Popular Medicine in Graeco-Roman Antiquity: Explorations 9004325581, 9789004325586

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Popular Medicine in Graeco-Roman Antiquity

Columbia Studies in the Classical Tradition Editorial Board William V. Harris (editor) Alan Cameron, Suzanne Said, Kathy H. Eden, Gareth D. Williams, Holger A. Klein, Seth R. Schwartz

Volume 42

The titles published in this series are listed at brill.com/csct

Popular Medicine in Graeco-Roman Antiquity: Explorations Edited by

W.V. Harris

LEIDEN | BOSTON

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Contents Preface vii List of Figures ix Abbreviations x Notes on the Contributors xiii 1

Popular Medicine in the Classical World 1 W.V. Harris

2

Pharmakopōlai: A Re-Evaluation of the Sources 65 Laurence M.V. Totelin

3

Asclepius: A Divine Doctor, A Popular Healer 86 Olympia Panagiotidou

4

Anatomical Votives: Popular Medicine in Republican Italy? 105 Rebecca Flemming

5

Between Public Health and Popular Medicine: Senatorial and Popular Responses to Epidemic Disease in the Roman Republic 126 Caroline Wazer

6

Metals in Medicine: From Telephus to Galen 147 Julia Laskaris

7

Crossing the Borders Between Egyptian and Greek Medical Practice 161 Isabella Andorlini

8

Representations of the Physician in Jewish Literature from Hellenistic and Roman Times 173 Catherine Hezser

9

Fear, Hope and the Definition of Hippocratic Medicine 198 Chiara Thumiger

10

Medical Care in the Roman Army during the High Empire 215 Ido Israelowich

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11

How Popular Were the Medical Sects? 231 David Leith

12

Popular Medicines and Practices in Galen 251 Danielle Gourevitch

13

Folk Medicine in the Galenic Corpus 272 Vivian Nutton Bibliography 281 Index 313

Preface A decade ago Fritz Graf wrote that research on ancient medicine had split into two fields, ‘the scientific, professional medicine of the Hippocratic doctors’ and temple medicine, a separation that he rightly deplored (Graf 2006, 3). But there was and is, I suggest, a still more serious failing in the study of ancient medicine—namely its pervasive if not unanimous refusal to explore popular medicine in a systematic fashion, which has led to a severely unbalanced narrative about ancient healthcare. It is fairly easy to understand why this should have come about: the large bodies of evidence that concern elite/learned/rationalistic medicine on the one hand and temple medicine on the other present a host of fascinating phenomena and problems, whereas the evidence about popular medicine, however we define that concept, is scattered, refractory and elusive. Furthermore, like the majority of classical scholars, students of both elite medicine and temple medicine habitually neglect the social structure of the world they are trying to study, so that rich and poor, townspeople and countrypeople—not to mention other distinctions—, are ruthlessly homogenized. I say all this with the proper diffidence of a non-specialist who may seem to be criticizing scholars of the very first calibre who have devoted their careers to the study of ancient medicine. In order to explore the apparent gap in the study of ancient healthcare I organized a conference at Columbia University’s Center for the Ancient Mediterranean on 18 and 19 April 2014 under the title ‘Popular Medicine in the Graeco-Roman World’. An excellent cast of speakers took up the challenge, and an occasion of quite exceptional scholarly interest ensued. Not least because some of the speakers more or less denied that the subject existed, or proceeded as if it did not exist. The terms of that debate are set out in this book, which may—one hopes—encourage other scholars to adopt a broader, more comprehensive approach to the study of ancient healthcare. As for a definition I suggest this: ‘those practices aimed at averting or remedying illness that are followed by people who do not claim expertise in learned medicine (Gk. iatrike) and do not surrender their entire physical health to professional physicians (Gk. iatroi)’. It is a great pleasure to thank the contributors to this volume for their hard work and their spirit of cooperation. Particular thanks are also owed to an anonymous reviewer who began to help me at a relatively early stage; his learning and good sense have been extraordinarily useful.

viii

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I also wish to offer profound thanks to Caroline Wazer for all her help in organizing and managing the 2014 conference. Only those who have done it themselves can know what it is like to take responsibility for the petty details of a conference, from hotel reservations to reimbursing travel expenses, while also preparing a scholarly paper for the same conference, as Caroline did on this occasion. I am also very pleased to thank the Columbia University History Department, the Stanwood Cockey Lodge Foundation, and Columbia’s Program in Classical Studies, and all the colleagues who captained these institutions at the time, in particular Rashid Khalidi, Deborah Steiner and Katja Vogt, for their generous financial help. W.V. Harris Pisa, July 2015

List of Figures 1 2 3

Map of central Italy showing the main sites referred to in this chapter. Source: Ancient World Mapping Center, adapted by Alessandro Launaro and Rachel Aucott 106 Sepia photograph of a selection of votives and other items from Lord Savile’s original glass plate negatives of the excavations at Nemi in 1885. Source: Nottingham City Museums and Galleries 112 Selection of anatomical (and other) votives, including both external and internal body parts; from Tessennano (Vulci). Source: The Mediterranean Museum, Stockholm 113

Abbreviations The titles of works by classical authors are abbreviated according to normal conventions; in case of obscurity see LSJ or OLD. References to Hippocratic works including ‘L’ or ‘L.’ refer to the edition of E. Littré; references to works by Galen including ‘K’ or ‘K.’ refer to the edition by C.G. Kühn. AÉ L’Année épigraphique ANRW H. Temporini (ed.), Aufstieg und Niedergang der römischen Welt ARG Archiv für Religionsgeschichte BHM Bulletin of the History of Medicine BKT Berliner Klassikertexte BL Berichtigungsliste der griechischen Papyrusurkunden aus Ä gypten CIG Corpus Inscriptionum Graecarum CIL Corpus Inscriptionum Latinarum CMG Corpus Medicorum Graecorum CML Corpus Medicorum Latinorum CQ Classical Quarterly Dig. Digesta, ed. T. Mommsen DK H. Diels and W. Kranz (eds.), Die Fragmente der Vorsokratiker (seventh ed.) FGrHist F. Jacoby (ed.), Die Fragmente der griechischen Historiker FIRA S. Riccobono et al. (eds.), Fontes Iuris Romani Anteiustinianani GMP I. Andorlini (ed.), Greek Medical Papyri I.Délos Inscriptions de Délos, ed. A. Plassart et al. I.Ephesos Die Inschriften von Ephesos (IGSK 11–17) IG Inscriptiones Graecae IGSK Inschriften griechischer Städte aus Kleinasien IGUR Inscriptiones Graecae Urbis Romae I.Kibyra Die Inschriften von Kibyra (IGSK 60) ILAfr Inscriptions latines d’Afrique, ed. R. Cagnat et al. ILAlg Inscriptions latines de l’Algérie, ed. S. Gsell et al. ILS Inscriptiones Latinae Selectae, ed. H. Dessau Inscr.Cret. Inscriptiones Creticae, ed. M. Guarducci Inscr.It. Inscriptiones Italiae IPerg Die Inschriften von Pergamon (Altertümer von Pergamon VIII) I.Sestos Die Inschriften von Sestos und des thrakischen Chersones (IGSK 19) JHS Journal of Hellenic Studies JRA Journal of Roman Archaeology

Abbreviations

JRS JRSM LDAB

xi

Journal of Roman Studies Journal of the Royal Society of Medicine Leuven Database of Ancient Books (LDAB), online at LGPN P.M. Fraser and E. Matthews (eds.), Lexicon of Greek Personal Names Liddell and H.G. Liddell, R. Scott and H.S. Jones, Greek-English Lexicon Scott LIMC Lexicon Iconographicum Mythologiae Classicae LSJ H.G. Liddell, R. Scott and H.S. Jones, Greek-English Lexicon Montanari F. Montanari, Vocabolario della lingua greca MP3 Catalogue des papyrus littéraires grecs et latins (Mertens-Pack3), online at OLD Oxford Latin Dictionary P.Ant. The Antinoopolis Papyri, ed. C.H. Roberts et al. P.Cair.Zen. Zenon Papyri, ed. C.C. Edgar PCG R. Kassel and C. Austin (eds.), Poetae Comici Graeci PGM K. Preisendanz (ed.), Papyri Graecae Magicae. Die griechischen Zauberpapyri (Stuttgart, 1928–1941; revised ed., Stuttgart, 1973–4) P.Herc. Herculaneum Papyri, listed in M. Gigante (ed.), Catalogo dei papiri ercolanesi (Naples, 1979) P.Horak Gedenkschrift Ulrike Horak, ed. H. Harrauer and R. Pintaudi PIR 2 Prosopographia Imperii Romani, second ed. P.Köln Kölner Papyri, ed. B. Kramer et al. P.Lit.Lond. Catalogue of the Literary Papyri in the British Museum, ed. H.J.M. Milne P.Lond. Greek Papyri in the British Museum, ed. F.G. Kenyon et al. P.Mil.Vogl. Papiri della R. Università di Milano/ Papiri dell’ Università Statale di Milano, ed. A. Vogliano et al. P.Oxy. The Oxyrhynchus Papyri, ed. B.P. Grenfell et al. PPM Pompei: pitture e mosaici, ed. G. Pugliese Carratelli Preisendanz: see PGM P.Ryl. Catalogue of the Greek Papyri in the John Rylands Library, Manchester, ed. A.S. Hunt et al. PSI Papiri greci e latini (Pubblicazioni della Società Italiana per la ricerca dei papiri greci e latini in Egitto), ed. G. Vitelli et al. P.Tebt. The Tebtunis Papyri, ed. B.P. Grenfell et al. P.Turner Papyri Greek and Egyptian . . . in Honour of Eric Gardner Turner, ed. P.J. Parsons et al. P.Vars. Papyri Varsovienses, ed. G. Manteuffel et al.

xii RAC RE

abbreviations

Reallexikon für Antike und Christentum Realencyclopädie der classischen Altertumswissenschaft, ed. Pauly—Wissowa—Kroll RIB The Roman Inscriptions of Britain, ed. R.G. Collingwood et al. SEG Supplementum Epigraphicum Graecum Sel. Pap. Select Papyri, ed. A.S. Hunt et al. SHA Scriptores Historiae Augustae SNG Sylloge Nummorum Graecorum TAM Tituli Asiae Minoris Trismegistos http://www.trismegistos.org/tm/detail.php?quick TAPhA Transactions of the American Philological Association UPZ Urkunden der Ptolemäerzeit, ed. U. Wilcken ZPE Zeitschrift für Papyrologie und Epigraphik

Notes on the Contributors Isabella Andorlini is Associate Professor of Papyrology at the University of Parma and is widely recognized as the leading authority on medical papyri in her generation. Among her numerous publications are the two volumes of Greek Medical Papyri (Florence, 2001 and 2009), following the volume she edited under the title ‘Specimina’ per il Corpus dei Papiri Greci di Medicina (Florence, 1997). She has co-authored Medicina, medico e società nel mondo antico (with Arnaldo Marcone, Florence, 2004), and Das Archiv des Aurelius Ammon (with K. Marersch) (Paderborn, etc., 2006) (Pap.Col. XXVI/2A+B). Rebecca Flemming is Senior Lecturer in Ancient History in the Faculty of Classics, and a Fellow of Jesus College, University of Cambridge. She has published widely on medicine and gender in the ancient world, both jointly and separately. She is currently collaborating on a long-term history of reproduction—Reproduction: A History from Antiquity to the Present—, and finishing a book entitled Medicine and Empire in the Roman World, both of which will be published by Cambridge University Press. Danielle Gourevitch is a former Directeur d’études at the Ecole pratique des hautes études (Paris). She studied at the Sorbonne, Ecole normale supérieure, Ecole française de Rome, and received her PhD in Paris. She has published fifteen books (in French, Italian and English) and some 300 articles or chapters about ancient medicine and about medical erudition in France in the 19th century. She received the Légion d’honneur for her scientific merits and a book of Mélanges from her colleagues and students, Femmes en médecine. She is presently the editor of Histoire des sciences médicales, official journal of the Société Française d’Histoire de la Médecine and is now working on realia in Galen, and on ancient culture in the French army (especially in Algeria). W.V. Harris is Shepherd Professor of History and Director of the Center for the Ancient Mediterranean at Columbia University. His most recent publications include Dreams and Experience in Classical Antiquity (2009), Rome’s Imperial Economy (2011), and the edited volumes Mental Disorders in the Classical World, The Ancient Mediterranean Environment between Science and History, and Moses Finley and Politics (all 2013). His new book Roman Power: a Thousand Years of

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Empire will be published by Cambridge in 2016. He is a Corresponding Fellow of the British Academy. Catherine Hezser is Professor of Jewish Studies at SOAS, University of London. She is the author of Jewish Travel in Antiquity (2011), Jewish Slavery in Antiquity (2005), Jewish Literacy in Roman Palestine (2001), The Social Structure of the Rabbinic Movement in Roman Palestine (1997) and the editor of The Oxford Handbook of Jewish Daily Life in Roman Palestine (2010) and Rabbinic Law in Its Roman and Near Eastern Context (2008). Forthcoming in 2016 is her volume on Jewish Art in Its Late Antique Context, co-edited with Uzi Leibner. She has just finished a book entitled Rabbinic Body Language: Non-Verbal Communication in Rabbinic Literature of Late Roman Palestine. Ido Israelowich is a senior lecturer in the Department of Classics at Tel Aviv University. His research focuses on the history of medicine in classical antiquity, social history and Roman law. His publications include Society, Medicine and Religion in the Sacred Tales of Aelius Aristides (Brill, 2012), and Patients and Healers in the High Empire (Johns Hopkins University Press, 2015). Julie Laskaris is an Associate Professor of Classical Studies at the University of Richmond. Among her publications are The Art is Long: On the Sacred Disease and the Scientific Tradition (2002), ‘Nursing Mothers in Greek and Roman Medicine’ (American Journal of Archaeology 112, 3 (2008), 459–64), and ‘Treating Hemorrhage in Greek and Roman Militaries’, (in G. Lee et al., Ancient Warfare: Introducing Current Research I, 2015). She is currently working on the use of metallic medicines. David Leith is a Research Fellow in the Department of Classics and Ancient History at the University of Exeter. He is one of the principal contributors to volumes LXXIV and LXXX of The Oxyrhynchus Papyri series, and is currently preparing a collection of the fragments of Asclepiades of Bithynia. He has published articles on various topics in Greek and Roman medicine, especially on the interactions between ancient medicine and philosophy. Vivian Nutton emeritus professor of the history of medicine at UCL, is now professor of the history of medicine at the First Moscow State Medical University. The revised

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edition of his Ancient Medicine appeared in 2013, the same year as his annotated translation of Galen’s De Indolentia, in Galen, Psychological Writings. A Fellow of the British Academy and of the German Academy of Sciences, he has written extensively on ancient medicine. He is preparing an annotated translation of a sixteenth-century work on anatomy, the Institutiones anatomicae, written by Johann Guinter and revised by Andreas Vesalius in 1538. Olympia Panagiotidou is a Post-Doctoral Researcher at the Aristotle University of Thessaloniki. She holds a joint PhD and MA in Cognitive Science and the Study of Religion from Aristotle University at Thessaloniki and Aarhus University in Denmark. She is working as co-author with Roger Beck on a book entitled The Roman Mithras Cult: A Cognitive Approach, and on a monograph entitled Healing, Disease and Placebo in Graeco-Roman Asclepius Temples: A Neuro-cognitive Approach. She has published articles in the Journal of Cognitive Historiography, Culture and Research, Religio, Sacra, Pantheon and the Bulletin for the Study of Religion. Chiara Thumiger’s past research topics include Greek tragedy (resulting in a book on Euripides’ Bacchae: Hidden Paths, 2007), ancient views on animals and animal imagery, and ancient representations of character and mental life, especially the emotions (Eros in Ancient Greece, co-edited with E. Sanders, 2013), and madness in ancient cultures. Her co-edited volume on ancient patients has just been published (Homo Patiens, Brill 2015, with G. Petridou), and her monograph Mental Health in Classical Greek Medical Thought is forthcoming with CUP (2017). She currently holds a Wellcome Research Fellowship in Medical Humanities at Warwick University (Department of Classics). Laurence Totelin is Senior Lecturer in Ancient History at Cardiff University. Her research focuses on the history of Greek and Roman botany and pharmacology. Her publications include Hippocratic Recipes: Oral and Written Transmission of Pharmacological Knowledge in Fifth- and Fourth Century Greece (Brill 2009) and, with Gavin Hardy, Ancient Botany (2016). Her work on pharmakopōlai is part of a longterm research progress on drug consumption and consumerism in the ancient world. Caroline Wazer is a PhD student of Ancient History at Columbia University. She is working on a thesis entitled Salus Patriae: Public Health in the Early Roman Empire.

chapter 1

Popular Medicine in the Classical World W.V. Harris Tel est l’heureux optimisme des âmes croyantes

—Marc Bloch, Les rois thaumaturges



Popular Medicine as a Concept

Into the room at Tyre where the Greek heroine was playing her kithara flew a bee, which stung her slave-attendant. Leucippe had an effective remedy though—she recited a pair of charms (remata) that she had previously obtained from ‘some Egyptian woman’ (Achilles Tatius, Leucippe and Cleitophon 2.7).1 (The exceptional quality of Egyptian drugs and doctors was enshrined in Odyssey 4.219–234, but when Galen waxed indignant about charlatanry he readily turned to the image of the supposed sorcery of old Egyptian women).2 Achilles Tatius’ story looks like an allusion to popular medicine. A scholar will wonder, admittedly, whether Achilles Tatius merely contrived a quite unrealistic scene as an introduction to the following trope about the sting of eros, and whether Leucippe is being shown to us as somewhat naïve because she believes in remedies from such sources; and may wonder also what Achilles imagines Leucippe would have done if her attendant—or she herself—had fallen ill with something more serious than a bee-sting. There remains, however, a plausible ‘ring of truth’ in Achilles’ story—so it may be thought. Another case, this time factual. When the Great Pestilence, usually known as the Antonine Plague, which was probably an epidemic of smallpox, landed on the Roman Empire, physicians were perfectly, and understandably, helpless. Some people—whole communities in some instances—turned to oracles, and some of the inhabitants of western Asia Minor and Thrace turned to the 1  There is more Egyptian medicine in 4.15. For its prestige among the Greeks see Von Staden 1989, 1–3. 2  De simpl.med. 6 pr. (XI.792K)—the passage is quoted in full below, p. 251. Elsewhere Galen seems unprejudiced with respect to Egyptian medicine (he corrects ‘the wisest of the Egyptians’ at De simpl.med. 3.10 = XI.562K, but without abuse).

© trustees of columbia university in the city of new york, ���6 | doi ��.��63/9789004326040_002

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famous oracle of Apollo at Claros—appropriately, since Apollo was known as the cause of plagues. Just as the Athenians, during the famous plague that they endured six centuries earlier, had turned to oracles (Thucydides 2.47).3 In the Antonine case, the oracle of Claros duly gave advice, in three instances at least instructing cities to set up statues of the god at the city gates. ‘Sacrifice to the gods beneath the earth’, a Thracian town was also told, ‘and heed the libations on each occasion’.4 Marcus Aurelius himself consulted the oracle.5 Everyone will have understood these procedures, as well as the initial impulse to consult an oracle in a medical emergency. ‘Popular medicine’, and ‘folk medicine’ too, are problematical categories, especially in societies such as those of the classical Greeks and Romans in which there were professional healers but no ‘professions’ in a modern sense (it will be argued below, however, that classical doctors eventually became more professionalized than is sometimes recognized). ‘Popular medicine’ is however an indispensable category if we are going to understand the way in which healthcare really worked in antiquity.6 This for the obvious reason that when people had to deal with physical ailments7 or wanted to ward them off, they very frequently turned to the gods and their representatives, or to healers whose ‘knowledge’ and techniques, handed down to a large extent by word of mouth,8 3  I return to these great epidemics at the end of this paper. 4  I.Sestos (IGSK 19) 11 (these two instructions are in lines 29–30 and 23 respectively), with the textual and historical comments of Faraone 1992, 61–2. This inscription is also in Merkelbach and Stauber 1996, no. 9. Six responses are known altogether, though it cannot be guaranteed that all of them concerned the Great Pestilence. 5  C.P. Jones 2005. See below. 6  With great reluctance I exclude late antiquity from this introductory chapter. The cultural changes that occurred from the mid- and late third century AD onwards re-set popular medicine in ways that would require a separate study. 7  In this discussion, while recognizing the artificiality of the distinction, I mainly avoid mental disorders, concerning which see the essays collected in Harris 2013, especially, for nonphilosophical non-medical reactions to mental disorders, Peter Toohey’s paper on madness in the Digest (Toohey 2013). Philip van der Eijk, in the same volume (2013, 310), lucidly poses the question as to where people turned when faced with mental illnesses. 8  But not entirely. On Cato’s pre-scientific medical commentarius and the folk remedies in De agri cultura see esp. Boscherini 1993. Among extant pharmacological texts that seem quite far removed from elite/learned/rationalistic medicine see Thessalus, De virtutibus herbarum (a late-antique production unconnected presumably with the first-century doctor Thessalos of Tralles, most recently edited by H.-V. Friedrich (1968); see further Flemming 2000, 143–7); Marcellus Empiricus, De medicamentis (c. 400 AD, last edited by E. Liechtenhan (1968)); and the collection of quasi-magical cures known as the Cyranides (last edited by D. Kaimakis, 1976). But some of the pharmacology in the Hippocratic corpus, especially in

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were mostly—though with many exceptions—rejected or marginalized by the elite/learned/rationalistic doctors (let us call them rationalistic, not rational, for the moment) whose writings dominate modern histories of ancient medicine. Or they might turn to family members or friends, or to memories of what they had learned in their own social circles—all of which might lead away from the ‘higher’ medicine.9 Not that this was an exclusive characteristic of pre-modern societies. Even in modern America and Taiwan, according to the medical anthropologist Arthur Kleinman, ‘the popular sphere of health care is the largest part’, managing 70 to 90 per cent of all ‘illness episodes’.10 And what makes it certain that these were the normal patterns of behaviour in antiquity is that most people lived in the countryside,11 where doctors were not indeed invisible (there were doctors who practised in villages, in some periods and regions), but where they are likely to have been fairly scarce,12 and were quite probably not the most impressive members of their profession. Furthermore we have only to ask how ordinary Greeks and Romans often explained sickness to realize that they often thought outside the thoughtworld of the elite/learned/rationalistic medical writers, and in particular that they often attributed responsibility to the gods or a god.13 The anthropologist

Diseases of Women, is very similar (see Nutton this volume pp. 276–7). The pharmacology in Pliny’s Natural History includes a strong popular element (Capitani 1972, 132–40), which was intensified by the author of the so-called Medicina Plinii, a text of the fourth century (apparently) that states its aim as circumventing dishonest doctors (edited by A. Önnerfors, 1964). The recipe collection of Serenus Sammonicus (ed. F. Lombardi, 1963), in verse, seems on the other hand to be mainly a learned compilation. For some other lateantique texts of a medico-magical character see Gribomont 2004 and Nutton this volume, pp. 276–7. The Greek medical papyri seem to come to a great extent from people who were employing elite/learned/rationalistic medicine or trying to (cf. Andorlini 1993), but more than eighty medico-magical papyri are listed in (accessed 4 July 2015), and P.Oxy. LXXX (2014) added a few more. 9  Who, falling ill or fearing illness, turned first to a doctor and who to other healers or practices is a question that will be addressed below, pp. 35–40. 10  Kleinman 1980, 50. As to how he defines this sphere, see below, p. 15. 11  Cf. Horden and Purcell 2000, 92, Harris 2005, 30–1. 12  Cf. Parker 1983, 238. I do not share the view of Cohn-Haft 1956, 23–6, that doctors are likely to have been in short supply in Greek cities, but they are not likely to have been overabundant either, and some of his arguments are relevant to the supply of country doctors. See further below, p. 38. 13  Parker 217–18 and chapter 8 (note the passage of Aristophanes’ Heroes described at 243–4: the text is now fr. 322 in PCG ed. Kassel-Austin, III.2). On the whole topic see further

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George Foster made a very useful distinction between personalistic and naturalistic sickness aetiologies:14 a personalistic medical system is one in which disease is explained as due to the active, purposeful intervention of an agent, which may be human (a witch or sorcerer), nonhuman . . . or supernatural . . . The sick person literally is a victim, the object of aggression or punishment . . . naturalistic systems [on the other hand] explain illness in impersonal, systemic terms. Disease is thought to stem . . . from such natural forces or conditions as cold, heat . . . and, above all, from an upset in the balance of the basic body elements. . . .15 As Foster observed, however, neither kind of aetiology is normally exclusive in any society, and that was also true in much of the high-classical world: the two systems intermingled.16 Another sign that ordinary Greeks and Romans thought outside the thought-world of the elite/learned/rationalistic medical writers is that the very term nosos referred to a wide range of unpleasant conditions in addition to illness.17 I should say at the outset, however, that I intend in this essay to concentrate on medical treatment and other responses to illness, to the relative neglect of the physiological beliefs of the Greeks and Romans. It was, for example, a popular as well as a medical belief in antiquity that a woman could feel the moment when she became pregnant (a belief with a number of practical Nutton 2004, chapters 7 and 18. For illness as divine punishment in the ‘confession inscriptions’ of Lydia and Phrygia see Chaniotis 1995. 14  Foster 1976. 15  Foster 775. This distinction was put to work by Giovanni Levi in a history of an exorcist who lived in rural Piedmont at the end of the seventeenth century (Levi 1988). Alas we ancient historians never, I think, have enough evidence to be able to follow Levi in arguing for a connection between an outbreak of exorcism or any other healing practice and particular local conditions.—Greeks and Romans routinely ascribed illness to the will of the gods, but sometimes to black magic (though the latter affected individuals, not, with very few exceptions, whole communities: Graf 1992, 276–7). 16  And ‘ordinary people’ could of course agree with the author of the Hippocratic Affections that ‘all human diseases arise from bile and phlegm’, when ‘one of them becomes too moist, too dry, too hot or too cold; they become this way from food and drink, from exertions and wounds, from smell, sound, sight and sex, and from heat and cold’ (1). 17  Parker 1983, 220, Lloyd 2003, 12 n. 2. The wide range of the term nosos may be regarded as typical of societies not yet dominated by biomedicine; cf. Janzen 1978, 204, Schoenbrun 2006, 1417–18.

