subjected to a raft of psychological interventions designed to restore their tranquillity: group therapy, talking therapy, various arts therapies, dream healing; all combined with rest and relaxation. There was also an emphasis on locotherapy – the psychological benefits of locomotion as well as being in a specific place (location). There is evidence for eye care and surgery being undertaken at Lydney too.
Water was also an extremely important element of many sanctuaries and was drunk for its healing properties as well as being used for bathing, hydrotherapy and ritual cleansing. Some sites, such as Bath, were associated with hot springs or waters with specific mineral constituents. At Lydney the iron-rich nature of the waters might have encouraged individuals suffering from anaemia to visit, based on the finding of a votive hand exhibiting koilonychia (spoon-shaped nails), a sign of iron-deficiency.
Nick Summerton is a medical doctor with a longstanding interest in Roman Britain. His fifth book Greco-Roman Medicine and What It Can Teach Us Today will be published later this year by Pen and Sword Books. You can find him on Twitter @YorkshireGP