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consequences).18 A reasoned study of such popular beliefs would be worth writing, but the world of healing, real and hoped-for, is in itself going to require a quite long chapter. The concept ‘popular medicine’ is an old one, sometimes traced back to the sixteenth-century physician Laurent Joubert and his book Erreurs populaires au fait de la médecine et régime de santé (Bordeaux and Paris, 1578).19 It has no ancient equivalent, but it has ancient roots: the most relevant ancient idea may be that country people often have remedies.20 The concept has in any case been faulted as very hard or impossible to define clearly, even negatively as the medicine that was separate from that of the rationalistic doctors (since it is supposed that the latter were a nebulous group—a point of view that I shall contest later in this paper). I shall have much more to say about the borderlands between elite/learned/rationalistic medicine and popular medicine (which for the sake of brevity I shall usually refer to from now on simply as rationalistic medicine), but I contend that the two realms can be distinguished, and usefully distinguished, and that the practices described in the second half of this article are sufficient proof of that. For a generation or more it has been the custom among many historians of pre-modern medicine to minimize the differences between rationalistic and popular medicine,21 and as we shall see the differences were also much slighter in classical antiquity than they have been since the early or middle nineteenth century. In addition, exponents of this point of view have sometimes gone to exaggerated lengths22 in reaction against what used to be called a ‘whiggish’ optimistic view of history. But as far as classical antiquity is concerned, the point is that there were indeed, as we shall see, crucial differences, as well as some overlaps, between rationalistic medicine and popular practices. Diminishing the existence of ‘popular medicine’ and the active role that

18  Soranus 1.14, etc.; Mattern 2013, 232; but see Dean-Jones 1995, 46 n. 17. 19  On this work see Charuty 1997, 48–55. 20  Cf. Gourevitch this volume pp. 253–4. It may be significant that when Theophrastus singles out those parts of Greece that produce the most useful pharmaka (Hist.Pl. 9.15.4–8) he mostly lists deeply rural areas. Pliny, NH 25.6: ‘the reason why more herbs are not familiar is because experience of them is confined to uneducated country people . . .; moreover nobody cares to look for them when crowds of doctors are to be met with everywhere’. 21  Lindemann 1999 is characteristic of a whole current in this respect. 22  Lindemann 1 admits, with apparent reluctance, that medicine has made ‘undoubted progress . . . since the middle ages’. But she is also impatient with ‘the whole idea of a popular medicine conveyed by oral tradition through the centuries’, which according to her ‘might be the figment of an overheated historical imagination’ (4).

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ordinary people played (often out of necessity) in ancient healthcare, scholars have often distorted ancient medical history. The role of popular medicine is, almost needless to say, very difficult for a historian of antiquity to get at, notwithstanding the fact that we have no fewer than eight books of Pliny’s Natural History largely though not explicitly devoted to the subject. We are attempting to write the history of sick people and healers who had in many cases little reason to become literate, let alone record their activities. In some places and periods, furthermore, some magical practices at least were illegal or in effect illegal,23 and people who employed them therefore needed to be discreet. Our source material is thus elusive (though it is also extensive). When writers who were interested in medicine but outside the medical profession, such as Dioscorides and Pliny, distance themselves from common reports with such expression as ‘they say that . . .’, ‘it is said that . . .’,24 they seem to open a window towards popular ideas; the trouble is not only that such reports may derive from single individuals but also that a great deal else in their writings, especially in the case of Pliny, also represents popular ideas. Then there is the question of diachronic developments. Simply to take one example, ritual purification for medical purposes could be derided on the Athenian comic stage by Menander’s time (Phasma 50–6), but does that mean it was then a subject of contention at Athens, or was in decline, or was more popular than ever? Finally, there is the matter of social level and social identity: even when we know quite a lot, as in the case of temple medicine, the clients as a group are socially elusive. Was it only—or partly—the fairly wellto-do who travelled to the shrines of Asclepius at Epidaurus and Pergamum, or for that matter to the oracle of Dodona in northern Greece (where people regularly went to ask the presiding gods for information, and specifically which gods to sacrifice to in order to recover their health)? Then again, did the poor have access to doctors, did they want to have access to doctors? Thus the history of popular medicine in the classical world presents many problems. Such a history could be written, but not yet. In this paper I shall concentrate on definitional problems, and on social-history problems such as 23  There are complex issues here. Practising magic was never as such a criminal offence in classical Athens, but as we shall see it might lead to a charge of ‘impiety’. What exactly counted as impiety is not clear, however, and probably was not. Known defendants were all women. See for discussion Dickie 2001, 50–54, Rücker 2014, chapter 3. Anyone who could be deemed a practitioner of goeteia (sorcery) was at risk of prosecution in most fourth-century BC Greek cities: Plato, Meno 80b (exaggerating perhaps). For the criminalization of magical practices in the Roman world see Rives 2003, Rücker, chapter 4. 24  E.g. at Dioscorides 3.131 and 4.76, Pliny, NH 23.138 and 28.33. Cf. Riddle 1985, 84–5, 1993, 105.

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the following. Who were the healers and helpers actually available to people who experienced illness or wished to forestall illness? What was the role of drug-sellers (pharmakopolai)? What sorts of people turned to elite practitioners and who turned to the practices and practitioners of popular medicine, and in what circumstances?25 How much did the answers to these last questions depend on the type of medical problem in question (a doctor could bind up a wound, but it was never obvious that he could remedy a persistent internal pain)? It is these social-history questions, rather than questions that belong more to religious history or to the history of rationalistic medicine that will take up the latter part of this chapter. But there are some other important issues to set out first.

Some Fundamentals

There was indeed no strictly demarcated line between the elite practitioners and the others, or between their respective practices. But before we even begin to look more closely at this claim, two historical statements impose themselves—obvious truths that tend to be forgotten once one enters the labyrinth of Graeco-Roman healthcare. In the first place, there was little that was effective that anyone could do in the face of serious illness. Rationalistic Greek medicine was a marvelous structure and a major step forward from what came before it,26 but the fact is that, except in the face of moderate traumas, doctors’ treatments generally did more harm than good. They were relatively good at orthopaedics.27 But bleeding (phlebotomy) alone did extensive harm.28 Drug treatments were often reckless; 25  A larger treatment would also consider how much ancient populations chose to live as they did because of their ideas about their health and that of their family members; such a treatment would include diet but also many other matters such as urban residence and family size. 26  Many scholars have considered how Greek medicine differed from Mesopotamian and Egyptian medicine: see for instance Lloyd 1979, 153 and 231, Horstmanshoff and Stol 2004a. For a good short account of the similarities and differences between Egyptian and Greek medicine see P. Lang 2013, 125–8. See further Nutton 2004, 43–5, Asper 2015. 27  Nutton 93–4, referring to the Hippocratic works Joints, Fractures and Method of Reduction (often known by its Greek title Mochlicon). 28  There were admittedly differences of opinion as to how often this procedure should be employed, the Empiricist school showing some reluctance (cf. Nutton 93 and 240). But it seems to have grown even more popular with doctors in the first century AD: Celsus, De medicina 2.10.1. Some of Galen’s colleagues were opposed: De venae sect. adv. Eristrat. 1

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varieties of hellebore, for instance, were the plants most popular with the Hippocratics.29 Doctors were essentially quite helpless in the face of the major childhood illnesses. Epidemics, which were frequent,30 swept all before them.31 Historians of ancient medicine are by and large reluctant to admit these facts.32 As one of them has observed, ‘criticizing the errors of past or foreign cultures has become unfashionable’;33 but that trend has the very bad effect of making it more difficult to understand one of the central issues in this enquiry—the attitudes and behaviour of lay-people. Primitive healthcare kept lives short: almost all students of ancient demography are now agreed that expectation of life at birth was about 25 years,34 low by comparison with even the most deprived modern countries (it was about 39 years, for example, in Lower Zaire at the time of independence).35 And while estimates vary as to the amount of useful pharmacological knowledge the ancients possessed, the few statistical analyses that have been attempted suggest that it will have been a very fortunate patient who gained any serious benefit.36 (XI.187–9K). On changing attitudes towards bloodletting in antiquity see also Kuriyama 1995, 16. 29  For the consequences see below, p. 24, and Harris forthcoming. 30  Duncan-Jones 1996, 109–11. 31  Cf. Massar 2005, 85–7. 32  Scholars sometimes point with justifiable surprise to the evidence that, as in other ancient cultures, people sometimes survived trepanation surgery (see Roberts and Manchester 2005, 124–8, Gourevitch 2011a, 167–8) but never seem to ask whether there was any real medical justification for performing the surgery in the first place; as far as classical antiquity is concerned the procedure is good evidence of the harm that doctors could do. (But see further Arnott 1997).—Jackson 1993, 94, judges apologetically that ‘one cannot help but feel’ that doctors in the Roman world were quite dangerous. Greek doctors tried to avoid hopeless cases (Nutton 2004, 92), but as W.H.S. Jones pointed out (1923, 144) nearly sixty per cent of the cases described in detail in Books I and III of the Hippocratic Epidemics ended in death (this has limited significance, however; most of the patients were already very ill). Much the most readable account of the efficacy of ancient trauma treatments is Majno 1975: Guido Majno was a professor of pathology well versed in the Greek and Roman sources. 33  Kuriyama 1995, 24. 34  Hin 2013, chapter 4. 35  Janzen 1978, 26. 36  Prioreschi et al. 1998. John Riddle’s methodology for dealing with this question (Riddle 1985, 42) seems misconceived: ‘take drugs known today that are derived from plants native to the Old World and seek to find them in Dioscorides’. No one I think doubts that Dioscorides and company knew of some efficacious drugs; the point is rather to evaluate

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It is true that some scholars take a relatively optimistic view of the pharmacological knowledge that had been accumulated by the time of Dioscorides.37 And rationalistic medicine as a whole had not always had a uniformly bad reputation—far from it, to judge from well-known passages in Prometheus Vinctus (478–83) and Antigone (363–4). In fact the Hippocratic doctors were better in some respects than in others: prognosis, in particular, was certainly much better developed than treatment.38 The continued existence of doctors, their respectability and, in some cases wealth, show that their reputation was not uniformly terrible. But the author of the Hippocratic Diseases complains that physicians receive little credit when their patients improve and plenty of blame when the opposite happens (Diseases 1.8). And the distrust that many people felt towards doctors, even elite doctors, was frequently expressed from the late-fifth century onwards—and it was very well-founded.39 According to their recommendations as a whole, or at least systematically. It is also vital to understand why people believed in folk remedies; for an excellent discussion of belief in plant-based remedies see Stannard 1982, 12–22. 37  This is especially true of Riddle, according to whom ‘there are many examples in Dioscorides’ work where the drug would have had a beneficial effect. . . . Based on what we know now, we can confidently report that Dioscorides was a rational user of drugs’ (Riddle, 1993, 111–12; cf. Riddle 1987). Dioscorides recommended eating bedbugs as a remedy for a quartan fever (2.34), and has 46 medical uses for the dung of various animals (2.80) (Galen too prescribes dung and urine: Keyser 1997, 188–91).—Most questionable is the approach of Hall and Photos-Jones 2008 to the problem of ‘Lemnian Earth’, which some ancient writers considered to have medicinal properties: ‘we approach the issue of the efficacy of the Lemnian Earth from the assumption that it did work as a medicine, and that this was not simply because people believed that it worked’ (1037, my italics). In reality Lemnian Earth is most unlikely to have been the name of a single chemical substance; some samples may have had some positive effects. Scholars of this stamp will probably take encouragement from the award of the 2015 Nobel Prize for Medicine to the Chinese scientist Tu Youyou who ‘turned to traditional herbal medicine to tackle the challenge of developing novel malaria therapies’ (, accessed 8 October 2015) and discovered the drug Artemisinin, but if so they will need to realize how much modern science was necessary in order to make the substance in question more than marginally useful. 38  Already by the time of [Hippocrates], Prognostic; see Lloyd 1979, 151–3; cf. Nutton 2004, 88–90. 39  Was this a new phenomenon, as argued by Pearcy 2013, 94–5 (cf. Dean-Jones 2003)? It does not seem likely, but distrust may have increased, for various reasons. Kosak 2004, esp. chapter 1, gives a good account of the apparent growth in negativity in post-Homeric times. The reason why doctors are treated with respect in the Iliad was probably because warriors found them useful—even though many ancient war-wounded must have died of peritonitis, gangrene or other conditions—; ordinary patients often presented more

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the Hippocratic Regimen in Acute Diseases (8), the whole of medicine (ietrike) ‘has a very bad name among ordinary people (demotai), so that no such thing is thought to exist’. ‘Medicine is of all the technai the one that is least esteemed’ ([Hippocrates], Law 1).40 Might as well take the advice of ‘some Egyptian woman’. And that was simply in what we can consider the core areas of the GraecoRoman world. Elsewhere distrust may have been even more widespread. We should furthermore take careful note of the fact that in some other premodern societies in which lay opinion is better documented than it is in the classical world elite medicine enjoyed a thoroughly bad reputation. In Tudor and Stuart England, for example, ‘the population at large disliked Galenic physic for its nauseous remedies . . . some of the most intelligent laymen of the day expressed total contempt for conventional medicine’.41 Historians of classical medicine have too often been distracted from lay reactions by the pretensions of the surviving medical writers. But there is another quite important problem here, the working of placebo effects in antiquity. While much remains uncertain, it seems reasonably clear that positive placebo effects depend to a high degree on the sufferer’s confidence in the authority of the medical adviser in question.42 Most GraecoRoman patients probably approached healers of all kinds with less confidence than patients usually feel in the contemporary world when they approach intractable problems. The helplessness of doctors in face of the Plague at Athens may also have had some effect. Distrust is deeply ingrained in comedy from early days (see especially Imperio 2012): note inter multa alia Aristophanes, Nub. 332, also Menander, Aspis, esp. 439–64, Phoenicides fr. 4 Kassel-Austin, Plautus, Menaechmi 876–965. See further Phaedrus 1.15, Pliny, NH 29.11–16 (quoting Cato), Martial 1.30, 1.47, 8.74. For many more such references see Nutton 2004, 400 n. 4 and 402 n. 49, McCreight 2006, 146–61. Whether the jibes against doctors in Varro’s Quinquatrus represented his own opinion is uncertain; his editor Cèbe thinks not (Cèbe 1996, 1812). When the gloomy Seleucus says in Petronius, Sat. 42 ‘medici illum perdiderunt, immo magis malus fatus; medicus enim nihil aliud est quam animi consolatio’, the second half of the statement is more interesting than the first.—There are of course elements of stereotyping and stock humour in all this, and literary genre is certainly relevant, but comic writers are obviously a channel to public opinion both in its more and in its less sophisticated forms. 40  On this passage see below, p. 30. I am not sure that the above translation (W.H.S. Jones) captures apoleipetai correctly—it might mean ‘is defective’; but the rest of the chapter seems to refer to reputation. Art 1 end (to be read in the edition of J. Jouanna) also refers to critics of iatrike. 41  K. Thomas 1971, 14, with plenty of documentation. 42  Miller et al. 2009, 531–2, with bibliography in the same article.

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their doctors; on the other hand, there will undoubtedly have been some more trusting psychological types who will have turned to elite physicians, temple medicine or magic, as the case might be, with enough faith to make some real difference. One of the most striking features of the medical lore reproduced by Cato in De agricultura (124–5, 156–60) is the author’s confident tone, which presumably carried over, in part at least, to his wretched victims. The question of confidence would thus merit a more extended investigation. One unsurprising corollary of the dubious reputation of doctors was that the ill must often have formed their own independent views about what should be done, and expressed them.43 In the face of arthritic pains, says Aretaeus of Cappadocia, patients know of all sorts of drugs that are not in the physician’s repertoire (Chron. Ther. 2.12). But it is of course women who are particularly likely to have to examine themselves, and sometimes they certainly came to conclusions about what was wrong with them.44 Generations of anthropologists have attempted to teach us not to be excessively judgemental about the efficacy of traditional remedies, and we certainly must be careful not to dismiss without reason practices that do not accord with official modern western medicine.45 But classical scholars have often erred in the other direction, grossly underestimating the medical revolutions of the nineteenth and twentieth centuries and hence overestimating ancient medicine (more about this later). Secondly, we can hardly avoid the banal observation that both popular medicine and rationalistic medicine, as actually delivered, varied enormously across time, place and social class within the Graeco-Roman world.46 ‘Popular’ in this context does not mean ‘universal’ and does not even necessarily mean ‘widespread’. The author I invoked at the beginning of this paper, Achilles Tatius—simply to take one ancient author—wrote for a well-educated Greek urban audience at the height of the Roman peace (no need to discuss here the identity of the Greek novelists’ imagined readers). But we should ask what happened in a wide variety of other circumstances, what for example happened in rural Italy in the middle and late Republic (the texts offer a little help, but it so happens that we have some much better evidence in the form of thousands of 43  See for instance [Hippocrates], Precepts 5. 44  For relevant Hippocratic evidence see Dean-Jones 1995, 53–5. 45  For a recent balanced discussion in a journal of medical anthropology, concerning in particular what counts as a cure, see Waldram 2013. For a positive view see for example Waldstein 2010. 46  Jackson 1993, 79–80, Pedrucci 2013, 262.

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anatomical votive offerings, discussed in this volume by Rebecca Flemming)? And what happened in bicultural or multi-cultural places such as say GraecoEgyptian Tebtunis? What happened in Gallic villages in the late fourth century AD (Marcellus Empiricus of Burdigala/Bordeaux knew something about this)? Of whom exactly was it true that ‘in sickness people first took recourse to human physicians’?47 This book is inevitably far from comprehensive, but one of its strengths is that it examines closely some particular milieux. Judaea and Egypt are of course the places where we can know most, outside the fully Greek and Roman areas of the classical world. The great shortages of evidence occur in the central and western provinces of the Roman Empire, where, however, there is probably much more, even now, to be learned from the systematic study of archaeological evidence such as the ex votos. Gender will also be an important axis in what follows. It would be plausible to suppose that given the social inhibitions that, in some Greek places at least, made it more difficult for women to obtain treatment from iatroi, they relied more often than men did on folk medicine. But many medical texts suggest that although the difference in male and female access to doctors was real it was not enormous.48 In the Hippocratic Epidemics I and III, for instance, 17 out of the 42 case histories concern female patients (40 per cent). We shall return to this question later.

‘Irrational’ Doctors?

No very clear-cut lines then between one kind of medicine and the other, that seems to be the accepted view. And it is easy to find instances of rationalistic doctors recommending or approving procedures that by our lights have no rational basis at all, apart from possible placebo effects.49 The Hippocratic On Regimen IV (89 and 90), for example, recommends prayer to specific gods— yet prayer is a minuscule element in that book, and the point was merely to counter unpropitious dreams.50 More significantly, Hippocratic writers seem 47  Edelstein and Edelstein 1945, II, 139. The general claim is quite unproved. 48  See Dean-Jones 1995, 42–43 (but see also 48–49), Nutton 2004, 100–1. 49  See in general Scarborough 1991, 151–2. Ancient doctors knew about some kinds of placebo effect: see e.g. [Hippocrates], Precepts 6. 50  See on this passage Pulleyn 1997, 214–15. On the Sacred Disease 4, denouncing ‘purifiers’ and the use of spells, says that those who consider epilepsy to be a ‘sacred disease’ should have prayed and taken the sufferers to temples to beg the gods for cures; this does not of course mean that the writer thought that that was the right treatment. There is a serious

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to have relied on folk medicine51 when it came to pharmaka for women: the treatise The Nature of Women offers more than 300 crude prescriptions against various ailments of the reproductive system, all of them presumably of folkmedical origin.52 And while the Hippocratics are often admired by moderns for their attention to diet, there is little medical rhyme or reason to be found in On Regimen.53 I suggest furthermore that the practitioners whose treatments are criticized in On the Sacred Disease chapters 2–4 are not, as is usually supposed, magoi and ‘purifiers’ but doctors who, in the author’s opinion, were like magicians and purifiers.54 The point here, however, is not to review the therapeutic practices of Hippocratic or later doctors, but to show that even illustrious members of the profession sometimes strayed outside the limits of therapies that the stricter members observed. And there were stricter members, not only the Hippocratics, but some later writers too. Aretaeus of Cappadocia was one such—his remedies were diet, simples, venesection and cupping, occasionally surgery.55 Soranus admits (Gynaecology 3.12)56 that amulets will ‘perhaps’ (tacha) have the beneficial effect of raising the spirits of a woman who is suffering from a uterine hemorrhage, but he obviously does not suppose that any physical benefit would result. Others were less strict. The writings of Scribonius Largus illustrate this. His medical training and a certain amount of scepticism notwithstanding,57 he sometimes recommends fantastic treatments (if the patient has a headache, lack of balance when Oberhelman 2013b, 9, asserts that ‘the Hippocratic writers . . . recommended prayers as a useful companion to medical treatment’, as if they regularly did so. 51  For this concept, see below, p. 15. 52  Cf. McNamara 2003–4, 17–18. These included the mythical beaver testicles debunked by Devecka 2013. Totelin 2009, 125, raises an important question here: some of these recipes include exotic ingredients such as myrrh and frankincense that ‘were unlikely to figure in the remedies of the majority of Greek households’. True, but quite apart from the possibility of ersatz materials, we should not think that the Hippocratic doctors were principally interested in their poorer clients. 53  On Hippocratic pharmacology see Nutton 2004, 98. 54  Just as the apateones (deceivers) who are denounced in [Hippocrates], Joints [Artic.] 42, were certainly iatroi. Compare Galen’s attitude towards Methodist physicians: Gourevitch this volume p. 251.—Those who accused Apuleius of magical practices believed or at least asserted that a doctor had taken an epileptic patient to Apuleius for a magical cure (Apuleius, Apol. 48); the accusation cannot have been altogether absurd. 55  Nutton 2004, 206. 56  I refer to the edition of Burgière, Gourevitch and Malinas (2003) (p. 46). 57  Concerning Scribonius’ mentality see Nutton 173.

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apply a live black sting-ray (torpedo nigra) to his head, two or three them if necessary, Compositiones 11).58 From time to time he recommends the use of amulets (sects. 80, 163–4). But in truth the whole of his book is a phantasmagoria. Rufus of Ephesus, a generation later, recommends a particular kind of finger-ring (whether as protection or cure is not clear) (fr. 90 DarembergRuelle).59 Galen too occasionally recommends the use of amulets—they puzzle him but he sometimes rationalizes and recommends them—,60 and as we shall see he accepted many drug-recipes from people who were not doctors of any kind. Some scholars hold that he believed in astrology—in an age in which it was taken very seriously—but the evidence scarcely supports such a notion.61 It is a little misleading62 to lump together in this respect high-classical doctors such as Galen and the sixth-century doctor Alexander of Tralles—a fascinating figure, who, however, lived in an intellectually quite different epoch. All this classical mingling of high and popular medicine seems to be normal rather than reverse, historically speaking,63 and does not by any means signify that we cannot distinguish the two.64 In these circumstances it is scarcely surprising that elite doctors were sometimes accused of irregular practices, as happened to Galen early in his career: his enemies said that he must have used magical arts, to make a certain prognosis.65 58  No need here to discuss the numbing effect of the sting of some Mediterranean Torpedinidae; Pease on Cicero, De Natura Deorum 2.127 has a learned note (Pease 1958, 858). See further Nutton this volume p. 275. 59  So at least Alexander of Tralles claimed. Since Rufus believed in dreams as a diagnostic tool (Harris 2009, 195–6) we should not be surprised. 60  See Gourevitch this volume, pp. 264–6. Cf. Mattern 2013, 176. 61  The case is put most forcefully by Barton 1994a, 53–4. She relies on De fac.nat. 1.12 (II.29K), which is certainly suggestive in this respect, and on other passages that may or may not establish her case. Cf. Nutton 2004, 266, who cites De simpl. med. 1.24 (XII.357.2–6K), but there Galen is referring to the practice of another doctor. Elsewhere Galen is critical: Nutton 266–8. G.J. Toomer, however, who published part of an Arabic translation of Galen’s lost commentary on the Hippocratic Airs, Waters, Places, concluded that Galen ‘believed firmly in the influence of the heavenly bodies on the physical changes on earth, including the changes in human bodies, however suspicious he may have been of practising astrologers’ (Toomer 1983, 194). 62   Pace Hirt in Hirt et al. 2014, 131–2. 63  For historical parallels see Nutton this volume pp. 272–3. 64  And it seems quite wrong to say that an ancient doctor might just as well prepare an amulet as write a prescription (Froschauer and Römer 2007, 1). 65   De praenotione ad Posthumum 3 (XIV.615.7–10K). See further Boudon 2003, 126–9.

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Much of the healthcare offered by the most prestigious ancient doctors outside the realms of trauma care and surgery was indeed by modern standards highly irrational (I will return shortly to the meaning of this expression).66 Yet there were principles, a sort of framework for logical thought. From the early fourth century BC onwards, no one could have claimed that Greek medicine was under-theorized.67 Instead of a sharp demarcation line, then, we might possibly think of a spectrum from the established, more or less collegial, rationalistic doctors to exorcists and magicians and to complete amateurs.68 But in the end this image is unsatisfactory, so I maintain here, because there was indeed a dividing line, albeit a fuzzy one—which is not unusual in the history of professions (see below). It was their methods and to some extent their education that determined whether people could get themselves recognized as iatroi or medici.

Folk-Medicine, Drug-Sellers, Root-Cutters, Magicians, Tricksters and the Boundaries of the Medical Profession

The difficulty of defining popular medicine becomes even more serious if we accept the influential distinction drawn by Arthur Kleinman between ‘popular medicine’ and ‘folk medicine’, the former representing the methods of healthcare that are transmitted by non-professionals, the latter representing the methods that are transmitted and put into practice by healers not officially approved by the state or by the ‘orthodox’ medical profession. Folk medicine is a mixture of many different components; some are closely related to the professional sector, but most are related to the popular sector . . . [it] is frequently classified into sacred and secular parts, but this division is often blurred in practice. . . . Early students of medicine in different cultures stressed sacred healing. . . . Far less attention has been given to the mundane secular forms of healing: herbalism, traditional surgical and manipulative treatments, special systems of exercise, and symbolic non-sacred healing.69 66  ‘There was no empirical evidence for an excess of a substance such as phlegm, rather than a god, being the cause of a disease; and certainly no trial . . . showed that treatments based on the former were more effective than those of the latter’, P. Lang 2013, 127. 67  See Nutton 2004, esp. chapter 5. 68  Nutton 248 suggests ‘a series of overlapping spectra’, referring to practitioners ‘wealth, status, education, ideology and methods’, but see the text. 69  Kleinman 1980, 59.

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It is clear that in antiquity too there was an intermediate sector. In the first place there was temple medicine, which we shall come to shortly. There were several other kinds of healers who were not iatroi or medici,70 quite apart from the people who presided over religious cult-centres. But establishing a typology, even telling individual professionals from part-timers from amateurs is difficult, sometimes impossible. The orthodox doctor Scribonius Largus writes, for example, of those who are ‘far removed from the discipline of medicine and are quite unrelated to its professio’, who nonetheless have cured people by means of efficacious medicines (Epist. 1). Who were they exactly? A prime exhibit here must be the pharmakopolai (drug-sellers) discussed in this volume by Laurence Totelin.71 The learned Theophrastus treats some individual pharmakopolai with respect72 while accusing the tribe in general of dramatizing, that is to say over-selling, their wares;73 but in general they were a disreputable crowd, not least because pharmaka included poisons. And a certain amount of scepticism may well have greeted the man who, quite typically, tried to sell such substances as ‘bile of sea-scorpion’ to the Greeks of Oxyrhynchus.74 I admit that I am not convinced by Totelin’s argument that drug-sellers had a neutral reputation in classical antiquity.75 But they certainly had clients and sometimes engaged in active healing. The pharmakis Theoris of Lemnos whom a fourth-century BC Athenian orator said that Athens had put to death with ‘her whole family’ (for what crime exactly? presumably 70  For a typology see Gordon 1995, 363. Gordon 374 underlines the obstacles in the way of studying Graeco-Roman folk medicine. 71  Anyone interested in pharmakopolai can benefit from reading Ramsey 1988, chapters 3 and 4, on the much better attested charlatans and empirics of eighteenth- and early nineteenth-century France.—It is barely worth pointing out at this date that the term pharmakopolai does not mean ‘makers of remedies’, pace Riddle 1985, 5. 72   Hist.Pl. 9.16.8, 9.17.1, 9.18.4. 73   Hist.Pl. 9.8.5: ‘statements made by pharmakopolai and rhizotomoi, which in some cases are perhaps to the point but in others contain exaggerations’ (the word is epitragodountes). 74  One of the substances included in a list of materia medica in P.Oxy. LIII.3701 (2.27) (first c.). 75  Totelin this volume. Texts that are too libelous to be taken literally may still provide excellent evidence of public opinion. See for instance Cicero, Pro Cluentio 40. And in Scribonius Largus, Comp. 199, the phrase ‘execratissimi pharmacopolae’ (the only reference to them in his work) does not mean ‘of the worst pharmacopola’ (as distinct from the acceptable ones) but ‘of a highly detestable pharmacopola’, i.e. Largus thought that the typical drug-seller was detestable (pace Totelin this volume p. 72). Once, but once only, the pharmacopolae are known to have formed a collegium, at Brixia (CIL V.4489 = Inscriptiones Italiae X.5.280: for the text see Totelin this volume p. 72), a well-to-do town quite far, but not utterly remote, from the centres of medical learning; this was a sign of respectability.

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impiety) may well have been in reality a healer and a seer as well as an expert in drugs (it is impossible to get past the rhetoric of the sources).76 In various guises, drug-sellers are constantly present in the classical city. In order to stimulate doctors to study medications more thoroughly, Scribonius Largus asserts that he has ‘often’ seen non-physicians produce cures by means of medicamenta while the actual doctors were dithering about (Epist. 1), and these non-physicians may well have been pharmakopolai.77 Scholars have analysed the various sub-types.78 The pigmentarii institores (drug-dealers)79 whom Scribonius Largus faulted for selling bogus opium (Comp. 22) were presumably at one time a well-known group. You found pharmakopolai in the agora, naturally (Epictetus, Discourses 3.24.80)—how many of them, one wonders, and did you also find them traveling the countryside? It has been reasonably suggested that the poor reputation of the pharmakopolai may have been at least partly a consequence of competitive slandering by physicians,80 and since the latter were also supposed to know about pharmaka (Theophrastus, Hist.Pl. 9.16.8, makes it clear that such knowledge was regarded as part of iatrike), there was a degree of competition, this may be right. We might assume that if you as a medical practitioner could get away with it you preferred the title iatros/medicus, but this may not always have been true: some patients will probably have preferred a healer who offered fabulous remedies, especially if the available doctor was, like the famous Asclepiades of Bithynia, opposed to the use of pharmaka. It is at any rate obvious that the educated distinguished sharply between iatroi and pharmakopolai.81 76  Ps.-Demosthenes, Against Aristogeiton I (25).79–80, asserts that she and her husband used spells as well as drugs. Philochorus (FGrHist 328 F60) referred to Theoris as a mantis. Even if much of Ps.-Demosthenes’ story is untrue (for a full discussion see Rücker 2014, 130–41), it was one that much of an Athenian audience would have found somewhat credible. The term pharmakis is not of course synonymous with pharmakopoles. 77  Naturally he did not use the term here, since he shared the general suspicion that they aroused (see Comp. 199). One might guess that the reason why Pliny used the term herbarius instead was that he found the Greek term unduly derogatory, but he was suspicious of the herbarii too (NH 21.144, 26.24). 78  For the classical and Hellenistic worlds see Samama 2006; for imperial Rome see Korpela 1995. 79  Korpela 101 and Samama 12 discuss the meaning of pigmentarius. 80  Samama 26–7. Once at least the pharmakopolai exacted revenge via the bizarre story recounted in Diodorus Siculus 32.11 (see below, p. 81). 81  See inter alia the texts gathered by Samama 23: Teles, De fuga p. 26 Hense, Plutarch, Quomodo quis suos in virtute sentiat profectus 8 (Moralia 80a), Sextus Empiricus, Adversus Professores 2.41–2.

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Another important element in the supply chain consisted of the ‘plantcutters’, rhizotomoi, but their function was apparently to supply doctors and pharmakopolai with plant materials, not to deal directly with the public.82 (The word rhiza, it should be noted, often means a medicinal plant in general, not just a root: Theophrastus, Hist.Pl. 9.8.1). They were sometimes treated with considerable respect,83 and while most of them were no doubt skilled but unpretentious workers others had larger ambitions: the root-cutter Crateuas who is mentioned by Dioscorides (I, praef.2) lived at the court of King Mithridates VI of Pontus and was a man of learning whose works were later used by Galen among a number of others.84 But the rhizotomoi too had an equivocal reputation; this was already the case in the time of Sophocles, who wrote a play called Rhizotomoi, concerning Medea and her poisons (Macrobius, Sat. 5.19.9–10). We have already noticed Theophrastus’ highly informed opinion (n. 73). Clouds of suspicion that they knew too much about poisons and practised sorcery continued to hang over them.85 But it could be argued that the disapproval comes from the educated urban elite and that the root-cutters, though sometimes dishonest, performed a vital social function by supplying the ordinary population with substances that were from time to time medically effective. We also need to look carefully at the people whose occupations are described in the sources with iatro- words, not only the often-mentioned iatraleiptai, but also iatroklustai, iatromaiai, iatromathematikoi and iatromanteis (these are all of the iatro- occupations listed by Liddell and Scott and Montanari).86 Their titles seem at first sight to leave them in limbo as doctors who were not simply or exactly doctors. They fall into two groups, not perhaps along the lines one might have expected. Most of the above terms are rare. The word iatromantis, for example, after some references in Aeschylus, is virtually unattested; its supposed appearance in an inscription from Elea/Velia is very dubious and would in any case be connected with the local healing cult of Apollo Oulios.87 There 82  But see Samama 14. 83  This is implied by the fact that the eminent physician Diocles of Carystus wrote a work called To Rhizotomikon (Schol. Nicander, Theriaka 647 = fr. 204 van der Eijk). 84  Kind 1922. 85  Watson 2003, 235, who however pays no attention to their respectable activities. 86  Belting-Ihm 2007, 200, invents a whole story about ‘iatromageia’, a phantom word. 87  On the latter see the references given by Nutton 2004, 352 n. 41. All who have edited or referred to this honorific inscription (for which see L. Vecchio (ed.), Le iscrizioni greche di Velia (Vienna, 2003), no. 20, of the first c. BC or AD) have claimed that this term should be restored, but there is an interpunct after the letters iatro [sic, not of course a real word] and before the mu, after which the line breaks off (see Vecchio fig. 45). The word

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were always of course seers (manteis) in considerable numbers, but very few of them, apparently, added the specialist (and pretentious) iatro- to their selfdescriptions. The only iatro- word for an occupation that was ever in common use was that of the iatraleiptes. The term is usually translated as ‘masseur’, but that does not capture the Greek word’s pretension. As far as one can tell, the function of an iatraleiptes was roughly equivalent to that of a physiotherapist.88 This occupation had at least one period of respectability, from the Flavians to the Antonines or later: Vespasian gave them some privileges,—distinguishing them from iatroi—,89 and later there was an official iatraleiptes of ‘the emperors’, probably Septimius Severus and Caracalla (I. Ephesos 629).90 No one much confused them with doctors, as far as we know. It seems only to have been in the case of certain midwives that there was some confusion as to whether they should be considered doctors or not. Certainly most midwives, full-time or part-time, had no such pretensions; very very occasionally they are referred to as iatromaiai.91 It has often been supposed that iatrinai and medicae were in reality midwives (that is how Liddell and Scott translate iatrine),92 but in fact it seems reasonably clear that both terms were normally applied to women who had wider medical skills, comparable to those of the iatroi, though some of them probably treated mostly female patients.93 We shall return later to the role of midwives (Gk. maiai, Lat. obstetrices), but ample evidence shows they might add to their basic function assorted skills that did not go with Hippocratic doctoring. One can cite for example Salpe, an obstetrix mentioned four times by Pliny who provided aphrodisiacs, used urine against poor eye-sight and against sunburn (with the white of an ostrich ‘iatromantic’ seems to have taken on a life of its own in recent scholarship, e.g. in Israelowich 2015, 118. 88  So translated by B. Fuchs in Anonymus Parisinus, De morbis acutis et chroniis 27.8 (Garofalo 1997, 153). The derogatory version (Pliny, NH 29.4) was that doctors employed them to rub patients down with oil and as general assistants (‘unctoribus . . . medicorum ac mediastinis’). Cf. Sherwin-White on Pliny, Ep. 10.5.1. Applying oil was also a common technique of Christian and no doubt other exorcists. 89  F IRA I no. 73. 90  In IGSK 13 (Ephesos III). 91  Cf. SEG 37 (1987), no. 1854. Add now an attestation from Sardis: Keen and Petzl 2014. 92  Montanari gives ‘levatrice, ostetrica’. 93  Robert 1964, 175–8, and also Israelowich 2015, 74–84, both with references to earlier literature. SEG 61 (2011), no. 494 (Dion, second century AD), refers to a woman doctor who treated men and was also a maia.

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egg, when available), depilated slaves for market, and knew how to stop dogs barking.94 The vocabulary applicable to some of the ‘paramedical’ occupations of antiquity teeters on the border between description and abuse. When the author of On the Sacred Disease denounces those who in his opinion are in error on the subject (2), he lists magoi (magicians) and kathartai (purifiers), who would I suppose have recognized themselves under these labels,95 but also agurtai (begging friars?), who probably did not, and alazones (charlatans or crooks—this is a very broad term of abuse), who almost certainly did not.96 Of course a magos or a kathartes or an agurtes might theoretically pass himself of as an iatros, but there is no reason to think that much confusion reigned as to who was what, in spite of the fact that even a Greek city might also be home, after a certain date, to a number of miracle-working Jewish exorcists (Acts 19.11–19). It is in fact perfectly possible to draw a line of demarcation between elite/learned/rationalistic medical practitioners on the one hand and those who provided or helped with popular methods of medical care on the other, even though the former, as we have already seen, sometimes strayed into the territory of the latter. As for magicians, the large amount of intellectual effort that has been devoted to defining magic97 and to describing magical practices has not 94  See NH 28.262, 28.66, 32.135 and 32.140 respectively. She presumably wrote something, since Pliny writes of her both in the perfect tense and in the present. 95  A kathartes is listed among other occupations in IG V (1).209, line 25 (Sparta, first c.). 96  The attempt by Samama 2004 to make a consistent figure out of the charlatan was misguided. 97  Briefly: Keyser 1997, 175, offers a standard kind of definition: ‘excluded practices depending for their effect on forces or powers in the world beyond human understanding’, adding that any such definition is subjective because it will always depend on who is doing the excluding. But since we go on using the term, we need something more objective. Bremmer 2015, 11, rightly objects that characterizations such as ‘unsanctioned religious activity’ (Gordon and Marco Simón 2010, 5 n. 19) seem to presuppose that there was a regulating authority, and though Bremmer errs in supposing that ancient communities never tried to regulate such activities prior to the spread of Christianity (see above, p. 6), they did not always try to do so (and we may add that they seldom if ever succeeded). The element that is missing here is secrecy, not absolute secrecy of course, but the secrecy that keeps the procedures out of sight of hoi polloi. That characteristic of magic is the reason why, for example, Achilles Tatius does not tell us the nature of the spell of the ‘Egyptian woman’: to describe it would be to take away one of its magical qualities. See further Dickie 2001, 39–40. The best overall account of the conceptual problem known to me is now to be found in Frenschkowski 2010, cols. 873–6.—Not surprisingly, some ancient writers on the subject seem to be not only ambivalent but confused: Pliny approved of

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produced a clear social profile. That may be unavoidable—practitioners of magic, however you define it, were highly diverse.98 It was not perhaps after all so very difficult to tell whether a person was an iatros/medicus or not. Then as now there were some borderline cases (see further p. 31), then as now the competence of physicians was highly variable, and then as now there were some occupations in the middle ground. But there are several conceptual problems that might serve as bases for a counter-argument against the view I am putting forward. Four in particular require attention. It seems clear, in any case, pace the distinction made by Kleinman, that an investigation of popular medicine in antiquity needs to take in pharmacopolai, magoi and kathartai, as well as temple-medicine, old women, and amateur help of all kinds, for what we are in search of is the experience of people suffering from physical ailments when they did not, or could not, rely on an elite doctor.

Further Conceptual Problems

(1) Where should we locate temple medicine?99 What was the exact role of the people who represented the deities who concerned themselves with healing, above all Asclepius? On the one hand, serious rationalistic doctors openly made time for Asclepius and were expected to do so.100 And more generally we must assume that most physicians shared the religious world-view of the society at large. In a sense the priests of Asclepius reciprocated in that they publicized cure narratives in which the god behaved (in the supplicants’ dreams) very much like a human doctor, applying drugs and performing surgery.101 As Geoffrey Lloyd observes, ‘the methods of healing used both in what we may call

(Roman) magic (NH 28.10–34) but also disapproved of magic (NH 30.1–20; cf. 25.25, 26.18 and 20) (cf. Keyser 175). 98  M. Smith 1978, 84. 99  It is fairly common to divide ancient medical practices into three—Hippocratic medicine, temple medicine and magic (e.g. Nagy 2012, 71)—but that is unsatisfactory, especially because temple medicine was no more (and no less) ‘medicine’ than say the use of amulets, and partly because some popular medicine was not magical in any accepted sense of that fuzzy term. Nor is a model of three overlapping spheres (Oberhelman 2013b, 6–8) much better: it tends to exaggerate the overlaps between rationalistic medicine and the other spheres. 100  Nutton 2004, 111 and 281. 101  Edelstein and Edelstein 1945, II, 112.

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“rationalistic” and in temple medicine had much in common’102—yet it was all a charade, and underneath there was always a degree of competition (see further below, p. 46).103 When the famous Alexandrian physician Herophilus said that drugs (pharmaka) were ‘the hands of the gods’,104 he may sound pious, but given the prominence of divine hands in temple medicine,105 he may well have been entering a counter-claim—it was not the priests but drugs that were the instruments of the gods’ benevolence.106 We might want to categorize the priests of medical cults as practitioners of ‘folk medicine’ in Kleinman’s sense, but for the most part they did not, as far as we know, offer medical treatment or even advice.107 (They might recommend fasting, and Galen complains that the patients at the Pergamum Asklepieion obeyed the god in this respect though they would not have obeyed a doctor (In Hippocr. Epid. lib. VI Comm. 4.8 = XVII, 2, 137K). We should therefore see 102  Lloyd 1979, 45. 103  It is intriguing that in the relatively new Galenic text On Examining the Best Physicians (an Arabic text published by A.Z. Iskandar in 1988 as De optimo medico cognoscendo/On Examinations by which the Best Physicians are Recognized) the author inveighs against temple medicine (1.4). This has been thought to be inconsistent with what he says about Asclepius elsewhere (Nutton 1990, 254–5). Strictly speaking, there is no contradiction, but if this sentiment is judged non-Galenic, then the whole question of the authorship of the treatise needs to be re-discussed. The question of authorship, however, does not matter for my immediate purpose, for here in any case is a doctor writing in the 170s AD who is hostile to the temple medicine of Asclepius and Apollo. Cilliers and Retief 2013, 74, repeat the received opinion that there was no competition between the Asclepius and the doctors, but this is to a significant degree erroneous. They are no doubt right, however, to suppose that some of the cases that found their way to healing temples would have been avoided by iatroi as being hopeless. 104  Scribonius Largus, Epist. 1 and others = Herophilus fr. 248 Von Staden (though this editor gives the reference to Largus incorrectly). For parallels see Weinreich 1909, 37. I see no reason to follow Von Staden (1989, 8) in his view that this phrase was probably no more than ‘a metaphorical evocation of the power and importance of drugs’. A classic paper by Ludwig Edelstein (Edelstein 1937) showed that the Hippocratic writers and their successors saw no conflict between a naturalistic and a religious understanding of the physical world. See further Lloyd 1979, 41–3. 105  Weinreich 1–37. 106  For his enthusiasm for medicamenta see Celsus 5 praef. 107  As noted above, Egypt was different.—Wickkiser 2006, 34–7, was rightly sceptical about the supposed medical instruments found at certain Asklepieia and, where they do exist, about their actual use. So also Dodds 1951, 129 n. 74, Bliquez 2015.—Dodds points out that after Aelius Aristides had dreamt of a certain ointment, the temple warden provided it to him, Orat. 49.21–3; but it was apparently chance that the warden had it available, and there is no hint of a commercial transaction.

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them mainly as fomenters of popular religious beliefs (which is not to deny that temple medicine must sometimes have had a positive placebo effect). But it was a particular form of belief: as Robert Parker has remarked, ‘those who underwent incubation dreamed not of angry gods but of skilful surgery and subtly balanced regimen’.108 Real-life surgery on the other hand was as far as we know the exclusive province of iatroi and medici, just as one would expect given the very serious pain that was almost certain to be involved.109 There is no real evidence for the notion that the functionaries of Asclepius temples sometimes performed actual surgery.110 In Roman times we occasionally meet Greek doctors who held official positions at famous shrines: two zakoroi (= neokoroi, temple wardens) of the Asklepieion at Athens—two only, however—are known to have been iatroi),111 but this is a sign that the position was now an honourable one—nothing to do with sweeping the temple floor—,112 not that anyone was actually practising medicine in the Asklepieion.113 In what circumstances and to what extent the inhabitants of the classical Mediterranean entrusted themselves to divine help against their physical ailments, and how they set about obtaining such help, are in any case vital topics to which we shall return. (2) A great deal of Hippocratic medicine, and a fair amount of later elite medicine too, was in fact ‘popular’ in the sense that it stemmed, without much admission to this effect, not from anatomical investigation or experimental results, but rather from centuries-long, perhaps even millennialong, or relatively brief processes of trial and error carried out by interested amateurs; this must have been the case, for example, with those few elements in the classical pharmacopoeia that had some real positive effects. There always existed a huge world of herbal cures that were known to ordinary lay 108  Parker 1983, 250. ‘Hyper-skilful’ one might say. 109  For the history of anesthesia in Hellenistic and Roman medicine see Harris forthcoming. 110  As supposed by Cilliers and Retief 2013, 80, and some others. Aristophanes, Plutus 716– 25, is no evidence that incubants received actual medical treatment (cf. Edelstein and Edelstein 1945, II, 150 n. 23). 111   I G II2.3798 and 3799, both Hadrianic. Cf. Aleshire 1989, 87–8. 112  There were for instance just two neokoroi at the great Asklepieion of Pergamum in Aelius Aristides’ time (Orat. 48.30). 113  Israelowich 2015, 155 nn. 174–5, seems to err on this subject, partly because he supposes that a neokoros was a ‘priest’. The Asclepiacus who assisted Aelius Aristides was both a doctor and a neokoros of the Pergamum Asklepieion, but that does not mean that he practised medicine in the shrine. For the social level of the neokoroi in Hellenistic and Roman times see Hanell 1935, cols. 2423–4, etc.

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people, some of which graduated, by processes that are not at all clear, into the medicine cabinets of the rationalistic physicians. ‘Hippocratic medicine is in many respects a continuation of traditional practices and beliefs’, as Parker remarks.114 The whole story of Hippocratic hellebore is to be understood in this way: it is the medicine that the Hippocratic writers recommended more than any other, for all sorts of conditions. In reality black hellebore is highly toxic, while white hellebore is effective and useful only as an evacuant.115 When the Hippocratic doctors treated people with hellebore, some of their patients must have died in consequence (and sometimes we know that they died), while most others will have experienced no positive effects, placebo effects aside. Doctors’ affection for this plant presumably went back to popular knowledge that consuming it had dramatic effects.116 This may also be one useful way of seeing the role of Dreckapotheke, mainly urine and excrement, in the Hippocratic writers’ treatment of women’s illnesses—i.e. it could be hypothesized that the underlying aim was a popular male desire to eliminate dirt with dirt—I am building here on a persuasive hypothesis framed by Heinrich von Staden—, but the role of such substances in earlier Egyptian medicine may be an obstacle to such a thesis.117 The Hippocratic Affections (45) tells the physician (who at this point seems to be the imagined reader) that he can learn of drugs for internal or external use from anyone, including laymen (idiotai), because it is chance not gnome (reasoning? theory?) that leads to discoveries in this area (but there is some ambivalence later in the chapter).118 The Hippocratic Precepts (2), probably a Hellenistic composition,119 tells the physician not to hesitate to ask questions of laymen (idiotai again) if that seems likely to improve a treatment. And

114  Parker 1983, 213. 115  Girard 1990. 116  Cf. Stannard 1982, 12. The origins of very many therapeutic ideas we find in ancient medical writers are bound to remain obscure: when, for example, Scribonius Largus recommends live black sting-rays as a remedy for headache (above, p. 14), we might think that this was a popular idea, but given the practical difficulties headache-sufferers are like to have had in laying hands on live black sting-rays we might think instead that it was the brain-child of a theorist who knew that the touch of a sting-ray has a numbing effect. 117  The essential reading here is Von Staden 1992a. 118  Much of this treatise is addressed to laymen, but Potter 1998, 4–5, showed that it was partly addressed to physicians. 119  Cf. Jouanna 1999, 405–6.

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sometimes the elite doctors seem merely to have rationalized traditional ideas, with regard to regimen for instance.120 There may have been some change in the attitude of at least the more pretentious doctors in late-Hellenistic and Roman times. Scribonius Largus and Galen cheerfully admit on occasion that they have obtained sound recipes from lay people, and Scribonius can be quite generous about their activities—he mentions a ‘little woman from Africa’ who cured many people’s gastric pains at Rome (Comp. 122).121 Galen obtained recipes from a boxer named Flavius, from a groom named Orion, from a centurion, from a Bithynian barber, and from two ‘crowd-pullers’ (‘itinerant hucksters’?),122 as well as from pharmakopolai, an iatraleiptes and a rhizotomos.123 But they did not recognize any of these amateurs as people from whom iatroi/medici might learn more than a single recipe; almost all sound medical knowledge was supposed to reside within the profession. There may of course have existed practising iatroi and medici who had little to do with rationalistic medicine. Yet if such persons did exist they may all have belonged to archaic Greek times or to late antiquity. Marcellus Empiricus, a one-time Master of the Offices under Theodosius I, may possibly have been one such, if he did in fact practise medicine.124 He includes in his pharmacology remedies (‘fortuitous and simple’ ones) which he has learned ‘ab agrestibus et plebeis’, who have, he says, proved their value in practice.125 Marcellus’ medicine, it is said, ‘was virtually folk medicine with no pretence of being connected to the Hippocratics and Galen’.126 120  McNamara 2003–2004, 6. 121  As we have already seen, Scribonius elsewhere refers to certain remedies as ‘falling outside the profession of medicine’ (17). He also refers to recipes that he has obtained from a respectable matrona at Rome (Comp. 16), and from hunters in Sicily (163). Celsus occasionally refers respectfully to therapies that came from rustici (4.13.3, 5.28.7, 6.9.7) or from idonei auctores ex populo (4.7.5), suitable authorities among laypeople. 122  See respectively De comp. med. sec. loc. 9.5 (XIII.294K); De comp. med. per gen. 7.13 (XIII.1038K); De comp. med. sec. loc. 9.3 (XIII.260K); De simpl. med. 4.18 (XI.681K); Antid. 13 (XIV.180 and 182K). Liddell and Scott’s ‘mountebank, charlatan’ will not do for ochlagogos, but the precise meaning is uncertain: they were probably traders of varying degrees of honesty who travelled from town to town (Guardasole 2006, 30). Vivid illustrations of this kind of activity in early-modern France can be found in Ramsey 1988, e.g. p. 141 (a drawing of 1776). 123  See further Nutton 2004, 252. 124  For this possibility see Kind 1930, col. 1499. 125  ‘quae experimentis probaverant’, p. 1 Helmreich = p. 2 Liechtenhan. 126  Riddle 1993, 119. That may be over-stated.

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(3) The informal nature of medical education, in a system without any kind of certification, certainly meant that some of the practitioners of rationalistic medicine knew relatively little about it. Some of those who studied the higher medicine seem not to have been deeply educated in the first place. ‘Some began their medical education from a low enough level’, Peter Parsons remarks, referring to medical texts rather clumsily copied by Oxyrhynchites.127 But as Parsons points out, there was also abstruse learning among the doctors at Oxyrhynchus, in the form of a commentary on Nicander’s Theriaka (it seems a reasonable guess that this text belonged to a doctor since it has medical recipes on the back).128 When the elder Pliny complains about the harm that doctors do, he cuts a poor intellectual figure himself—he is intolerant of differences of medical opinion and of original medical ideas, and of Greeks,129 and his complaint is not in any case that doctors are untrained. It is said that doctors in the army had only ‘basic medical training’,130 but there is no evidence to that effect and they were presumably expected to deal with a wide variety of complaints in addition to wounds (however they are not likely to have been the best trained members of their profession).131 Galen’s efforts to discredit some of his colleagues are too obviously self-serving to be taken literally or anything like it.132 It was an old practice—going back in my view to On the Sacred Disease if not further—for established doctors to treat rivals as charlatans and ignoramuses.133 On one occasion Galen refers to a young patient of his who was ‘quite skilled in iatrike . . ., one of those who practise medicine empirically (empeirikos) on the basis of practical experience (ek tribes te kai gumnasias) (De meth.med. 5.12 = X.361–2K); a doctor in fact, though not one whom Galen could possibly regard as an equal. 127  Parsons 2007, 179, with reference to P.Oxy. XXXI.2547 (third c.) and PSI XII.1275 verso (second c.). A text such as P.Mil.Vogl. I.15 (on which see Leith 2014) strongly suggests that at the period in question (third or early fourth century AD) you could get a kind of medical education in the town of Oxyrhynchus. For the availability of medical education in a much smaller place in mainland Greece see Nutton 2004, 262. 128   P.Oxy. XIX.2221 and P.Köln V.206. 129  At NH 29.11 he notoriously reports the epitaph ‘he died of a crowd of doctors’. 130  Israelowich this volume p. 219. 131  It is of interest incidentally that the Roman imperial army seems, as far as we can tell, to have stayed with a version of rationalistic medicine. But pity the soldier who had the elder Pliny as his commanding officer. 132  See in particular the treatise De optimo medico cognoscendo—if it is really Galenic (see above, n. 103). Vegetti 1994, 1674–6, was not sceptical enough about these texts. 133  Cf. P. Lang 2013, 130–1. There is work to be done about ancient professional competitiveness more generally.

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A graduate of a modern medical school can look forward with confidence to psychological and material satisfaction. The medical profession in classical times was by no means so comfortable, and one may doubt therefore that it attracted many who were too lazy to acquire what passed for a solid training. (4) Another minor difficulty is where to locate people who were not practising doctors but knew a great deal about medicine. It looks as if, in Hippocratic times at least, doctors sometimes wrote for lay readers: Airs, Waters, Places, for example.134 But the phenomenon to be considered here is something different from the interested layman. Aristotle already recognized the existence of well-informed non-practitioners when he divided doctors into three categories—ordinary practitioners, leading doctors (architektonikoi), and those who happened to be learned on the subject (Politics 3.6.1282a3–4). Presumably he would have admitted his extraordinary pupil Theophrastus to the last category. Varro also knew and wrote a great deal about the medicine of his time.135 These are probably the people who are occasionally referred to in the sources as the philiatrountes or philiatroi—‘men with a passion for medicine’ (see for instance Dioscorides 5.19).136 As Nutton has pointed out, Galen’s advice in On Examining the Best Physicians could not have been followed by a layman unless he/she was also highly knowledgeable about medicine.137 Neither Theophrastus nor Varro was a doctor, and if we knew more about Celsus’ life we would no doubt be able to decide whether he was one or not—probably not. There is no real difficulty here in distinguishing doctors from non-doctors.

Rational Medicine?

Is Plato’s opinion about the cause of epilepsy any more rational than that of the ‘charlatans’ denounced in On the Sacred Disease? ‘White phlegm, when mixed with black bile, can overlay and confuse the divine circles in the head; if this happens in sleep the effect is comparatively mild, but an attack in waking hours is more difficult to throw off. And as the sacred part [i.e. the head]

134  Nutton 1992, 17. 135  Boscherini 1993, 740–4. 136  L SJ were probably in error to translate philiatrein as ‘to be an amateur doctor’, as if philoteknein meant ‘to be an amateur child’. 137  Nutton 1990, 243–9.

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is affected, the disease is appropriately called “sacred” ’ (Timaeus 85a).138 The answer to this question might in fact be ‘yes’, since Plato and the medical thinkers from whom he took this idea were at least trying to solve the problem in secular and material terms. As for the prognoses of ancient physicians, the terms ‘rational’ and ‘irrational’ do not cover the whole map: many of them partook of rationality without being rational. Some medical historians do seem to attribute too much rationality to what I have been calling rationalistic ancient medicine.139 But the tradition of the classical Greek medical texts did in fact to a noteworthy extent approach illness in rational ways:140 (a) it attended carefully to symptoms and compared them with those that were described in the medical tradition, both written and oral; (b) it applied its basic biological principles (such as the theory of the humours) in a systematic fashion; (c) it attempted to present its conclusions as a result of a reasoning process—Galen emphasized logos iatrikos—roughly, ‘medical logic’;141 (d) it interested itself in regimen; (e) it sometimes admitted its own helplessness; and (f) it tended to exclude religion-derived aetiologies and remedies (while quite often failing to do so).142 But this is not the place to 138  I am making the conventional—though not universal—assumption that this is Plato’s own view; cf. Lloyd 2003, 153. 139  It is still quite normal to refer to classical Greek medicine as ‘rational medicine’, e.g. Jouanna 2011, 48. Laskaris 2002, 6–14, points out some of the limits of the rationality of the Hippocratic doctors but attempts to save them by reference to their critical attitude towards existing explanations. According to Dodds 1951, 116, ‘we should not allow the modern reaction against rationalism to obscure the real debt that mankind owes to those early Greek physicians who laid down the principles of a rational therapy in the face of age-old superstitions’. Palmieri 2003 is a disappointing collection because in spite of its title none of its contributors offers a detailed discussion of the terms ‘rational’ and ‘irrational’ themselves. Van der Eijk 2011, 23–6, over-reacting I think to the supposed rationality of Greek medicine, dismisses it too readily. 140  For studies of the contrasting approaches of the three medical ‘sects’ see the works cited by Leith, this volume. 141  What is really impressive in Hippocratic medicine is its commitment to debate; see, for instance, [Hippocrates], Diseases 1.1 end. For Galen’s devotion to ‘reason’, as he understood it, see Keyser 1997, 176–7, and esp. Von Staden 2003, and the bibliography the latter assembled (18–19). Conversely alogos, irrational, is one of his favourite terms of abuse (Von Staden 19). 142  Horstmanshoff and Stol 2004a, in a one-sided attempt to show that Greek medicine was not rational, ignore most of the relevant evidence and go to the opposite extreme: see Harris 2009, 230 n. 2. There are, or at least have been, medical anthropologists who have radically assailed rationality in medicine: Good 1994, 181, preferred ‘the meaningful, mythological, and transcendent dimensions of illness [and] healing’, whatever that means.

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discuss in any detail the development and limitations of scientific method in antiquity.143 Others besides doctors were certainly interested in regimen,144 but it is a reasonable hypothesis that ‘folk’ healers and ordinary people when they were attending to medical matters very seldom met criteria (a), (b) or (c). A reasonable hypothesis to which there may have been some exceptions. But what most perhaps distinguishes rationalistic doctors from other healers is that the former were quite often called upon to justify themselves in public, and did so.145 This is a complicated matter. Plato notoriously makes Gorgias say that a Greek assembly would appoint a good speaker as a public doctor rather than an actual doctor (Gorgias 456bc), and while that was no doubt untrue laymen may often have been poor judges of a doctor’s real abilities. The same applied when the ordinary private-practice doctor was subjected to the informal judgement of the patient’s relatives and onlookers (classical doctors would have been puzzled by the relative privacy that surrounds modern medical consultations).146 And other kinds of healers might offer selfjustifications too; the proprietors of healing-shrines were not shy about the cures they claimed to have effected. But a reasoned exposition of views was an important part of classical medical practice, and it had its written form too. Here, as in a number of other fields, the effects of committing technical knowledge to writing have been debated, but it is very likely to have deepened the gap between rationalistic medicine and the popular kind.

Doctors as Professionals

So we come to the matter of the medical profession, which requires consideration here if we are to have a clear concept of popular medicine. It must be admitted that scholars sometimes seem to assimilate the classical medical profession to the modern one to an excessive degree. And we must allow for 143  From a large bibliography on this subject I simply cite here Grmek 1997 as being especially concerned with medical thinking. Fifth-century Greece bore some resemblance to eighteenth-century Britain in that ‘physicians finally ceased to regard epilepsy as supernatural . . . they now grasped that the problem was a technical one, open to human investigation’ (K. Thomas 1971, 660); why the outcome was different is a question beyond the scope of this paper. 144  McNamara 2003–4, 5–7. 145  See Nutton 2004, 87, Massar 2005, 47–8, etc. 146  For the public nature of ancient medical practice see Nutton 263–4.

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a wide variety among ancient doctors, with respect to education and social status. Greek medical culture that came to dominate rationalistic medicine all over the Graeco-Roman world, but we cannot know of course how closely the practices of typical doctors resembled those described by the extant medical writers. Yet the recent trend has been to go too far in the other direction: scholars have repeatedly stated that there was no medical profession in a modern sense in antiquity. The claim is literally true but quite misleading.147 In most cases it was, I would suppose, quite clear whether a person was a doctor or not, and in time doctors formed guilds148 and public authorities worked out ways of deciding who was qualified to speak professionally. A rudimentary code of professional ethics existed from Hippocratic times onwards.149 There is no need to set out the case in full in this context—the point is, first, that most people most of the time will have known whether the person who was advising them or applying a treatment for a given sickness was a doctor or not, and second that we can reasonably treat all other healers as belonging to the realms of folk or popular medicine. Geoffrey Lloyd has written that ‘in the ancient world’ there was ‘no equivalent to the modern, legally recognized, professional medical qualification’,150 but that was true throughout the world until the nineteenth century. Aristotle, in the passage of Politics 3.6 referred to above, recognizes that there are complications in deciding who possesses medical expertise, but he shows no doubt whatsoever that is feasible to say who is an iatros and who is not. When the Hippocratic Law (1) claims that there are many who claim to be iatroi but few who really are, the thoroughly rhetorical nature of the passage needs to be recognized (it was entirely false for instance that Greek states subjected incompetents in every other techne to legal sanctions, as the author implies).151 Lloyd himself lists many passages in the Hippocratic corpus where authors take for granted the distinction between doctors and laymen.152 147  I came too close to accepting this notion in Harris 2013, 7. 148  See Nutton 1995, 4–8, and 2004, 250–1. An Alexandrian inscription of 7 AD (Römer 1990 = SEG 40 [1990] no. 1552) already shows the plethos of the city’s doctors honouring one Themison (scarcely the famous physician of that name). 149  Kudlien 1970, Nutton 2004, 68–9, 155–6. No other ancient occupation could say this. 150  Lloyd 1979, 38–9. 151  And the author’s repeated insistence that a doctor needs to start learning in boyhood looks very much like a justification for the Greek tendency to restrict the profession to the sons of doctors. 152  Lloyd 1979, 39 n. 152: e.g. Regimen in Acute Diseases 1, Ancient Medicine 2 and 9. Similarly Nutton 2004, chapter 17.

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It is true that there were a few people it may have been difficult to classify, but so there are now (MDs who do scientific research or work for insurance companies and do not practise, medical students volunteering in very poor countries, practitioners of non-western medicine of the kind encountered by Kleinman in Taiwan). There is no clear evidence, pace Vivian Nutton, that doctors to any significant degree practised other occupations at the same time153 (midwives were quite probably another matter—a small community in any traditional society has to have a part-timer to fill this role).154 The only case I know of is that of Sex. Iulius Felicissimus of Aquae Sextiae in Gallia Narbonensis, an arena fighter who specialized in wild animals and died at the age of nineteen (CIL XII.533): his epitaph slips in the paradoxical information that was also a doctor (‘medicus tamen’); presumably he knew how to administer first-aid to men injured in the amphitheatre. We are not dealing with a deeply bureaucratized society such as came into being in Europe in the nineteenth century,155 yet there is no sign that it was a difficult question in classical or Hellenistic Greece to decide whether a person was a doctor or not, and Roman law eventually provided a definition. There will sometimes have been less clarity outside the Graeco-Roman mainstream. Other peoples might organize things quite differently, as classical writers sometimes knew: Pliny’s encyclopedia deplores the Druids, for example, but calls them medici as well as vates (NH 30.13—for him, however, medicus was almost a term of abuse). In Graeco-Roman Egypt doctors might practise inside temple complexes.156 The institution of public doctors, which had already started in Greece by the late sixth century BC (to that extent at least we should trust Herodotus 153  The fact that some owned land is not relevant: buying land was one of the chief options of the ancient saver and investor. Nutton 1992, 54 and 248, takes satirist Phaedrus 1.14 (not to mention Martial) altogether too literally. Nutton 2004, 251–2, without referring to his source, speaks of an Athenian ‘medicine man’ who was also a snake-handler, but Aelian, Nature of Animals 9.62, refers to him as a pharmakotribes (drug-preparer) not an iatros. For the zakoroi (temple wardens) who were iatroi at Athens see above, p. 23. But I might be wrong—can one be sure that there were not a number of people who, rather like William Dyer of Bristol (1730–1801), whom we happen to know about because he kept a diary that has survived (see Barry 1985), had non-medical middle-class careers but also administered cures outside their families and corresponded with medical men? 154  For a part-time midwife see Eunapius, Vit.phil. 21 (a reference I owe to Vivian Nutton). 155  Nor with a wealthy modern country such as Great Britain; anyone with experience of medicine in a developing country will know that even licensed physicians come in all shapes and sizes. 156  Dunand 2006, 6–8. So at least it appears.

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3.131—part of his story about the physician Democedes of Croton) and is well attested in the following century, does not admittedly establish that there was a clear dividing line, but there are ample signs of professionalization by the late fifth century. The Hippocratic Oath shows a certain desire to maintain a closed corporation. We have just seen that the Hippocratic writers insisted on distinguishing themselves from laypeople. The way you established your identity as a doctor was by reference to your teacher and if possible by the testimony of people you had cured.157 It helped if you could gain the approval of other doctors.158 Mostly you would disdain procedures that seemed to be magical.159 When Hellenistic and Roman-period towns wished to appoint a public physician or decide whether a person should be exempt from civic obligations on the grounds that he was a physician, they clearly had no difficulty in principle in deciding whether the applicants were doctors.160 It has been said that the examination of potential public doctors, the dokimasia, was not like a professional test;161 it was certainly not a test of whether you were a doctor or not, it was more like a set of job interviews. Early imperial Latin authors actually use the term professio to refer to the medical profession (Celsus, prooemium 11, seems to be the earliest surviving instance). A little later Scribonius Largus, in a passage already cited, refers to medicines that ‘fall outside the profession of medicine’ (Comp. 17).162 Whether tax exemption for the whole medical profession began with Augustus, as claimed by Dio (53.30), we need not decide,163 but Vespasian certainly confirmed or initiated tax privileges for physicians and he must have assumed that it was not particularly difficult to decide who qualified for the exemption. Ulpian gives us a partial definition of a medicus, admitting that there were some doubtful cases: 157  See Massar 2005, 47–8. 158  Nutton this volume p. 274. 159  Nutton this volume, pp. 5 and 8, Gourevitch this volume p. 251, Nutton this volume pp. 275, 279. 160  For doctors’ tax privileges, from Hellenistic times onwards, see Nutton 2004, 249–50. But it seems misleading to imply that anyone was ‘left out’ (250) of the profession when Antoninus Pius attempted to restrict tax privileges; the emperor did not deny the title of iatros or medicus to anyone. A useful recent study of the public doctors in Roman Egypt: Gad 2012. 161  Nutton this volume p. 272. 162  Nutton 2004, 174, wishes to translate professio in this passage as ‘public declaration’, meaning the Hippocratic oath, but while Largus might have written that such medicines were contrary to the oath he can hardly have written that they were outside it. 163  An inscription from Ephesus appears to show that some such privileges were in existence by the 30s BC: I.Ephesos 4101 (IGSK XVII.2).

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They take care of people’s health . . . female obstetricians . . . seem to practise a sort of medicine. Some will perhaps also regard as doctors those who offer cures for a particular part of the body or a particular pain, as for instance an ear specialist, a throat specialist or a dentist. But one must not include people who make incantations or imprecations or, to use the common expression of impostors, exorcisms. For these are not branches of medicine, even though there are people who publicly assert that such persons have helped them (Dig. 50.13.1.1–3). The second half of this statement (‘But one must not include . . .’) sounds admittedly as though it is a contradiction of an alternative view. Ulpian would certainly not have counted as medici such specialized healers as the North-African Psylloi and the Italian Marsi, both fairly well-known in Roman times as healers of snake-bite. The former are most famous because Octavian summoned them to thwart Cleopatra’s suicide (he wanted to make her part of his triumph: Suetonius, Div. Aug. 17).164 The Marsi were known at Rome, down to the time of the elder Pliny at least, as snake-splitters but also as healers of snake-bite and as the possessors of medically useful herbs.165 It is of course one thing to distinguish doctors from other medical practitioners, professional or part-time, and another thing to distinguish rationalistic medicine from popular medical practices. We have now considered the personnel of the healing occupations, and we shall shortly turn to popular practices. The fact that some of them were more or less endorsed by (some or many) rationalistic doctors complicates the task but does not make it impossible.

An Interlude There were two epidemics of measles during the decade [the 1880s, in a village nineteen miles from Oxford], and two men had accidents in the harvest field and were taken to hospital; but, for years together, the doctor was only seen there when one of the ancients was dying of old age, or some difficult first confinement baffled the skill of the old woman who, as she said, saw the beginning and end of everybody. —Flora Thompson, Lark Rise (1939), ch. 1.

164  The fullest ancient reference is in Celsus, De med. 5.27. 165  For the Marsi and snake-bites see Pliny, NH 28.30–32; for herbs, NH 25.86, with the note of J. André. The fullest collection of evidence about them is in Letta 1972, 95–9.

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Is that also how it was in the world of the Greeks and Romans? Yes, but in fact mostly no. The ‘old woman’ had her ancient counterparts, as we have seen, and doctors probably appeared in the countryside infrequently (but Galen speaks of ‘those doctors who work in the countryside and the villages’—he may have been thinking of western Asia Minor under the Antonines, De simpl. med. 10.22 [XII.299K]—see further below).166 Hospitals seem to have existed only in the imperial Roman army and sometimes on large Roman landed estates and perhaps in a few urban households of the very wealthy,167 though there may also have been resident patients. The nineteenth-century British doctor will have had a medical degree and after the Medical Act of 1858 he will have been registered. (France was far ahead: the key legislation was passed on 19 Ventôse Year XI).168 Yet the American medical profession was essentially unregulated until after the Civil War, and the key legal decision was not pronounced until 1889.169 The generation prior to the 1880s had meanwhile witnessed a medical revolution (Jenner, Pasteur and vaccination, effective anaesthesia during surgery starting in 1846, Lister and antisepsis from the 1860s, etc.), the effects of which spread out into the whole community thanks to widespread literacy, among other factors. There was print, there were journals (The Lancet began in 1823, the British Medical Journal, under a somewhat different name, in 1840). Professional domination of medical treatment was well on its way. Yet ‘not until the middle or even end of the [nineteenth] century, were [western] Europeans successfully medicalized to the extent that physicians became their clear first choice as healers’.170 It would of course be misleading to suggest that the professionalization of doctors was a nineteenth-century development. It had already gone a long way in the Renaissance, for example in Florence where doctors aimed to restrict the practice of medicine to paid-up members of their guild, for example in a

166  Cf. De simpl. med. 11.1.49 (XII.367K). 167  There were also embryonic cottage hospitals: Nutton 2004, 263 (the Hellenistic original of Plautus’ Menaechmi envisaged the doctor taking the patient into his own house, 948– 56). Hospitals in general: Korpela 1987, 179, 182–3, Nutton 1992, 50–2, Jackson 1993, 88–9. Celsus pr. 65 refers to ampla valetudinaria, ‘large hospitals’, and the superficial care the patients received in them. For a sceptical view about the existence of military hospitals see Baker 2002. 168  That is to say 10 March 1803. See Ramsey 1988, 77–9. 169  Mohr 2013. 170  Lindemann 1999, 195.

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statute of 1349 (the year after the arrival of the Black Death).171 But they failed to establish a monopoly of healthcare or anything like it.172

Who Turned to Whom? Purification therapy defines the termination of the illness, an important motif in central African healing. After the sufferer and his surroundings have experienced pain, tension, anger, and accusation, purification expurgates this ‘dirt’, allowing a sense of healing to pervade. Patients who submit to such therapy often say they feel better. —Janzen 1978, 209.

How should one organize the mass of heterogeneous and spotty evidence that we possess concerning what Greeks and Romans did about their health problems apart from turning to elite medicine? So many different practices are involved, and besides the fairly obvious variables—place, class, gender, type of illness, period—there was always individual temperament and there was usually family influence helping to determine what actions would be taken. That means that single items of evidence will be most uncertain guides. And very seldom do we possess a full story: Sulla, simply to take one small example, went from Athens to the hot springs of Aidepsos in Euboea for his gout (Plutarch, Sulla 26), but that is not to say that he did not consult doctors about it as well.173 In consequence of all this the rest of this paper consists of suggestions not conclusions. It might be a reasonable guess, to begin with, that in a world full of unavoidable and mainly unappeasable pain, much of the population was slower to seek help of any kind than modern people are.174 There is at least some evidence that the ancients were more pain-tolerant than the average inhabitant of a well-off modern nation, and they sometimes underwent cosmetic as well as essential surgery without anesthesia.175 In Roy Porter’s words, we have to ask

171  Park 1985, chapter 1. 172  Park, esp. 48. 173  Caracalla asked Apollo Grannus, Asclepius and Sarapis for medical help, according to Cassius Dio (78.15), but presumably he asked doctors too. 174  I argue this in a separate paper: Harris forthcoming. 175  C. Marius decided to have his varicose veins removed (Plutarch, Marius 6), and Plutarch saw nothing remarkable in that, and neither did Pliny (NH 11.252).

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to what extent the sick ‘fatalistically or stoically accept[ed] suffering’176—and that will require further study elsewhere. There must always have been a good deal of self-treatment and treatment within the family (in a wide ancient sense). The story from Achilles Tatius recounted at the beginning of this article will have been typical enough. Galen on one occasion meets a vinedresser who has cut off his own finger after it has been bitten by a snake (but that was of course an emergency).177 A husband in Aristophanes’ Thesmophoriazousai—in the midst of an outrageous Old Comedy story admittedly—prepares a medicine for his wife’s supposed gastric pain; it seems an everyday detail.178 Galen refers to the patients of poor doctors, ‘who are satisfied, when they are ill, to take groats with a drink of honey and water and to have clean bread or some kind of wheat-meal that is useful for making a poultice’ (De comp.med.sec.loc. 6.2 = XII.909K)—treatments that obviously did not require a physician. And family care is naturally attested in papyrus texts.179 As for preventive medicine, many people had ideas about regimen, including Trimalchio (Petronius, Sat. 47)—unless that is merely another sign of his social over-reach (see further below). Xenophon assumes that the rural slaves of Ischomachus, if they fall ill, will be attended to by his wife (Oeconomicus 7.37)—though he also assumes (Memorabilia 2.10.2) that an Athenian would summon an iatros for a slave who was seriously ill. A Roman landowner of the old-fashioned kind, like the elder Cato, expected to cure on his own what was curable among his slaves, most of whom he regarded as valuable assets.180 (But later on Cato’s avoidance of doctors must have seemed an extreme position). To complicate matters, however, a certain amount of evidence points in the opposite direction, towards a tendency that is for Greeks and Romans to consult doctors with surprising frequency. From Hippocratic times onwards many people seem to have been interested in a preventive regimen (cf. Aristophanes, Ran. 939–44, for example), and they seem, later at least, to have consulted 176  Porter 1985, 5. 177   De loc. aff. 3. 11 (VIII.197–8K), with Gourevitch this volume p. 253. For another case of rustic self-treatment see De meth.med. 12.8 (X.865K). Whether these were people that Galen had really encountered in person is not crucial. 178   Thesm. 484–6: he pounds up juniper berries, anise and sage. 179  Cf. P.Oxy. VIII.1121 (295 AD), XI.1381, lines 102–40 (second c.). 180  According to Plutarch, Cat. Mai. 23, Cato regarded Greek doctors as dangerous: ‘he said that he had written a memorandum (hupomnema), which he followed in the treatment and regimen of any who were sick in his household. He never required his patients to fast, but fed them on greens or bits of duck, pigeon or hare . . . By following such treatment and regimen he said that he stayed well himself and kept his family in good health’.

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physicians on this subject quite heavily. Plutarch expatiates on the theme that a knowledgeable person should not need to do so (De sanitate tuenda 27 = Moralia 136f–137b), but he makes it evident that many did. This was no doubt a habit of the well-to-do only. Another widespread idea, more widespread indeed than the interest in regimen, was that purification (of various kinds) was a good way of counteracting illness. As in central Africa (according to the epigraph to this section), so in classical Greece, many people, doctors and laypeople, shared a concept of the body and its illnesses according to which cleaning out the body was an effective remedy. Hence the popularity of (white) hellebore with the Hippocratics. Many laypeople evidently preferred ritual purification.181 When in Aristophanes’ Wasps Bdelycleon attempted to cure his father’s illness (and it makes no difference I think that his illness was mental), his first idea after he has failed to talk his father out of it, was to ‘wash clean and purify him’ (Vesp. 118) (only later did he take him out of town to a sanctuary of Asclepius). Countrypeople Who then turned to whom? Let us start with some sociological analysis, and first of all with the countryside versus the town. We have to allow for many possibilities—that doctors commonly toured the countryside, and that countrypeople often went to town when they were moderately sick; there is evidence that both these things happened, but not enough evidence to allow confident generalizations. The cases described in the Hippocratic Epidemics are very occasionally village cases (e.g. 4.31 and 35), but mostly not.182 We hear from Galen about a countryman near Alexandria who went into the city to see ‘his usual doctor’ (iatron sunethe) (De loc. aff. 3.11 = VIII.197K).183 Galen clearly enjoyed hunting for useful herbs in the countryside, but he only mentions treating the rural sick when they come to town or when he happens to encounter them on his travels; he, however, was never a typical ancient physician.

181  See Parker 1983, chapter 7. 182  The patient in 4.45 is ‘from’ a village. 183   P.Oxy. XXXI.2601 (first years of the fourth c.), lines 31–3, also seems to refer to a proposed journey to Alexandria for medical treatment, this time all the way from Oxyrhynchus (cf. Parsons 2007, 179). But that was a different phenomenon, since Oxyrhynchus had its own doctors.

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The countrypeople around Pergamum come into the city every spring to be bled, he tells us, thereby suggesting that they were in awe of the iatroi.184 Some doctors were itinerant, in all periods; in the Hippocratic text Law (4), indeed, it is taken to be the trained doctor’s normal way of life.185 What this tells us about the availability of doctors, then or later, is unclear. It has suggested to some scholars that doctors were so numerous that they had to travel in order to find paying patients. Occasionally we can get a glimpse of ratio of doctors to inhabitants—in some Greek cities at least they seem to have been rather numerous186—, but that does not settle the question whether the market for a doctor’s assistance was generally a buyer’s market or a seller’s. We must in any case distinguish between two types of mobility. The fact that doctors often worked far from their home towns and sometimes removed from one town to another does not tell us anything relevant here—it is the constant traveler, who might often find himself in the countryside, who is of more interest, and in fact he is elusive though not invisible.187 He was probably commoner in the western than the eastern provinces of the Roman Empire, to judge from the distribution of finds of oculists’ stamps and medical instruments;188 those were areas where doctors were more likely to have to travel to make a living, partly because of a lower level of urbanization, partly perhaps because popular medicine retained its hold better in the face of the advance of Greek medicine than it did, for instance, in Italy. But for Lucian two fairly typical doctors, who have the temerity to sell an ointment that supposedly alleviates gout, are Syrians from Damascus who are compelled by poverty to roam land and sea in search of a livelihood (Podagra 265–9). I return later to the availability of doctors away from the major centres. Eventually the Roman imperial government, feeling that too many doctors were receiving exemptions from civic duties, restricted the exemptions to those doctors who were ‘periodeutai’ (sc. these were the doctors who were 184   De meth. med. 5.7 (X.334K). For a good account of Galen in the countryside see Mattern 2013, 109–10. 185  Cf. Airs, Waters, Places 1–2. See further Cohn-Haft 1956, 21–2. 186  We happen to know that there were at least seventeen doctors at Metapontum at one point in the third century BC; Nutton 1995, 14, estimates that the population would have been ‘at most’ 6,000–7,000. 187  Galen, De comp. med. sec. loc. 6.2 (XII.908–9K) faces up the fact that a poor doctor cannot take endless medical ingredients on his travels. 188  Nutton 1992, 44. They are strikingly widespread in Britain, Gaul and Roman Germany: see the map in Feugère et al. 1985, 476–7 (the map on p. 471, showing that the same stamps are sometimes found in both Britain and Gaul, deserves further analysis).

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most worthy of community’s gratitude) (Dig. 27.1.6.1, Modestinus.). The term periodeutes must mean ‘itinerant’, and suggests at least that such doctors travelled in the countryside.189 There are few parallels, but it may be relevant that the Carpathos once honoured a doctor for practicing in the peripolion, that is to say in places outside the main polis.190 Occasional epigraphical references to the extensive travels of certain doctors191 fail to solve the historical problem of doctors’ accessibility. There were, however, doctors whose practices were in the agroi, in the countryside, and in villages, and Galen, as we saw earlier, mentions them as a normal part of life (p. 34). It seems impossible to tell how widespread this phenomenon was. Elsewhere he assumes that to be in the country is to be away from doctors (De simpl. med. 10.15 = XII.286K). As for the West, only two of the 25 physicians recorded epigraphically in Gaul lived in small places, petites bourgades, while the rest were residents of substantial towns.192 In these circumstances one may guess that much of the population will have turned to local deities such as Apollo Grannus, who had more than a dozen cult centres in the middle Rhine and upper Danube areas and was the chief healing deity there.193 It is probably to be taken as axiomatic in any case that in any pre-modern society doctors will be much harder to find in the country than in towns or cities. We should not of course assume that when illness struck in the countryside ordinary people, if they did not have a doctor nearby, usually turned at once to spells and magic. They had more or less traditional physical remedies available to them, and a number of texts suggest unsurprisingly that countrypeople often had a repertoire of herbal remedies (see above, n. 20, on Theophrastus).194 The local knowledge that formed the basis of much of the Graeco-Roman

189  But the term is rare: Galen, De comp. med. sec. loc. 5.3 (XII.844K) mentions one ‘Magnus the periodeutes’ as an informant. See Nutton 1995, 15, for some further evidence; he conjectures that there were circuit doctors in Italy and Gaul. 190  I G XII.1.1032 (= Samama 2003 no. 118, with a less convincing translation of the term), lines 15–17 (third or second c. BC). I thank John Ma for bringing this text to my attention. 191  Nutton 2004, 261. 192  Rémy 1984, with a map on p. 116. It is to be assumed that in most or all of the western provinces of the Roman Empire doctors were less numerous than they were in Greece and the Hellenized provinces more generally: cf. Nutton 1992, 43–4. 193  The best accounts of him seem to be Weisgerber 1975, 106–10 (map on p. 108) and Bauchhenss 1984. 194  Strangely, there is little or nothing about this topic in works that have been wholly or in part devoted to the Graeco-Roman countryside.

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pharmacopoeia was clearly rural. Sometimes such knowledge would remain largely local.195 The most intriguing body of evidence concerns rural shrines. Shrines of deities with healing abilities were spread very widely across the countryside of the Greek and Roman world.196 Rebecca Flemming analyses the ex-votos from a number of such sites in Italy later in this volume. Another illuminating collection of material consists of the ‘confession inscriptions’ from Lydia and Phrygia under the high Roman Empire. In the villages in question many (at least) of the sick attributed their ill health to divine displeasure (a very widespread attitude) but also (this was less typical) supposed that what caused the displeasure was their own (usually religious) offence;197 once the sin was expiated, health returned. Noting that iatroi are sometimes attested in remote parts of Asia Minor, Angelos Chaniotis has argued that ‘some general knowledge of medical practices [sc. rationalistic medical practices] and medical terminology could reach even the uneducated people who dedicated the [confession] inscriptions, or the priests who in some cases wrote them for them’;198 the second of these conclusions is much more convincing than the first. At all events, another lesson to be learned from this material is that there were significant regional variations in the way in which sick people approached the gods.

The Social Elite

Let us now consider how far social class made a difference to the medical strategies of the unwell. (We have to make allowance, however, for the fact that those who were gravely ill or injured might be willing to spend far beyond their incomes for medical assistance). As far as the social elite is concerned,199 we may hypothesize that in high classical times, let us say from the late fifth century BC onwards in Greece and from the late second century BC onwards in 195  Thus, for example, ‘circa Ariminum’ there is a plant name reseda that cures inflammations (Pliny, NH 27.131). 196  The shrines of Apollo Grannus, just mentioned, were partly at least of this nature. 197  For the ample precedents for this attitude see Chaniotis 1995, 325–6. Chaniotis makes a number of interesting observations, e.g. that eye disorders are disproportionately prominent in these records (327), presumably because they were especially hard for the villagers to explain in a secular fashion. 198  Chaniotis 331. 199  My opinions about the social structure of the Roman world is outlined in Harris 2011, chapter 1.

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the (rest of the) Roman world, men of this kind, when seriously sick, turned first to iatroi or medici, but that they were also susceptible to the advice of others, such as dream-experts and (when these came into fashion) iatraleiptai (physiotherapists).200 Our writers tend to be close to the social elite if not part of it. A passage in Diodorus Siculus (31.43) probably describes part of the attitude of most such people: those who suffer long diseases lose heart, he says; when they find that the doctors’ treatments bring no improvement, they have recourse to thutai (diviners) and manteis (seers), ‘while some countenance the use of spells and all kinds of amulets’.201 When Pericles was sick and in fact near to death, his ‘women’ put an amulet round his neck, though he was supposed to have regarded this as ‘foolishness’.202 As we saw earlier, highly respected doctors such as Scribonius Largus and Galen, who served the social elite, sometimes made room for this kind of aid. Some well-to-do people such as Aelius Aristides tried a multiple approach: he simultaneously entrusted himself to the temple medicine of Asclepius and kept on call the conventional Pergamene doctor Theodotus (Orat. 48.34–5, etc.);203 he also, quite independently of temple contexts, followed the medical advice that he thought he received in dreams.204 Aristides was a hypochondriac and was thus perhaps atypical in this respect, but as we shall see others too tried a multiple approach. There was in fact serious disagreement among Romans in the time of the elder Pliny, according to whom it was an open question whether ‘words and incantations’ had any power of healing (NH 28.10; cf. 28.29); all the wisest men reject the idea, he says, but he himself—a man hostile to doctors, it will be 200  The chronology of the rise to power of rationalistic medicine is hard to trace both in Greece and at Rome. Pindar, Pyth. 3.47–53 (datable to the period 476–467) may suggest that the Hippocratic revolution was still fairly distant. The Hippocratic Ancient Medicine, more relevantly, emphasizes the antiquity of what the author considers to be real medical knowledge, without indicating any chronology. Cato’s denunciation of Greek doctors (Pliny, NH 29.6–8) presumably reflected their growing popularity at Rome in the second quarter of the second century BC; by the time (74 BC) when the young Julius Caesar travelled with a personal physician (Suetonius, Div.Iul. 4) well-to-do Romans must commonly have been relying on them. 201  Similarly a speaker in Plutarch’s dialogue De facie quae in orbe lunae (1 = Moralia 920b) says that when people with chronic diseases despair of orthodox medicine they turn to purifications, amulets and dreams. 202  Plutarch, Pericles 38, on the authority of Theophrastus (fr. 483 Fortenbaugh et al. 1991); but scepticism is in order. This story is roughly paralleled in Diogenes Laertius 4.54. 203  Cf. Behr 1968, 44. 204   Orat. 49.20 and 21, etc.

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remembered—leans in the other direction (28.13).205 The controversy about magical remedies went on and is illustrated from the sceptical standpoint by Lucian’s dialogue Philopseudes (The Lover of Lies), where he makes mock of the medical use of amulets (sects. 7, 11) and spells (8, 11) and also of exorcists (16); he is explicitly on the side of orthodox iatroi (8–10, etc.).206 Is there any reason to think that at this social level women patients’ reactions to illness differed much from those of men? When Varro wrote that ‘most women’ go to a magician woman rather than a doctor (‘ut faciunt pleraeque, ut adhibeant praecantrices nec medico ostendant’),207 there was obviously some exaggeration involved. But it may well be true, as well as being a topos, that women were inclined to rely less on rationalistic physicians; they had plenty of reasons for mistrust. As we shall see later, there is at least some evidence that when they were sick well-to-do women in second-century AD Rome paid attention to astrologers as well as to doctors. And in the more gender-conservative kind of family, typically Greek rather than Roman, there would be psychological barriers and male control of access to the female patient: such was the case when Galen and other doctors treated the (unnamed) wife of the ex-consul Flavius Boethus: for a long time her illness (whatever it was) was treated by midwives (plural), but it was Boethus, at least in Galen’s account (who knows what marital dynamics may have underlain his decision?) who decided to turn to iatroi and later to rely on Galen exclusively.208 But women had a special need of medical help because of the uncertainties of fertility, miscarriage, childbirth and child care. And here, because of the 205  He mentions two Roman consuls of his own time who wore amulets to ward off lippitudo, a condition of the eyes (28.29). He also asserts that ‘even today in many places medical help is sought from oracles’ (29.3), where the social referent is unclear. Pliny’s own credulity concerning medical matters scarcely needs documenting. 206  His low opinion of those who resort to purifications or spells to treat gout comes out in Podagra, lines 171–3. Line 174 refers with equal disdain to the (little-known) healing goddess Kuranne. 207  ‘Catus’ fr. 15 Bolisani (Bolisani 1937, 27). 208  This story is told in De praenotione ad Posthumum 8 = XIV.641–7K. Cf. the comments of Flemming 2000, 264–5, and Mattern 2013, 165–7. Galen says that the patient was initially ‘in awe of (aidoumene) the most respected doctors’, and that was why she at first relied on midwives, so she had a degree of choice (does Galen mean that the doctors inspired awe because they were men or because they were the most respected ones? Probably both. Flemming 264 [so too Mattern 165] says that she was ashamed to reveal her condition to ‘any iatros’, but that is not quite what Galen says). Disorders of the reproductive system, such as affected this patient, may well have raised more barriers than fevers or broken bones.—Details about Boethus are to be found in PIR2 F 229.

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fairly evident uselessness of doctors, the class difference between the wellto-do and the middle classes may have been relatively unimportant. Pliny’s Natural History contains more than 140 supposed remedies for difficulties that might arise during pregnancy and childbirth,209 and most of these will probably have been ‘popular’ ideas in the limited sense that they did not originate with or owe their circulation to doctors.

The Wider Population

What of the wider population? Did people only consult doctors for major problems? Ordinary families knew how to deal with minor illnesses without the intervention of doctors and must very often have made use of pharmakopolai. We might hypothesize that in a city or town anywhere in the Greek world, and eventually in the western Roman provinces, any free male of what we can roughly call the middle classes would, if he thought that there was something seriously wrong with him, turn quite quickly to an iatros or medicus, not without having received amateur advice from family members and quite probably forming his own ideas about what ought to be done. Nutton points out that the Hippocratic Epidemics ‘shows members of all classes of society being treated by the doctor’, such as a potter, a carpenter, a vine-dresser and a sailor.210 These were typical patients apparently. Greek carpenters, when they were sick, simply went to doctors—so at least Plato assumed (Rep. 3.406de).211 What is even more striking is that the authors of the Epidemics saw and treated innumerable female patients. And also children.212 They also saw and treated many slaves (a point to which I shall return shortly).213 None of this means that all Greeks of the high classical period, even those who lived in towns, preferred the help of learned iatroi to all other forms of healthcare—nor that the comportment of the medical profession was always so ‘democratic’ in later periods. Thus we return to the actual availability of doctors. In the Greek world, even some small towns had public doctors by Hellenistic times: Olous, for example, in eastern Crete, and even more strikingly Brykous at the northern end of Carpathos, and the Samian colonists in the ‘city’ (at most a large village, 209  Richlin 1997, 213. 210  Nutton 2004, 100. For cobblers see 2.2.17, 5.45 and 7.55, for a cook 5.52, for a fuller 7.79. 211  But if the treatment is too elaborate he goes back to work and either survives or not, depending on his constitution. 212  E.g. 4.11, 4.19, 4.31, 4.36. 213  E.g. 1.15, 1.21, 4.9, 4.13, 4.38, 5.17, 5.19, 5.25, 5.35, 5.37.

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demographically speaking) of Minoa in western Amorgos.214 There were doctors fairly readily available (for a fee) in a partially Hellenized province such as Judaea in the first century AD: after Josephus broke his wrist in a fall from his horse in battle, he sent for iatroi (Vita 404), and given the circumstances these are likely to have been civilians. One of those whom Jesus was reputed to have healed had previously undergone ‘long treatment by many doctors, on which she had spent all she had’ (Mark 5:26),215 and all the synoptic gospels report versions of Jesus’ saying to the effect that ‘it is not the healthy that need a doctor, but the sick’ (Mark 2:17), which clearly implies that there are iatroi available. A distribution map of the recorded burial places of doctors could point in either direction: it shows quite a cluster in northern Gaul and Roman Germany but far fewer in Italy than might have been expected.216 The fact that medical instruments have often been found on quite minor civilian archaeological sites in the western Roman world is certainly suggestive.217 Pompeii too is suggestive: medical instruments are said to have been found in twenty-five houses there,218 an arresting figure, especially when one considers that one-third of the town remains unexcavated. But this figure probably gives an exaggerated impression of the number of resident doctors. Lawrence Bliquez, the most meticulous recent student of the material in question, seems to show that approximately eight houses in Pompeii were in use by physicians in 79 AD,219 though, as he observes, some others may have succeeded in fleeing with their instruments in the town’s last hours.220 If we suppose that say two did so, that would imply a total of some fifteen doctors for an urban population of perhaps 20,000. Yet few towns in the western provinces are likely to have enjoyed such a relatively high ratio of medici. But what most of all suggests that the western Roman provinces were always relatively short of doctors is that the 214   Inscr. Cret. I.xxii.4; IG XII.1.1032; IG XII.7.231 (Samama 2003, nos. 176, 118 and 160 respectively). Nutton 2004, 261, appositely cites the cases of Tithorea in Phocis, and Daldis in Asia Minor. 215  Cf. the inscription (SEG 47 [1997], no. 1932) from the famous sanctuary of Baitokaike in Syria in which the dedicant claims to have been treated unsuccessfully by thirty-six doctors before being cured there (but thirty-six was probably a symbolic number according to Samama 2003, 565). 216  Künzl 1988, 78, not entirely to be relied on however. 217  Künzl 1982. 218  Nutton 262 (as he points out, not all of these houses were necessarily the residences of doctors). 219  Bliquez 1994, 94–5. 220  Bliquez 93.

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preponderance of doctors of the ones we know of, or at least a hefty proportion of them, always came from the Greek world.221 (To complicate matters still further, time also made a difference. When Caesar attempted to attract doctors to the city of Rome by offering them Roman citizenship (Suetonius, Div.Iul. 42) he was presumably hoping to improve the lives of the city’s fairly ordinary residents and thought that doctors were in short supply.222 A century and a half later on the other hand Epictetus tells us (Discourses 3.23.27) that doctors in the city had begun to solicit patients,223 which suggests a certain degree of over-supply). In any case you normally had to pay.224 The Hippocratic Precepts suggests (6) that the doctor should sometimes waive all or part of his fee for a xenos (an outsider) who is hard-up, but that does not make for socialized medicine. The ‘public’ doctors of Greek cities were from time to time honoured for providing treatment gratis,225 but nothing suggests that doctors commonly waived their fees if the patient was poor.226 Not that alternative kinds of treatment were free either. Indeed you sometimes had to pay a large sum for medical care. Concerning a fertility treatment that is described in the Hippocratic Barren Women (221 Littré = 9 Potter), Laurence Totelin has written that ‘only a wealthy Greek woman could have afforded it’,227 and the same applies in varying degrees to many other treatments involving drugs recommended by the Hippocratic and other ancient medical writers. Not surprisingly, rich Romans sometimes spent heavily for medical assistance.228 This question too merits further research.229

221  Nutton 2004, 257. 222  The offer had nothing to do with recruiting doctors into the army, contrary to Israelowich 2015, 23. 223  Epictetus had been exiled from Rome in 89 AD. 224  Cohn-Haft 1956, 32–45, upsetting some earlier views. 225  Cohn-Haft 35, Massar 2005, 94–5. 226  As to the complications involved in deciding who was poor in the classical world see Harris 2011, chapter 2. 227  Totelin 2009, 129 (foreshadowings of contemporary fertility treatments). The Hippocratic treatment was certain to be ineffective. 228  A Roman knight spent 200,000 sesterces to be cured of ‘mentagra’ (Pliny, NH 26.4— specialists came from Egypt to treat the epidemic, he says), and the senator Boethus, whom we met earlier, rewarded Galen with 40,000 (XIV.647K), but these were exceptional amounts. 229  Nutton 2004, 260–3, has some valuable material on the economic status of Greek and Roman doctors, but we need the patient’s perspective.

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Pliny tells of the wealth of certain physicians (NH 29.7–8, 22–3) but unfortunately does not tell us how much they demanded from individual patients. The claims we sometimes encounter that a god had saved patients whom secular doctors had failed to save imply that people commonly went to iatroi first.230 That is the major question here: how soon, and in what proportions, did people of this kind turn to popular medicine? Did it make much difference if the condition was congenital? Trauma and wounds would certainly send one to a doctor if one was available. For other kinds of cases we should probably assume, as a sort of default position, that in most places most people in this middle section of society turned fairly readily to non-‘elite’ types of remedies, spells and charms (amulets) in particular, as Plato apparently supposes (Rep. 4.426ab).231 Were religious solutions usually the first step or not when a person fell sick or considered that their bodies were not functioning properly? Once again, we hear frustratingly incomplete stories. Thus at Oxyrhynchus, one Neilammon asked the oracle of Zeus Helios Sarapis whether he should use the doctor Herminos of Hermopolis (more than fifty miles away) to treat his eyes (P.Oxy. XLII.3078, second c.).232 But one might guess that he had already tried some Oxyrhynchite doctor, who was certainly available. The extraordinarily large number of anatomical ex-votos that survive in both Greece and Italy (but not only there) from the fourth century BC to the second century AD strongly suggest in any case that very many ordinary people and their relatives turned fairly promptly to prayer. Great numbers of people, at least in some regions and periods, dedicated such images of body parts.233 Those who hoped that a god would heal a particular bodily organ were, as is well known, in the habit of

230  Diodorus Siculus 1.25.5, Aelian fr. 89 (Edelstein and Edelstein 1945, I, T. 309; cf. II, 169). They are also a clear sign of competitiveness between secular and temple medicine. This is often denied (e.g. Dunand 2006, 7) on the inadequate grounds that their relationship was symbiotic. More on competition: a priestess’s freedwoman refers to money spent on iatroi as a waste: SEG 39 (1989), no. 1276 (third c.), with Chaniotis 1995, 331. 231  Socrates: ‘Isn’t it one of the unattractive characteristics [of ordinary undisciplined people] that when someone tells them the truth it is the most hostile thing of all to do, because until one stops getting drunk, stuffing oneself, devoting oneself to sex and wasting time, neither drugs nor cautery nor surgery, nor again magical spells or amulets or anything else of that sort will do any good?’ 232  As improved in BL VIII, p. 265. See Parsons 2007, 176. 233  For the Greek material see esp. Van Straten 1981, 105–51, and 1992, and see Forsén 1996, esp. 179, for the apparently modest status of votive-dedicants at Athens. For the Italian material see Flemming, this volume.

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dedicating a model of the affected part.234 The tens of thousands of mostly terracotta anatomical ex-votos that have been discovered on central Italian sites and are analysed in this volume by Rebecca Flemming demonstrate that ordinary people, women emphatically included, thought this procedure worthwhile. Many central Italian sites have been identified, stretching from Vulci to Paestum. A wide variety of gods were involved, and the phenomenon had deep indigenous roots, for it began well before the major increase in the popularity of Asclepius in central Italy (which was marked, though not initiated, by his official adoption at Rome in 293 BC).235 Sanctuaries of Asclepius naturally received many other votives besides anatomical ones, and since some votives were made of valuable materials the ones dedicated at the Asklepieion in Athens were periodically inventoried;236 once again it is plain that many of the dedicants were from the middle orders of society.237 As in this case, ‘middle-class’ patients, like their wealthier neighbours, sometimes combined secular and religious treatments. Neilammon is one example. A dedicant at the shrine of Asclepius at Kibyra thanked the god for ‘saving’ her, but also thanked the Tyche of the city and the doctor who had ‘looked after’ her.238 In a similar though somewhat different fashion, a cavalry officer at Rome made a dedication to Aesculapius and ‘Hygia’, i.e. Hygieia [Health], and

234  Mägele 2005, 298, raises the interesting question whether votives were normally offered in hope or in gratitude, preferring the latter view. But the enormous number of such dedications points in the other direction. 235  The hardest question that this material gives rise to is why it largely ceases in the first century BC. The most likely explanation, in my view, is the theory adumbrated by Flemming to the effect that larger urban shrines—with a different sense of decorum about exvotos?—captured the clientele of the earlier rural sites. But how they did so remains mysterious. 236  Aleshire 1989. The chronology of these inventories runs from the mid-fourth century to the last quarter of the second century BC. 237  Aleshire concluded (70) that ‘the majority of the dedicants were probably of a lower status [than the priests and temple wardens]’. Anatomical ex-votos are seldom mentioned in literature but see Theophrastus, Char. 21.10, unless the reference is to a ring dedicated to Asclepius, as some editors think. 238   I.Kibyra (IGSK 60), 83, with Nissen 2009, 215–18 (the text is also in Samama 2003, no. 274 = Prêtre and Charlier 2009, no. 13). In a possibly similar case at a site near Sinope on the south shore of the Black Sea where there was a sacred spring, the dedicant honours Asclepius, the Nymphs and (perhaps) an archiatros (Samama no. 326 = Prêtre and Charlier no. 22; cf. Nissen 218–19).

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included his doctor, who, he said, ‘looked after me carefully in accord with the gods [secundum deos]’ (ILS 2194). But these are quite exceptional texts.239 The options were not of course confined to rationalistic medicine on the one hand and the straightforwardly religious on the other. It was commonplace to look for medical advice in dreams. Quartilla the priestess of Priapus parodies this procedure in Petronius’ Satyrica (17).240 But belief in advice gleaned from dreams varied from milieu to milieu and from period to period—a complex history.241 The fact that the Hippocratic writers do indeed sometimes treat dreams as symptoms242 is suggestive but no more. When Aristotle wrote that ‘even medical experts say that one should pay extremely close attention to dreams’, since they potentially have diagnostic value (De divinatione per somnum 1.463a5–6), that too may suggest that many ordinary Greeks of his time thought that dreams could help to tell you what was wrong with you. But the ordinary Greek, faced with a pressing need for a cure or for relief, could not expect that dreams would give intelligible answers, and their role remains somewhat unclear. Much later, Galen’s occasional but still remarkable degree of trust in the advice about treatment that he received in his dreams243 may also suggest, but tentatively again, that plenty of people were also willing to take hints about medical treatment from this source, with or without the help of dream-interpreters. The anxiety produced by a major illness clearly made people more attentive. The social range of those who consulted astrologers about medical matters is difficult to grasp. The fact that astrological handbooks refer to a wide range of modest occupations244 does not carry us far. But there are clues elsewhere that suggest that in certain environments at least (Rome, Egypt, but also for example Africa Proconsularis) astrologers were listened to by ordinary people as well as by the well-to-do (see below, p. 60). The first-century AD astrological writer Dorotheos of Sidon, who claimed to be able to tell people among other things when they should undergo surgery (pp. 419–20 Pingree), apparently assumes that his clients will belong to the propertied but middling sort.245 239  It is scarcely correct to say that inscriptions ‘regularly’ ascribe a healing both to the gods and to a physician (Israelowich 2015, 67). 240  She is probably not alluding to incubation (contrary to G. Schmeling ad loc.): it was not much available in Italy. 241  Harris 2009, esp. 129–34. 242  Harris 243 n. 75, Hulskamp 2013, 51–3. 243  Harris 2009, 209–12. 244  Barton 1994b, 162. 245  Cf. Barton 175. The full range of the astrologers’ pretensions with regard to illness and injury can be seen in Ptolemy, Tetrabiblos 3.12.

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Astrologers might enable you to know whether you would recover and whether and when to undergo a treatment.246 As for temple medicine, Aeschines may have been fairly typical: he is said to have turned to Asclepius’ temple medicine after a year’s useless treatment from ‘the arts of mortals’, presumably iatroi (Anth.Pal. 6.330).247 It has been suggested that this ‘last resort’ model for temple medicine is mistaken,248 but long journeys to Epidaurus or Pergamum were not undertaken on the spur of the moment. An inscription from the temple of Aesculapius at Rome detailing four cures mentions that two of the patients had been ‘despaired of by every human being’, while the other two were blind and therefore obviously incurable by any normal means.249 And the Epidaurian miracle inscriptions very often refer to patients suffering from chronic conditions. Most other temples, however—Lebena in Crete for example, which has left us more epigraphicallyrecorded cures than any other Greek sanctuary except Epidaurus—may have drawn their devotees from a much smaller area; that was certainly the case throughout the long history of Lebena (fourth century BC to second century AD at least), where all the dedicants, as far as is known, were from Lebena itself or nearby Gortyn.250 Nothing in any case justifies the unrealistic claim of Ido Israelowich that ‘most patients who were contemporary to Galen sought cure through divine medicine’,251 if, as is apparently the case, he is referring to temple medicine: the only evidence cited is a passage of On Examining the Best Physicians (1.4, referred to earlier) which says nothing of the kind.252 Did women in this middle social group turn readily to iatroi or medici? Impressed by the frequent appearance of women patients in the Hippocratic Epidemics, Nutton has argued that even in classical Greece there was no great barrier between a woman invalid and a male doctor (women doctors begin to appear, always of course in small numbers, with the Athenian Phanostrate in 246  Barton 185–91. 247  Quoted below, p. 99. See further n. 230. For bibliography concerning the cult of Asclepius see Panagiotidou this volume. 248  McNamara 2003–4, 21, against Edelstein 1967c [1937], 245, and Parker 1983, 249. 249  I GUR I.148. For a number of other similar texts see Weinreich 1909, 195–7. For a catalogue of epigraphically attested blindness cures at Asklepieia see Wickkiser 2010, 168 n. 18. 250  Melfi 2007, 112; three exceptions, Italians in the first century AD, are more apparent than real. But Philostratus, Vita Apollonii 4.34, says that all Crete went there and many ‘Libyans’ do (the mixture of tenses is in the original). 251  Israelowich 2015, 62. 252  In the translation from Arabic by A.Z. Iskandar, the relevant sentence is this: ‘Kings are now ashamed of being instructed in this [i.e. the medical] art, and nowadays they seek recovery through divine medicine’.

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the late fourth century).253 Whether this was universally true does not have to be decided here,254 and at this social level too there is likely to have been a good deal of male family dominance, as in the case of Flavius Boethus. The Hippocratic Diseases of Women is quite explicit (1.62) that women ‘are too embarrassed (aideontai) to speak [sc. to a male doctor] even when they know what is wrong with them, and because of their inexperience and ignorance they think that it is shameful to do so’; yet the following sentences, and indeed the whole work, make it clear that they often overcame their embarrassment.255 When it came to childbirth, not surprisingly, it was the midwife (maia) not the iatros who was the usual helper, and Plato takes it for granted that she uses not only pharmakia (mild drugs?) but also (magical) incantantions (Theaetetus 149cd), both to start the birth pains and to make them less fierce.256 That midwives went on using pharmakia and incantations throughout antiquity seems reasonably certain. In describing the perfect maia, Soranus (1.3) specifies that she will not be superstitious,257 and indicates the commonest practices of those midwives who did not satisfy this requirement: they fail to do their jobs properly because of dreams, because of kledones (a kledon was a chance utterance taken to be an omen) ‘or because of some commonplace religious rite or secret cult practice’, a fairly plain reference to magical spells. It is to be presumed that very many fell short of Soranus’ standard. Since most slaves were valuable assets, slaveholders will have been willing to spend money on providing them with medical treatment. The well-to-do Athenian slaveholder would normally as we saw summon doctors when a slave of his fell seriously ill (Xenophon, Mem. 2.10.2, cf. 2.4.3).258 The Hippocratic Epidemics reports on slave patients’ being treated.259 Slaves and soldiers were the intended beneficiaries of Roman hospitals of imperial times, as we noticed 253  The evidence about Phanostrate is her gravestone: IG II/III2.6873 (Samama 2003, no. 002, with bibliography). 254  The contrary evidence is not extensive, but Euripides, Hippolytus 293–6, seems to imply that classical Athenian women felt at least some inhibitions about taking women’s illnesses to iatroi. 255  Here the dichotomy between ‘experienced’ and ‘inexperienced’ women that Ann Hanson detected in the medical writers (Hanson 1990, 309) could be of considerable importance, but it is not clear how it played out. ‘Experienced’ women were presumably less intimidated by doctors, but they may also have felt more able to do without them. 256  However Socrates is obviously thinking of his own technique as an intellectual midwife when he speaks of pharmakia and incantations. 257  Though as we have seen Soranus was indulgent towards patients’ faith in amulets. 258  But this was to make the point that people looked after their property better than they looked after their friends. 259  N. 213.

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earlier (p. 34). What proportion of the slave population was affected by the economic imperative when it came to ill-health, we can scarcely guess,260 but it would have been consistent with the generally harsh treatment of Roman slaves if most of their health problems were ignored (injuries will have been another matter). Galen tells of a wealthy Roman who tried to treat by himself the ‘malignant wound’ [helkos—the word is generic] of a slave, clearly an especially favoured one, before recognizing that his treatment did not work and handing the slave over to Galen, whom we might term a society doctor (De comp.med. per gen. 3.8 = XIII.636K);261 later the same man treated other slaves (XII.638K). The life-conditions of slaves varied enormously, but the ordinary household or field slave will at best have relied on such herbs and spells as were known in his or her immediate circle. The same applies to the free poor, who will seldom of course have had access to orthodox physicians, and none to hospitals. Occasionally a physician might act gratis, but there were no social favours or honorific inscriptions to be won by helping the indigent. Malnutrition was a serious problem, almost everywhere, almost always.262 Yet it follows from the dangerous practices of the elite doctors that to be free of their attentions was often an advantage.

Popular Practices

Let’s now complete this survey by considering the evidence practice by practice.263 The risk in such a procedure is that it may give an excessive impression of orderliness and reasoned choice, whereas we are in reality considering a population driven by physical suffering, and by fear and hope, to seek more or less desperate remedies on the basis of appallingly slight information. My interest here is to categorize practices into those that were commonplace and widely used (and not usually very expensive), such as spells, amulets, and the consumption of herbs; practices that were commonplace but less widely used, such as exorcism; and lastly practices that though they were widely known-of 260  However one recalls Varro’s recommendation (Res Rusticae 1.17.2) that the unhealthy areas on a landed estate should be worked by hired workers not by the (more valuable) slaves. 261  Afterwards the slaveholder in question asked Galen for his recipe, with the intention of practising more ‘home medicine’. 262  The bibliography is now extensive; Garnsey 1999 provides an excellent introduction. 263  Another obvious way of analysing the evidence, to be attempted on another occasion, would be to classify it according to the different kinds of medical conditions that people had to deal with—traumas, fevers, internal sicknesses, congenital defects, childbirth, and so and so on.

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were used much less (in emergencies or by some limited group of people), such as oracle-consulting and astrology. Once again, I emphasize that I am proposing an analysis not laying down the law.264 And a sketchy analysis at that, for there is no space here to follow up the many interesting questions of psychological and religious history that will arise along the way. First, however, it should be noted that there was always a wide range of more or less popular beliefs supporting practices that do not fall into any of the above categories. Take for example this notion, which we encounter in the credulous but invaluable Pliny (NH 28.33–34): They say that difficult labour is concluded at once if someone throws over the house where the pregnant woman is a stone or a missile that has killed with a single stroke each of three living creatures—a human being, a boar and a bear. A successful result is more likely if a light infantry spear is used that has been pulled out from a human body, provided that it has not touched the ground. If the spear is carried indoors it has the same effect.265 A characteristic tale. Or take this, where the distancing ‘they say’ is absent: a skin abscess can be cured by a certain poultice, but those who have tried it (experti) have declared that it makes a very great difference if the poultice is applied to the patient by a naked virgin while both of them are fasting; she must touch him with the back of her hand and say ‘Apollo says that a plague (pestis) cannot increase in a patient for whom a naked virgin has quelled it’, and, with her hand reversed, she must repeat the formula three times, and both must spit on the ground three times.266 264  As far as possible I shall try to avoid repeating what I have said in the preceding pages. 265  But the most macabre of all Roman beliefs about medicine must be the notion that epileptics could benefit from drinking the blood of a wounded or just-killed gladiator or from eating his liver. Aretaeus of Cappadocia credibly claims (Chron.Ther. 1.4) to have witnessed someone (sc. an epileptic) holding a cup to catch the blood of a slain gladiator and then drinking it, and Celsus (3.23) and Pliny (NH 28.4) also say that it really happened. Others, Pliny asserts, ‘seek to obtain the leg-marrow and the brains of infants’. For a good though inevitably speculative discussion of belief in the efficacy of gladiator blood see Moog and Karenberg 2003. For some popular beliefs that even Pliny found ridiculous see NH 26.18–20 (magicae vanitates). 266  Pliny, NH 26.93. The extreme difficulty of performing these procedures precisely is of course reminiscent of many magical spells.

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Or, to go back in time, this, from the disapproving author of On the Sacred Disease (2): They267 forbade [to epileptics] . . . the wearing of a black cloak (black is the sign of death), lying on or wearing a goat skin, and putting a foot on a foot or a hand on a hand. . . . Such Greek and Roman ideas, which have never as far as I know been catalogued,268 make it plain that popular thinking played a role in the medical drama even greater than one might suppose from studying the practices described elsewhere in this paper. Then there is the role of prayer, often rather neglected in general works about Greek and Roman religion, not to mention books about healing.269 But of course people constantly prayed in one way or another for good health. Asclepius would naturally be the favourite god to address in most environments,270 but others could be addressed too (see above, p. 6). The very numerous anatomical ex-votos that have survived from the Graeco-Roman world all presumably followed prayers or accompanied them. Spells and amulets, which were sometimes combined (the amulet might include the text of a prayer or incantation),271 must have been available in every community. (A more detailed study would distinguish systematically between preventive and curative amulets; there were also very many amulets that did not have specifically medical purposes). Despised, as we have seen, by many men of learning,272 they were more or less accepted as possibly effective by the mass of the population. They probably ranged considerably in price.

267  On the identity of this ‘they’ see above, p. 13: they seem to be doctors of whose treatment for epilepsy the writer disapproves. But the origin of these prohibitions in popular medicine is obvious. 268  Riess 1894 remains a rich source of information. 269  Some exceptions are the papers of Versnel (Versnel 1981a, 17–19) and Van Straten (Van Straten 1981, 97–102). For other material see Weinstock 1955. 270  For a collection of evidence see Edelstein and Edelstein 1945, I, 320–5; some analysis, II, 184–6. 271  See Kotansky 1991, Dielemann 2015. 272  Above, p. 41. For a negative view of spells see again the Hippocratic On the Sacred Disease 2 and a number of other texts already cited. Disapproval of amulets: see further Theophrastus, Hist. Pl. 9.19.2. Galen, as we have seen (p. 14), came round to a degree of acceptance.

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They could be made of commonplace materials,273 and wise local women are not likely to have charged much for their spells. But amulets could also be made of, or include, expensive materials, including gold, and it is apparent that many believed that expensive materials made an amulet more effective.274 ‘The amulet against tonsillitis on the gold plate’, a Greek letter-writer in Egypt says, ‘send it to Sarmates, writing it on a tablet word for word’, this amulet— protection against a single, not life-threatening, illness—was not for a poor person.275 Herbs with real or supposed medicinal powers were universally available but must once again have varied in price. Here we encounter something of a puzzle. What is most striking about the textual sources, from the Hippocratics to Dioscorides’ De materia medica, is that they expect their readers’ patients to have access to materials that arrive in the Greek-speaking world from a vast geography. This is not new under the Roman Empire: the Hippocratic writers assume that materials from Iran, Arabia and Ethiopia in particular, will be available,276 and they are seldom if ever concerned about its price. Dioscorides’ own origin was Anazarbus in Cilicia, and much of the Roman world was foreign to him (the Appennines, for example, 3.51), yet he constantly mentions materials from Gaul and Egypt and occasionally from India, Ethiopia (i.e. Sudan) and Spain.277 The puzzle is that many of these materials ought to have been seriously expensive by the time they reached the Mediterranean consumer. And serious money could indeed be made in pharmaceuticals, as is evident from several remarks by Scribonius Largus (Comp. 97 and 172, for instance). Rich people in Galen’s time wanted expensive medicines (De comp.med. per genera 3.8 = XIII.635–7K), just as the well-to-do wanted costly amulets. Several factors no doubt combine to explain the apparently widespread availability of exotic materia medica. To some extent, the authors of our texts clearly had in view patients who were able to pay high prices, or who in 273  Only a small proportion of amulets contained gem stones: Mastrocinque 2014, 12. Mastrocinque also notes (13) that gem-amulets and papyrus-amulets targeted different physical conditions: the former aimed to protect the digestive system, the uterus, the liver and the hips, as well as warding off demons and scorpions, while papyrus-amulets offered protection from malaria, fevers and headaches. 274  Among the 68 inscribed Greek amulets made of various metals that were catalogued and analysed by Kotansky 1994, some 26 per cent had overtly medical purposes and some 62 per cent were made at least in part of gold. They mostly date from the second to the fourth centuries, and they come from most parts of the Roman Empire. 275   P.Oxy. XLII.3068 (third c.). 276  For a detailed discussion see Totelin 2009, 145–77. 277  For a fuller account of the geographical range of his materials see Riddle 1985, 3.

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desperation were willing to do so. There must also have been a good deal of fakery, and much that was supposed to have been imported from far away may actually have been local. But the Periplous Maris Erythraei, supported by the so-called Muziris papyrus, leaves not the least doubt that large quantities of medicinal plants were among the Roman Empire’s imports from India and Arabia.278 Bulk shipping must have compensated for the distances, the profiteering and the tariffs. In addition to plants, the Graeco-Roman medicine cabinet contained numerous animal and mineral substances (83 of the former and 89 of the latter are listed by Dioscorides, in De materia medica Books II and V respectively).279 All these substances range from the commonplace to the fantastically exotic, from frogs (2.26) to the testicles of a hippopotamus (2.23). The lore of nonmedical persons such as the elder Pliny covered a similar range. Gems too were widely believed to be capable of providing protection from illnesses, sometimes in amulets, but also as ring-stones. Many survive, and there is also textual evidence.280 Sometimes therapeutic powers, not simply protective ones, were attributed to them.281 Health-protecting rings were widely known by the time of Aristophanes’ Plutus (833–5), though most surviving ‘medical’ gems apparently date from the Roman Empire.282 Aristophanes suggests that the price might be a single drachma (a large sum for a day labourer, a tiresome but day-to-day expense for a ‘middle-class’ person).283 As for the materials most commonly used, their rarity is not clear: for example, haematite (iron oxide) should not have been very expensive, but chrysoprase certainly may have been.284 Bonner noted that the more valuable gem stones seem not to have been used,285 though he considered that the labour-costs of making ‘the more elaborate amulets’ would have made them unaffordable except to ‘the wealthier classes’.286 But further consideration needs to be 278  The references in the Periplous can be traced through the index to Casson 1989, s.v. medicaments. For the Muziris papyrus see Wilson 2015 with bibliography. 279  Pliny, NH Book XXVIII is in principle a collection of animal materia medica. 280  The classic work is Bonner 1950. For a thorough recent discussion see Nagy 2012. 281  Nagy 95. 282  Nagy 73. 283  The same price in the comic dramatist Antiphanes, fr. 175 Kassel-Austin. Cf. Kotansky 1991, 110–11. For curing rings in mediaeval England see the rich account in Bloch 1973 [1924], Book II Chapter 2. 284  Unfortunately Diocletian’s Price Edict is no help here, nor is the most careful investigation to date of ornamental semi-precious stones in antiquity, Moorey 1994. 285  Bonner 1950, 9. 286  Bonner 13.

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given to the geographical distribution of gems of this kind: it is striking that in Britain, where the gem finds have been the subject of a meticulous catalogue,287 only a tiny proportion of them have any medical reference.288 Was exorcism a widespread phenomenon in the classical world?289 We met earlier the apparently numerous Jewish exorcists of Ephesus at the time when Paul of Tarsus was there. But daemonic possession is little attested in the Greek world in earlier times.290 Ulpian mentions exorcists, as we already saw, but all the pre-Severan evidence refers to limited areas of the Hellenistic East and the eastern Roman Empire, and most of it has to do with ‘possession’, that is to say with conditions that were much more often psychiatric than corporeal. A text of the Christian Hippolytus (Traditio Apostolica 20–21) suggests that Christians were practising exorcism of a kind in Rome by the early third century AD, but they were not using it for medical purposes, and in any case some scholars think that this work was written in the East. Judaea and Egypt seem to be the epicentres (the gospels, Acts, Josephus and the magical papyri provide plenty of material),291 though that may be a distortion. Apollonius of Tyana was an exorcist, or at least, on a more sceptical view, Philostratus could count on his readers understanding the procedure; so could Lucian.292 Thus a widespread Greek-reading cultural elite was aware by this date that certain marginal figures claimed to cast out demons.293 One can readily imagine what the hard-headed Vespasian and his sons thought when they witnessed what Josephus considered to be an exorcism, performed in Judaea on a man ‘possessed by demons’ (Ant.Iud. 8.47–8).294 Marcus Aurelius expressed scepticism

287  Henig 1978. 288  Two out 811 items in Henig’s main catalogue show the goddess Salus. 289  The most detailed account is Thraede 1969, but he does not distinguish with sufficient care between different practices, periods and milieux; see also M. Smith 1978, chapter 7, Dickie 2001, 231–3. 290  W.D. Smith 1965, overstating his case somewhat, for example with regard to the curious figure of the prophet Eurycles (425–6). 291  Mk 1.23–28, 5.1–13 (and parallels), 6.7–13 (and parallels), 9.14–27 (and parallels), Lk 4.39, Acts 8.4–25, 16.16–18. Kottek 1994, 16, and others have pointed out, however, that there are no descriptions of exorcism in the Old Testament. 292   Vita Apollonii 3.38, 4.20 (mental disorders in both cases), and cf. 4.44; Lucian, Philopseudes 16. 293  Thus for example Plutarch knew that magoi claimed to treat those possessed by demons (the daimonizomenoi)—though not by exorcism: Quaest.Conv. 7.5.4 (Mor. 706e). 294  He gives no hint of their reaction. For Josephus’ belief in demonic possession see Bell.Iud. 7.185.

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about exorcism (that seems to be what he is referring to in To Himself 1.6).295 It was a potentially spectacular procedure open to any family in an eastern city that was sufficiently desperate to find a cure for the severe mental and possibly physical affliction of one of its members. But we may doubt whether it was a widely practised element in the medical life of any province (and the author of Acts may be suspected of having exaggerated its importance at Ephesus in order to glorify Paul). The question of exorcism (and the mention of Vespasian too) can lead us to consider the role of charismatic healers more generally. Wonder-working rulers have been familiar to historians since Bloch’s famous book Les rois thaumaturges,296 but they seem not to have been numerous in the classical world: King Pyrrhus of Epirus, Vespasian and Hadrian are known cases,297 but as Bloch remarked they were isolated instances.298 Other charismatic healers such as Jesus and Apollonius of Tyana are quite hard to distinguish from magicians, but in the scheme of ancient healthcare, though their techniques are fascinating, they were quite marginal.299 In crises, including medical crises, many people took notice of their dreams. Enough has already been said about this practice, and it merely needs to be added that while trust in dreams varied from time to time and from milieu to milieu, it will have been a rare ancient community of any size that lacked dream-interpreters.300 They are there in Homer, they are there in classical Athens, they are well-attested in Hellenistic times. Artemidorus (Oneirocritica 2.44 end and 4.22) shows that there were dream interpreters in the Greek world of his time who specifically claimed to translate dreams into

295  He thanks Diognetus for having taught him scepticism towards ‘what is said by fabulists and sorcerers about spells and exorcisms (daimonon apopompes) and such matters’. 296  Bloch 1973 [1924]. 297  Pyrrhus: Plutarch, Pyrrhus 3 (he cured people who had enlarged spleens); Vespasian: Suetonius, Vespasian 7 (he gained much-needed auctoritas when he restored a man’s eyesight and restored strength to another man’s leg, apparently while he was in Egypt), Tacitus, Hist. 4.81, Dio 66.8; Hadrian: Historia Augusta, Hadrian 25 (‘though Marius Maximus says that all these things were done per simulationem, by way of pretence’). 298  Bloch 1973 [1924], 34. No doubt he was right too to suppose that the Alexandrian backdrop was largely responsible for Vespasian’s achievement. 299  Another apparently charismatic figure was also a real doctor, Thessalos of Tralles: ‘no actor, no charioteer was attended by greater crowds when he walked out’ (Pliny, NH 29.9), in Rome under Nero. 300  See further Harris 2009, 134–9.

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quasi-prescriptions (suntagas).301 You would find dream-interpreters, like pharmacopolae, in the market-place (cf. Artemidorus 1 praef.). They were probably less numerous in the towns of the western Roman Empire, in fact specialist coniectores may have been concentrated in and around the capital.302 And it has to be remembered that the papyrological remnants of dream-books are negligible, which implies that few if any Greeks of even moderate education would have chosen to undergo a treatment because a dream seemed to recommend it. Travelling to a religious healing centre could be a moderately expensive or a very costly enterprise depending on the distance travelled and the expenses one incurred at the shrine itself.303 The sanctuary at Lebena in southern Crete was undoubtedly much more typical of the classical world than say Epidaurus was—most of its clients lived within walking distance, as we already saw. There were a number of variants of the religious healing centre, and two in particular deserve a place even in a summary account such as this. First, there is the question of curative springs, all the more interesting because they may sometimes have had genuinely positive effects, and because of the psychological basis of the hopes that they aroused in a world where ingesting impure water was a commonplace danger. Curative waters will also lead us in turn to consider the role in popular medicine of bathing practices and establishments—which have been something of an obsession in recent scholarship.304 It was assumed, in the city of Rome at least, that sick people frequented the public baths (thereby helping to ensure that they were centres of infection) (Historia Augusta, Hadrian 22.7). All questions concerning the medical uses of water are complicated by the fact that elite medicine sometimes turned in this direction too.305 Our question here, however, is simply about the availability of supposedly therapeutic waters in ancient communities. As far as bathing establishments are concerned, it is a commonplace that every town in the Roman Empire had at least one of them (the rural population had far 301  L SJ translate this term as ‘physician’s prescription’, which is slightly wrong, because the tone of the word is rather ‘oracular command’, and indeed the authors Artemidorus refers to in 2.44 offered ‘suntagai and treatments furnished by Sarapis’. 302  For the coniectores see Harris 2009, 136, 191. 303  On the expenses one would incur at a healing shrine or an oracle see Dillon 1997, 166–8. 304  Resulting in a flood of publications, very many of which can be traced through GuérinBeauvois and Martin 2007, Guérin-Beauvois 2015 and Israelowich 2015, 117–24. But no one has done justice to popular ideas on the subject. 305  See Israelowich 2015, 119, for references.

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fewer such amenities of course).306 That such baths were widely believed to be good for one’s health is implied by the ‘almost ubiquitous presence [in them] of statues of the key healing deities Asclepius and Hygiaea’.307 How much all of this had precedents in the classical Greek and Hellenistic worlds remains to be determined; the standard works on Greek bathing308 fail to give an adequate historical, let alone sociological, account of this matter. Curative springs were very numerous, but some enjoyed no more than local fame and many were only thought to be effective for particular conditions. They were to be found in almost every part of the classical world, from Carrawburgh on Hadrian’s Wall, via Italy and Greece, to Judaea and beyond.309 Asklepieia, which existed by the hundreds by the time of the Roman Empire, often exploited springs with supposedly curative properties.310 But once again many sick people would have had to travel in order to make use of this resource. Other sites, rather less numerous in all probability, offered hero-statues that were thought to provide miraculous healing among other benefits. A propos of the Thasian hero Theagenes, Pausanias says (6.11.9) that he knows of ‘many other places [in addition to Thasos], both among Greeks and among barbarians, where statues of Theagenes have been set up, who cures ailments and receives honours from the locals’.311 Polydamas too may have been quite widely known in this capacity since there was a statue of him at Olympia that had healing powers (Lucian, Concilium deorum 12). Nonetheless it is likely that such figures had relatively limited catchment areas, Protesilaos at Elaious in the Thracian Chersonese and Neryllinus at Alexandria Troas being the other

306  According to Delaine 2007, 31–2, ‘the therapeutic bathing routines of Asclepiades of Bithynia . . . gave the poor the best opportunities for obtaining health care at little or no cost without employing a doctor’, but ‘health care’ seems the wrong phrase for what the poorer customers obtained in Roman baths. 307  Delaine 32. 308  Such as Ginouvès 1962. 309  For Carrawburgh see RIB 1522–35; on sites in Judaea see Kottek 1994, 136–7. Pliny, NH 31.8– 20, lists springs from Gaul to India that are reputed to have curative effects. His sources are books, at least for the most part, but behind such sources lie popular beliefs. Vitruvius 8.3 and Pausanias (e.g. 5.5.11, 8.19.3) are other founts of information on this subject. 310  Though it is exaggeration to say that ‘most medical sanctuaries were built around a spring’ (Israelowich 2015, 117). 311  There is no saying which ‘barbarians’ are meant, since Pausanias travelled widely outside Greece, but Thrace would be the most plausible guess.

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known cases.312 A picture emerges of a practice popular in the region from the Troad to Thasos.313 (The evidence is all of the second century AD or later, though the heroes in question are mostly of much earlier date; it was an age of growing religiosity). Astrologers practised a more refined art than dream-interpreters (and a more strictly urban one), and may have been notably more expensive.314 We may think of their science as predictive, so that they could be used at best for prognosis, but their medical influence was wider than that. No one would want to believe anything that Juvenal says about women, but when he says that they will not take their medicine without consulting an astrologer—tendentially an Egyptian—about the right time to do so (Sat. 6.578–81), he is undoubtedly referring to a real phenomenon. It is rich women that he is talking about here, but the mediocres, ordinary women, are also—so he claims—eager to consult fortune-tellers and want to know what the stars will predict (582–91). Galen in effect confirms that astrology was quite important in the medical care of rich Romans in his period (all the evidence to this effect dates from the second century or later). As Nutton says, ‘even in Galen’s writings, the line between drawing acceptable and unacceptable conclusions from the positions of the stars was a very narrow one’.315 Astrologers were available in the capital, and presumably in the principal Greek cities. Not surprisingly, they were also to be found in Egyptian towns such as Oxyrhynchus;316 Tertullian seems to have encountered them in North Africa (De idololatria 9). Oracles were of course numerous in the Greek world, and fairly numerous in Roman Italy. But in ordinary circumstances they were not much use to a person who was ill. One might ask, as we saw in a case from Roman Egypt, whether it was worth consulting Doctor X, but few oracles recommended treatments, as far as we know. The oracle of Alexander of Abonuteichos did so, so we are

312  Protesilaos: Philostratus, Heroikos 16; Neryllinus: Athenagoras, Legatio 26 (with C.P. Jones 1985). Lucian mocks healing statues at Philopseudes 18–20. Gorrini 2012, 118, exaggerates when she writes that ‘a great many such figures are mentioned by Lucian and by Philostratus’. 313   C.P. Jones 2001, 148. Yet there were similar statues in late-dynastic Egypt: Gorrini 125, with bibliography. 314  On the great though no doubt exceptional wealth of the medical astrologer Crinas of Marseilles see Pliny, NH 29.9–10. 315  Nutton 2004, 266. See the whole section, 265–8. 316  See Parsons 2007, 185–8.

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told (Lucian, Alexander 22),317 but Alexander had learned his basic skills from a man who was a public physician (ibid. 5).318 Oracles varied greatly in prestige and drawing-power. The most prestigious ones, such as Claros was in its prime, attracted as clients cities that ranged from Crete to the northern Black Sea to Cappadocia.319 That involved considerable expense. But a public medical crisis could send authorities to such widely reputed sources of wisdom. Thus, if we accept the persuasive reconstruction of Christopher Jones, Marcus Aurelius consulted the oracle of Claros about the Great Pestilence (the ‘Antonine Plague’), and had the response publicized in many places from Hadrian’s Wall to Asia Minor (I return to this case below).320 But in situations of everyday medical distress no oracle was likely to help.

Reactions to Major Epidemics

Throughout this paper the inadequacy of the textual sources has frequently been visible, so I wish to end with some notes on popular reactions to the two best-attested among the many epidemics of the classical world, the ‘Plague’ of 430/429 BC described by Thucydides, and the Great Pestilence that began in 165 AD. There is no suggestion here that contemporary reactions to these dire events were typical ancient reactions to illness, or that such reactions were the same in all regions and all periods, but on the other hand infectious diseases often caused havoc in ancient populations, so there is probably something to learn. Greeks and Romans normally attributed plague events to acts of impiety and sought to mitigate them by placating the gods,321 but reactions were much more complex than that. In the case of the Athenian Plague (as I shall call it for convenience, though it was probably not plague in the sense of bubonic plague and was certainly not confined to Athens), Thucydides gives us some details:322 the first line of defence were the doctors, but because of their lack of 317  The hostile Lucian admits that he knew ‘many useful pharmaka’, often recommending ‘bear grease’. He ‘prescribed medical treatments and diets’. 318  Lucian claims (ibid. 23) that he charged 1 drachma and 2 obols for each oracle, which Lucian evidently considered a low price. Even if this was Alexander’s real price, the cost of a consultation, for anyone who had to travel to Abonuteichos, was vastly greater. 319  Ferrary 2014, I, 108–114. 320  C.P. Jones 2005 and 2006. 321  Duncan-Jones 1996, 113–14. 322  There is no need here to discuss hypercritical modern reactions to this account, though we should always be on the look-out for rhetorical distortions. The importance of the

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knowledge ‘they were inadequate’,323 and not surprisingly they tended to die from being infected by their patients; nor was any other ‘human techne’ any better (what non-medical techne did he have in mind? Not religious ones, since they come in the next clause—so perhaps pharmacopolai and root-cutters are meant). ‘Their supplications at sanctuaries and recourse to prophecies and the like were all useless. In the end they abandoned these . . .’. Other details emerge: ‘no single cure’ was found that was effective for everyone (2.51.2), which implies a social network (including doctors?) that continued to discuss remedies, and more surprisingly perhaps that some cures were considered to have worked; and the sick cared for each other (51.4). All this makes it clear, I suggest, that it is not accurate to say that ‘by far the greatest concern seems to have been to eradicate sources of religious pollution and propitiate the gods, especially Apollo’.324 It is true that irreligious Thucydides may have played down religious responses, but a mixed response of the kind that he describes is entirely plausible.325 What of the Great Pestilence of the Antonine age? The sources are more numerous, but there is no Thucydides, and indeed no organized narrative of any length. The course of the epidemic was very different from the Athenian plague: in particular it went on for many years, and later recurred.326 When it reached Aquileia the emperors fled (Galen, De libris propriis 2 = XIX.18K), event is guaranteed by the fact that Thucydides, writing a number of years later, refers to the Plague simply as ‘the disease’ (2.47.3), assuming that his readers will be aware of the exceptional nature of the event. 323  Not ‘[they] had no effect’, as S. Lattimore, though that may have been the case. 324  Longrigg 2000, 63. The sources cited do not justify this claim. In a brief and superficial account Diodorus Siculus (12.58.6) says that the Athenians—inevitably, one might say— ascribed the plague to divine agency (to theion), and in consequence of ‘some oracle’ proceeded to purify the sacred island of Delos, but the purification did not take place until 426 and therefore it was not an immediate reaction to the plague’s initial attack—which had, however, returned in force in the previous winter (Thuc. 3.87; see further Hornblower 1991, 519, on Thuc. 3.104). Diodorus does not contradict anything in Thucydides’ account, except by implication his statement that the Athenians (after a time) gave up on oracles. The pious Pausanias merely says briefly (1.3.4) that Apollo brought the plague to an end with an oracle from Delphi, though the Athenians probably did indeed consult the Delphic Oracle. Whether the plague led to the construction of the famous temple of Apollo at Bassae is another matter (cf. Nutton 2004, 103). 325  Another response was an aetiological fable—the Spartans had poisoned the wells (2.48.2). It is not clear whether the aetiological fables provoked by the Great Pestilence (Historia Augusta, Verus 8, and Ammianus Marcellinus 23.6.24) were contemporary with the event. 326  See above all Zelener 2012.

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as Galen himself did when it reached Rome (XIX.15K);327 indeed flight was a fairly widespread response,328 not noted during the fifth-century plague at Athens and extremely difficult while the war was on. In the Antonine case, Aelius Aristides caught the disease early, apparently relied at first on doctors (plural) in spite of his profound religiosity,329 and came close to death. He had a dream, described in detail, about the goddess Athena. ‘It immediately occurred to me to have a purge of Attic honey, and there was a cleaning-out of bile. And after this came cures (iamata) and nourishment . . .’, presumably as specified by his doctors (Orat. 48.38–43). Later he attributed his survival to Asclepius and Athena (50.9). We already noted that both the emperor and various cities resorted to the oracle of Claros. We possess inscriptions from six such cities, covering a fairly large area from Hierapolis and Sardis to Odessos up the Thracian coast—and since these were fortuitous finds quite a number of other cities must have done the same.330 But the most extraordinary part of the story is the part brilliantly unearthed by Christopher Jones. At a date that cannot be determined precisely, someone—and it can scarcely have been anyone other than Marcus Aurelius himself—, consulted the Claros oracle about the Great Pestilence and then had inscriptions put up all across the western Empire, from Britain to Rome and the Balkans, to ward off the plague; as it happens there is—somewhat mysteriously—only one Greek inscription that resulted from this initiative, in Pisidia.331 The general form is ‘Dis deabusque secundum interpretationem oraculi Clari Apollonis’, ‘To the gods and goddesses according to the interpretation of the oracle of Apollo of Claros’.332 A major medical crisis drove the ruler to consult one of the great oracles: he obviously took the oracle seriously, but to what extent he expected its advice to be effective is unknowable. Yet the religious response of the highest authority may have been quite slow, if we are to take literally what the Historia Augusta has to say about Marcus Aurelius—‘instante . . . adhuc pestilentia et deorum cultum diligentissime 327  On this behaviour of Galen’s see Storchi Marino 2012, 34. 328  Duncan-Jones 1996, 119, 121; cf. Andorlini 2012, 25. 329  Or does he simply say this to magnify the importance of his subsequent dream? 330  For the evidence see Merkelbach and Stauber 1996; the attempt by Bruun 2012, 134, to diminish its significance is wholly unconvincing and depends in part on a minimizing view of the Great Pestilence that is no longer sustainable. 331  Almost all the evidence is gathered in C.P. Jones 2005, the rest in Jones 2006. For four other inscriptions from Rome that may also be associated with the oracular response in question see Jones 2006, 369. 332  Like some others I am inclined to think this means an interpretation by the oracle, not of the oracle, pace Jones 2005, 297.

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restituit et . . .’, ‘with the plague still attacking . . .’ (in the context of 169 AD) (Marcus Aurelius 21).333 Now, consulting the oracle and restoring the worship of the gods are quite different matters, and it may be that the former preceded the latter. But a delay in the religious response, if it is real, is as interesting as the deed, since it must have become fairly evident in the first months of the epidemic that the physicians could do nothing useful whatsoever. To summarize, very briefly: we can identify practices largely distinct from elite/learned/rationalistic medicine that can be described as forms of popular medicine; they were extremely varied, with herbs and religious practices playing the leading parts. A great deal can be said about the choices people made in the face of illness and to ward it off. But a much more detailed and nuanced account of these matters will certainly be written in the future.

333  On the chronology see Birley 1987, 162. The epidemic had already been a very serious affair for at least two years.

chapter 2

Pharmakopōlai: A Re-Evaluation of the Sources Laurence M.V. Totelin The pharmakopōlai (Greek plural, singular: pharmakopōlēs; Latin singular: pharmacopola, plural: pharmacopolae), as their name indicates, sold drugs (pharmaka = drugs; pōlein = to sell) in the Greek and Roman worlds.1 Scholars who have studied these ancient drug-sellers suggest that they represented a ‘popular’ or ‘folk’ medical tradition. For instance, Leanne McNamara introduces her article titled ‘“Conjurers, purifiers, vagabonds and quacks”? The clinical roles of the folk and Hippocratic healers of classical Greece’ (2003) with the following words: This paper investigates the clinical roles these folk healers played in an attempt to challenge this depiction [sc. as quacks] by their Hippocratic rivals. . . . There were folk healers who principally used pharmaka (materia medica such as herbs) to heal their patients, including the rhizotomoi (rootcutters) and pharmakopolai (drugsellers) as well as the pharmakeis/ pharmakides (male and female witches).2 The notions of ‘popular’ or ‘folk’, however, often remain undefined. The folk/ popular category appears to include all healers who were not working in the Hippocratic tradition or in other, later, learned traditions. One of the questions I will address in this paper is the senses in which pharmakopōlai can be considered to belong to a ‘popular’ tradition. In particular, I will ask whether they were, in any way, marginal. Indeed, Véronique Boudon titled her article devoted to the pharmakopōlai and a plethora of other healers ‘Aux marges de la médecine rationnelle: médecins et charlatans à Rome’ (2003). Now to Galen, one of Boudon’s main sources, these healers were indeed at the margins of the art—he was at the centre. This does not necessarily mean that Galen offers us a trustworthy representation of the ancient medical market place.3

1  As a starting point on the topic, see Morel 1938. 2  McNamara 2003–4, 2 (my emphasis). 3  On the ancient medical marketplace, see Nutton 1992.

© trustees of columbia university in the city of new york, ���6 | doi ��.��63/9789004326040_003

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Like Boudon and McNamara, scholars tend to group the pharmakopōlai with other people who dealt with herbs in the ancient world: the rootcutters (Greek: rhizotomoi), the perfume-cooks (Greek: myrepsoi), the perfumesellers (Greek: myropōlai), etc.4 They do so because, in some cases, the same person may have been both an herb-gatherer and a drug-seller. For instance, Galen mentions both an Antonius rhizotomos (root-cutter) and an Antonius pharmakopōlēs. These two Antonii may be one and the same person, and they might, in turn, be identified with Antonius Castor, known for his garden in which he grew medicinal plants.5 I would argue, however, that it is legitimate to study the gathering of medicinal herbs (the domain of the rhizotomoi) and the selling of drugs (the domain of the pharmakopōlai) separately. There are sufficient sources in which these two activities are presented separately to justify studying the pharmakopōlai on their own; these sources are listed in Appendix One. In this paper, I will examine separately what I would call ‘mediated’ and ‘unmediated’ sources on the pharmakopōlai. The former category includes literary sources written by authors who did not identify themselves as pharmakopōlai, and indeed sometimes despised drug-sellers. The latter category includes sources written by pharmakopōlai, or to be more precise, on behalf of pharmakopōlai. These sources are epigraphical and papyrological.6 I argue that one has to be extremely careful not to take the literary sources relating to the pharmakopōlai at face value, and in order to make my point clearly, I start with a text accusing the philosopher Aristotle of being a drug-seller.

4  See e.g. Riddle 1985, 4–6; Korpela 1987, 20–21; Korpela 1995; Scarborough 1987a; Scarborough 1991, 144; Horstmanshoff 1999, 46; Boudon 2003; McNamara 2003–4; Samama 2006 (who focuses most on pharmakopōlai, but also considers several other types of healers). 5  Antonius rhizotomos: Galen, Comp. Med. sec. Loc. 2.1 (12.557 K); 2.2 (12.580 K); Comp. Med. per Gen. 6.15 (13.935 K). Antonius pharmakopōlēs: Galen, Comp. Med. sec. Loc. 9.4 (13.281–282 K). See Keyser 2008a. On Antonius Castor, see in particular Pliny, HN 25.9. 6  I exclude from this study an important body of epigraphical evidence: small drug containers that contained the unguent ‘lycium’ and that are inscribed with a personal name (e.g. Iason or Nicias). The expert in the matter, Luigi Taborelli, calls the people named on these containers ‘pharmacopolae’. Although it may be the case that pharmacopolae had such containers stamped with their names, many other people could have done the same, for instance, perfume-sellers or pharmacologists. See Taborelli 1998; Taborelli 2014a; Taborelli 2014b; Taborelli and Marengo 2010.

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Mediated Sources

Cynulcus, one of the guests at Athenaeus’ Deipnosophists, after discussing aspects of Aristotle’s zoology, adds the following on the Stagirite philosopher: I have still much to tell about what the pharmakopōlēs [sc. Aristotle] has foolishly said, but I stop. Yet I know that the wisest Epicurus, in the letter On Businesses, said that, after eating up his inheritance, Aristotle joined the army and, since he did not do well there, he went on to sell drugs. Then, Epicurus says, Plato opened his Peripatetic School, and Aristotle risked himself there and attended the lectures, as he was not stupid, and after a while, he took on a philosophical life. I know also that Epicurus is alone in saying these things against Aristotle—neither Euboulides nor Cephisodorus dared say such things against the Stagirite, even though they both wrote treatises against the man.7 In her study of the pharmakopōlai, Evelyne Samama rightly pointed out that this is a tradition malveillante, a slandering tradition, taking as its starting points Aristotle’s botanical knowledge and the profession of his father, who was a physician.8 There is, however, much more at stake here. For there were several other links between Plato, Aristotle, Epicurus, and pharmaka. First, there is the analogy between writing and pharmakon that was drawn by Plato in the famous passage of the Phaedrus and by Euripides in his Palamedes: writing is a drug against forgetfulness, but it never equals proper memory.9 7  Athenaeus, Deipn. 8.50 = Epicurus, Epist. 102: πολλὰ δὲ ἔχων ἔτι λέγειν περὶ ὧν ἐλήρησεν ὁ φαρμακοπώλης παύομαι, καίτοι εἰδὼς καὶ Ἐπίκουρον τὸν φιλαληθέστατον ταῦτ’ εἰπόντα περὶ αὐτοῦ ἐν τῇ περὶ ἐπιτηδευμάτων ἐπιστολῇ, ὅτι καταφαγὼν τὰ πατρῷα ἐπὶ στρατείαν ὥρμησε καὶ ὅτι ἐν ταύτῃ κακῶς πράττων ἐπὶ τὸ φαρμακοπωλεῖν ἦλθεν· εἶτα ἀναπεπταμένου τοῦ Πλάτωνος περιπάτου, φησί, παραβαλὼν ἑαυτὸν προσεκάθισε τοῖς λόγοις, οὐκ ὢν ἀφυής, καὶ κατὰ μικρὸν εἰς τὴν θεωρουμένην ἐξῆλθεν. οἶδα δὲ ὅτι ταῦτα μόνος Ἐπίκουρος εἴρηκεν κατ’ αὐτοῦ, (οὔτε δ’ Εὐβουλίδης, ἀλλ’ οὐδὲ Κηφισόδωρος τοιοῦτόν τι ἐτόλμησεν εἰπεῖν κατὰ τοῦ Σταγειρίτου), καίτοι καὶ συγγράμματα ἐκδόντες κατὰ τἀνδρός. Unless stated otherwise, all translations are mine. For an introduction to Epicurus’ letters, see Clay 2009, in particular 18–20. 8  Samama 2006, 22. 9  Euripides, Palamedes fr. 3 (ed. F. Jouan and H. van Looy p. 509): Τὰ τῆς γε λήθης φάρμακ’ ὀρθώσας μόνος, ἄφωνα φωνήεντα συλλαβὰς τιθεὶς. ἐξηῦρον ἀνθρώποισι γράμματ’ εἰδέναι. ‘Alone I have created pharmaka against forgetfulness: by establishing consonants, vowels, and syllables, I have invented letters for men to learn.’

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Epicurus might have played on words in the passage under consideration: in some senses, Aristotle did peddle pharmaka, as he wrote extensively, and in a style that departed from Plato’s conversational one. Second, there was of course the means of Socrates’ death: a poison, which may have been sold by a pharmakopōlēs (we will see that pharmakopōlai dealt with poisons). Finally, Epicurus had named his recipe for ataraxia (freedom from anxiety), the tetrapharmakon, the four-ingredient remedy: ‘Don’t fear god; don’t worry about death; what is good is easy; what is terrible is easy to endure.’10 ‘Tetrapharmakon’ was the name of an actual remedy, which is well attested in medical literature.11 However, a philosophical medicament, acquired through philosophical practice, was far superior to anything a peddler could sell. Pharmaka were equivocal products in Antiquity: at times healing, at times lethal. Often the boundary between healing medicament (which regularly took the form of purges in Antiquity) and poison lay in dosage: over-dose and kill.12 Add to this the lowly practice of selling, and one has a powerful metaphor, one that thinkers throughout Antiquity did not fail to exploit.13 Let us mention a few examples. The Stoic philosopher Epictectus wrote that: Plato, Phaedrus 275a: Τοῦτο γὰρ τῶν μαθόντων λήθην μὲν ἐν ψυχαῖς παρέξει μνήμης ἀμελετησίᾳ, ἅτε διὰ πίστιν γραφῆς ἔξωθεν ὑπ’ ἀλλοτρίων τύπων, οὐκ ἔνδοθεν αὐτοὺς ὑφ’ αὑτῶν ἀναμιμῃσκομένους· οὔκουν μνήμης ἀλλὰ ὑπομνήσεως φάρμακον ηὗρες. ‘For this [sc. the art of writing] will cause forgetfulness in the minds of those who have learned, because they will neglect their memory. Having put their trust in writing, they will recall to memory things from outside, by means of external marks; not from inside themselves, by themselves. You have invented a pharmakon not for memory, but for reminding’. This passage from Plato’s Phaedrus is extremely well-known and has been much discussed, in particular by Derrida 1972. For a study of the notion of pharmakon in ancient Greek, see Artelt 1968. On the oral nature of ancient society, and on the interplay between orality and literacy in the ancient world, see, among many others, Havelock 1963 (with a focus on Plato), Harris 1989, Thomas 1992, Small 1997. 10  See Diogenes Laertius, Vitae 10.139, citing Epicurus’ Kurioi doxai (where the name ‘tetrapharmakon’ is not used). See also P.Herc. 1005, col. 4 (Philodemus). See also Anonymus Londiniensis 14.19 (P.Lit.Lond. 165 = MP3 2339), for another place where the notion of tetrapharmakon is used in a figurative sense. 11  See for instance Celsus, De Medicina 5.19.9; Oribasius, Ad Eunapium 4.120 (CMG 6.3, p. 492 Raeder); Paul of Aegina 7.17.2 (CMG 9.2, p. 348 Heiberg). 12  For an introduction to the principles of pharmacology in Antiquity, and the links between poisons and drugs, see e.g. Stannard 1961, Scarborough 1983, Riddle 1985, Scarborough 1991, articles in Debru 1997, Horstmanshoff 1999, Cilliers and Retief 2000, Guardasole 2000b, Vogt 2009, Totelin 2009. See below on the issue of dosage. 13  On the mercantile aspects of ancient medicine, see e.g. Schmidt 1924, Nutton 1985, Korpela 1995, Cilliers and Retief 2000, Totelin 2009, chapter 4. On buying and selling drugs in the general context of ‘shopping’, see Holleran 2012, 127–129.

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you have brought back fine merchandise: syllogisms and hypothetical discourses. If it appeals to you, take a place in the agora and announce them for sale, as the pharmakopōlai do.14 And the historian Polybius compares the bad historian to the pharmakopōlēs who has no other aim but to increase his wealth through dubious means.15 Such metaphors are exploited throughout Antiquity. Thus, Lucian hypothetically compares the famous orator Aeschines to a pharmakopōlēs selling miraculous cough remedies while himself being afflicted with a terrible cough.16 Certainly, this source represents the drug-seller as dishonest, but it is also slanderous towards Aeschines. Interestingly, as we will see, Aeschines did mention a pharmakopōlēs in one of his speeches, and the clever Lucian 14  Epictetus, Discourses 3.24.80–81: καλὴν ἐστείλω ταύτην τὴν ἐμπορίαν, συλλογισμοὺς καὶ μεταπίπτοντας καὶ ὑποθετικούς· κἄν σοι φανῇ, ἐν τῇ ἀγορᾷ καθίσας πρόγραψον ὡς οἱ φαρμακοπῶλαι. 15  Polybius 12.25e: τὸν αὐτὸν δὴ τρόπον καὶ τῆς πραγματικῆς ἱστορίας ὑπαρχούσης τριμεροῦς, τῶν δὲ μερῶν αὐτῆς ἑνὸς μὲν ὄντος τοῦ περὶ τὴν ἐν τοῖς ὑπομνήμασι πολυπραγμοσύνην καὶ τὴν παράθεσιν τῆς ἐκ τούτων ὕλης, ἑτέρου δὲ τοῦ περὶ τὴν θέαν τῶν πόλεων καὶ τῶν τόπων . . .; τρίτου δὲ τοῦ περὶ τὰς πράξεις τὰς πολιτικάς, παραπλησίως ἐφίενται μὲν ταύτης πολλοὶ διὰ τὴν προγεγενημένην περὶ αὐτῆς δόξαν, προσφέρονται δὲ πρὸς τὴν ἐπιβολὴν οἱ μὲν πλεῖστοι τῶν γραφόντων ἁπλῶς δίκαιον οὐδὲν πλὴν εὐχέρειαν καὶ τόλμαν καὶ ῥᾳδιουργίαν, παραπλήσιον τοῖς φαρμακοπώλαις δοξοκοποῦντες καὶ πρὸς χάριν λέγοντες ἀεὶ τὰ πρὸς τοὺς καιροὺς ἕνεκα τοῦ πορίζειν τὸν βίον διὰ τούτων· περὶ ὧν οὐκ ἄξιον πλείω ποιεῖσθαι λόγον. ‘In the same way [as in the case of medicine], the practice of history is three-fold: one of these parts consists in researching writings and storing the material there found; the second deals with the appearance of cities and localities . . .; and the third with political affairs. Similarly [as in medicine], many attach themselves to this last one, because of its preconceived reputation. And many of the writers do to the subject no justice at all, nothing but dishonesty, impudence and self-indulgence. Like pharmakopōlai, they aim at increasing their reputation and they catch every opportunity to become richer. It is not worth saying any more about them’. 16  Lucian, Apol. 6–7: εἰ γοῦν ὑποθοῖτό τις τῷ λόγῳ τὸν Αἰσχίνην μετὰ τὴν κατὰ τοῦ Τιμάρχου κατηγορίαν αὐτὸν ἁλῶναι καὶ φωραθῆναι τὰ ὅμοια πάσχοντα, πόσον ἂν οἴει παρὰ τῶν ὁρώντων γενέσθαι τὸν γέλωτα, εἰ Τίμαρχον μὲν ηὔθυνεν ἐπὶ τοῖς καθ’ ὥραν ἡμαρτημένοις, αὐτὸς δὲ γέρων ἤδη τοιαῦτα εἰς ἑαυτὸν παρενόμει; τὸ δ’ ὅλον ἐκείνῳ τῷ φαρμακοπώλῃ ἔοικας ὃς ἀποκηρύττων βηχὸς φάρμακον καὶ αὐτίκα καταπαύσειν τοὺς πάσχοντας ὑπισχνούμενος αὐτὸς μεταξὺ σπώμενος ὑπὸ βηχὸς ἐφαίνετο. ‘If someone [a rhetorician] were to propose an argument whereby Aeschines, after his indictment of Timarchus, was himself tried and proved guilty of the same inequity, can you imagine how much laughter there would be among the audience, if he had accused Timarchus for youth’s mistakes, whereas he was himself an old man when he committed these offenses? Why, you are like the pharmakopōlēs who offers a cough remedy that promises to cure the affliction immediately, but utters his offer between fits of coughing’.

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might have sneakily alluded to this here. The comparison between bad orator and drug-seller is also found in Latin literature. Aulus Gellius, in the Attic Nights, has a chapter on babblers; there he reports what Cato had to say on self-centred orators, comparing them to drug-sellers: and you hear his words, but you do not listen to him, just as if he were a pharmacopola. For the words of a pharmacopola are heard, but really nobody trusts himself to him, if he is ill.17 Again, the drug-seller does not fare particularly well here, but no worse than the bad orator. Although all the texts we have examined so far do say something about pharmakopōlai, it is of the upmost importance not to take them too literally. One should instead try to understand the metaphors that make the fabric of these stories. These comparative sources warn us to be careful when analysing all evidence relating to pharmakopōlai, for most of it comes from sources that are expert in manipulating that other type of pharmakon, the written word. It is in their interest to present drug-sellers negatively, to put them at the margins. With these warnings in mind, let us consider what other literary sources tell us about ancient drug-sellers. First, some may have collected herbs. Thus, Theophrastus writes of the drug-seller Thrasyas, that he discovered [a drug] such as, as he said, to cause a death that is easy and painless, using the saps of hemlock, opium-poppy and other such plants. . . . He took the hemlock not from wherever it happened to grow, but from Lousoi or from some other cold and shaded place.18 The Greek verb elambane (he took) is rather ambivalent, and could refer to Thrasyas’ personal gathering of plants. Lousoi is located in Arcadia, which was Thrasyas’ native region—he is identified as Mantinean by Theophrastus.

17  Cato, Orationes 111.5 = Aulus Gellius, Noctes Atticae 1.15.9: ‘Itaque auditis, non auscultatis, tamquam pharmacopolam. Nam eius verba audiuntur, verum se ei nemo committit, si aeger est’. 18  Theophrastus, HP 9.16.8: Θρασύας δ’ ὁ Μαντινεὺς εὑρήκει τι τοιοῦτον, ὥσπερ ἔλεγεν, ὥστε ῥᾳδίαν ποιεῖν καὶ ἄπονον τὴν ἀπόλυσιν τοῖς ὀποῖς χρώμενος κωνείου τε καὶ μήκωνος καὶ ἑτέρων τοιούτων . . . ἐλάμβανε δὲ τὸ κώνειον οὐχ ὅθεν ἐτύγχανεν ἀλλ’ ἐκ Λούσων καὶ εἴ τις ἄλλος τόπος ψυχρὸς καὶ παλίσκιος·.

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However, as their name indicates, drug-sellers were primarily sellers. Like other sellers, whom the pre-Socratic Critias listed perhaps contemptuously, they sold their wares on the agora in the Greek cities, and on various markets in the Roman towns.19 They appear to have accompanied their sale-pitches with feats, such as eating large amount of hellebore, a drug used for purging, without suffering from diarrhoea or vomiting. According to Theophrastus, they did so with varying levels of success, and Thrasyas was beaten at his own game by a peasant.20 The drug-sellers are associated in our sources with poisons or lethal drugs and aphrodisiacs.21 Samama argues that aphrodisiacs were sold sous le manteau.22 I would be wary of such moralising interpretations: aphrodisiacs were important in pro-natalist societies, especially when people believed that both men and women had to orgasm to emit a ‘seed’.23 While there are few references to aphrodisiacs in our earliest medical texts (the Hippocratic corpus), there are many in later ones, indicating that it is possibly the physicians who stepped onto the pharmakopōlai’s territory, rather than the opposite.24 As for killing drugs, selling them for the purpose of homicide was of course to be condemned, but the city-state of Athens did put people to death through poison—witness Socrates’ condemnation. Furthermore, Greek and Roman

19  Critias fr. 70 = Pollux, Onomasticon 7.197: τὰ δ’ ἐφεξῆς τὰ μὲν πλεῖστα Κριτίας λέγει, πολλοὶ δὲ καὶ τῶν μᾶλλον αὐτοῦ κεκριμένων τὴν εὐφωνίαν. χαλκοπῶλαι, σιδηροπῶλαι, λαχανοπῶλαι τυροπῶλαι· . . . συρμαιοπῶλαι, στυππειοπῶλαι, ἐριοπῶλαι, λιβανωτοπῶλαι· λιβανωτοπωλεῖν δὲ Ἀριστοφάνης (fg 807) ἔφη. ῥιζοπῶλαι, σιλφιοπῶλαι, καυλοπῶλαι σκευοπῶλαι, σπερμολόγοι σπερματοπῶλαι, χυτροπῶλαι . . . φαρμακοπῶλαι, καὶ τὸ ῥῆμα φαρμακοπωλεῖν, καὶ φαρμακοτρίβαι παρὰ Δημοσθένει. βελονοπῶλαι βελονοπώλιδες· ‘Critias lists many of these [sellers], and many were chosen by him on account of euphony: bronze-sellers, iron-sellers, vegetable-sellers, cheese-sellers. . . . Emetic-sellers, flax-sellers, wool-sellers, frankincense-sellers (Aristophanes says ‘selling frankincense’), root-sellers, silphiumsellers, green-grocers, pottery-sellers, seed-sellers, pot-sellers . . . Pharmakopōlai (one finds the verb pharmakopōlein and pharmakotribai in Demosthenes), needle-sellers, female needle-sellers’. 20  Theophrastus, HP 9.17.1–2. On hellebore in Antiquity, see André 1954; Girard 1990; Amigues 1999. 21  Theophrastus, HP 9.16.8 (death); 9.17.2 (poisons); 9.18.4 (sexual potency); Cicero, Clu. 40 (poisons); Ptolemy, Tetrabiblos 4.4.4 (reference to aphrodisiacs?). 22  Samama 2006, 17. 23  On aphrodisiacs see Faraone 1990 and 2009, Taberner 1985; Totelin 2009, chapter 5. On seeds and who emits them in Antiquity, see Flemming, forthcoming c. 24  See, among many examples, Pliny, HN 20.227, mentioning the first-century BCE physician Xenocrates.

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societies did not, on the whole, condemn suicide or what we would call ‘euthanasia’, the ending of one’s life for medical reasons.25 Even the socalled ‘euthanasia’ clause of the Hippocratic Oath may be read as a prohibition against murder—that is, using one’s knowledge of drugs to kill someone— rather than one against assisting the dying.26 Similarly, Scribonius Largus’ comments on lethal medicaments may be a warning against murderous physicians and drug-sellers rather than a prohibition against assisting the dying: Taking note of the names and forms of lethal medicaments will not cause harm, but knowing their dosage will do. This, the doctor must neither seek nor possess, unless he wants deservedly to be hated by both gods and men and, going against divine and human law, go outside the limits of the profession. But it is necessary for him to know these, I mean the forms and names, so that he may himself avoid taking them in ignorance, and so that he may prescribe them to others: this is the domain of medicine, but the rest is that of the worst pharmacopola, completely opposed to its ethics, as it is noticed in other arts: for there is no [art] that has a profession opposed to itself under the appearance of similarity.27 This text is usually read as a blanket condemnation of the pharmacopolae, but note that Scribonius is singling out one type of drug-seller, the worst type. Scribonius is here discussing the ‘profession’ (in the sense of ‘vocation’ rather than in the modern sense of the word) of healing and those practitioners who explicitly fall outside it—he is not stating that all pharmacopolae act unethically.28 Besides their knowledge of plants, especially those that are poisonous and aphrodisiac, ancient drug-sellers kept spiders and snakes. Thus Aristotle 25  The literature on the topic is large, see Flemming 2005 for references. 26  The literature on the interpretation of the Hippocratic Oath is, again, extensive. See von Staden 1996 as a starting point. 27   Scribonius Largus, Comp. 199: ‘Medicamentorum malorum non nocet nominum aut figurarum notitia, sed ponderis scientia. hanc porro medicus nec quaerere nec nosse debet, nisi diis hominibusque merito vult invisus esse et contra ius fasque professionis egredi. illas autem, figuras dico et nomina, necesse est ei scire, ut et ipse devitet, ne per ignorantiam aliquam sumat et aliis idem praecipere possit: hoc enim proprium est medicinae, et illud execratissimi pharmacopolae contrario oppositi virtuti eius, ut et in ceteris artibus animadvertitur: nulla enim est, quae non habeat adversantem sibi sub specie similitudinis professionem’. 28  See Jouanna-Bouchet 2004, 47–49; Samama 2006, 24. On Scribonius Largus, his preface and the notion of ‘professio’, see, Hamilton 1986, Baldwin 1992, Sconocchia 1993.

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gained information on these animals from the pharmakopōlai. Drug-sellers may have simulated bites, which they would then have ‘cured’ with the antidotes they sold.29 Aristophanes too mentions snakes in relation to druggists: in a fragment of the Amphiaraus, the healing hero (or one of his priests) is accused of acting like a pharmakopōlēs because he keeps snakes in baskets.30 Aristophanes also tells us that drug-sellers sold crystals.31 They may also have sold magic rings. Indeed in the Plutus (883–4), the Just Man purchases a ring (for one drachma) from a certain Eudemus. Now, Eudemus is the name of a pharmakopōlēs mentioned by Theophrastus and the comedians Eupolis and Ameipsias (contemporaries of Aristophanes).32 Perhaps we have one and the same person here, though the chronology makes this a little difficult.33 The other named pharmakopōlai of the classical period for which we have evidence are Thrasyas of Mantinea (whose student Alexias was ‘also experienced in the art of medicine’), Lysias (who debated the existence of the gods with the pre-Socratic philosopher Diogenes, on the evidence of Diogenes Laer­ tius), Aristophilus of Plataea (Theophrastus), and Aristobulus (Aeschines).34 Suzanne Amigues, editor of Theophrastus’ Enquiry into Plants, proposes to identify his Aristophilus with Aeschines’ Aristobulus, named in Against Ctesiphon as the father of Aristion of Plataea, who resided with Demosthenes.35 Aeschines was of course trying to discredit his rival Demosthenes for keeping young men in his house—young men whose fathers were merchants. Whether we follow Amigues or not in her identifications, it remains that pharmakopōlai were well-known figures in Attic society in the fifth and fourth centuries BCE; they deserved mention in the writings of philosophers, orators, and playwrights. Besides the mentions in Aristophanes, the comic poet Alexis (fourth century BCE) composed a play entitled ‘Crateuas pharmakopōlēs’; and Mnesimachus may have written a ‘Pharmakopōlēs’. Unfortunately, the fragments from these plays do not inform us about the reputation of the druggists.36 29   Aristotle, HA 594a23 and 622b34. 30  Aristophanes, Amphiaraus fr. 28 Kassel-Austin = Pollux 10.180. The hero Amphiaraus was celebrated for his healing at Oropos, see Stafford 2005, 132. 31  Aristophanes, Nub. 766. 32   Theophrastus, HP 9.17.2. Ameipsias fr. 26 (from an unknown play) = Schol. Aristophanes, Pl. 883; Eupolis fr. 96 (from the Baptai) = Schol. Aristophanes, Pl. 883. 33  See K. Holzinger ad loc., and cf. Jacques 2008. 34   Aristobulus: Aeschines, In Ctes. 3.162. Aristophilus of Plataea: Theophrastus, HP 9.18.4. Eudemus: Theophrastus, HP 9.17.2. Lysias: Diogenes Laertius, Vitae 6.42. Thrasyas of Mantinea: Theophrastus, HP 9.16.8; 9.17.1–2. On Thrasyas, see Keyser 2008b. 35  Amigues 2006, xxxii–xxxiii and 222. 36   Alexis, fr. 115 Kassel-Austin; Mnesimachus fr. 6 Kassel-Austin.

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Interestingly, ‘Crateuas’ is the name of the most famous root-cutter of Antiquity, who corresponded with the Pontic King Mithridates VI and wrote a highly reputed herbal. There also exists a pseudepigraphic letter from the great Hippocrates to Crateuas, whom he calls an ‘excellent rhizotomos’, who learnt his art from his grandfather, also named Crateuas. That letter is a fake, but that does not preclude the existence of herb-dealers thus named in classical Greece.37 The evidence of Aristophanes seems to indicate some links between pharmakopōlai and the cults of the healing god Asclepius and the healing hero Amphiaraus. It may not be a coincidence, therefore, that our main evidence relating to a pharmakopōlēs in the Hellenistic period locates him in Epidaurus, the site of one of the main sanctuaries of Asclepius. It is the extraordinary story of Callō, a lady from Epidaurus who had an imperforated vagina. She married, but could not have normal sexual intercourse. She then developed an illness: Later an inflammation occurred around her genitals, and as it gave rise to terrible pain, a number of physicians (iatrōn) were called. None of the others took upon themselves to treat her, but a certain pharmakopōlēs who accepted to cure her cut the swollen area, whence male genitals fell out, namely testicles and an imperforate penis. As all the others were struck with wonder, the pharmakopōlēs improved the remaining deficiencies. First of all, cutting into the top of the penis, he made a perforation into the urethra, and inserting a silver catheter, he drew out of her the liquid residues. Then by scarifying the perforated area, he united the parts. After achieving such a cure, he demanded a double fee. For he said that he had received a sick woman, and turned her into a healthy young man.38 It is true that this pharmakopōlēs has asked for a double fee, but he is also the only one who was able to provide any help, and he appears to have done so in a compassionate manner. None of the sources I have mentioned so far is particularly negative towards the pharmakopōlai. They are presented as acting differently from physicians, 37   Epist. 16 (9.342–348 Littré = 70–72 Smith). Dioscorides (preface 1) held Crateuas in high esteem. 38  Diodorus Siculus 32.11. The passage was transmitted by the ninth-century patriarch of Constantinople, Photius, Bibliotheca codex 244, 378b. On hermaphrodites in Antiquity see Garland 1995, 102; Ajootian 1997; Brisson 1997, esp. 35–36; Graumann 2013, esp. 194; King 2013, esp. 104–105.

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but they are also recognised for their knowledge. Similarly, Galen was rather neutral towards the pharmakopōlai. The physician even mentioned medicaments created or used by two named drug-sellers: Antonius and Mantias.39 When he accused herbalists of not knowing what they were talking about, he singled out the perfume-makers and not the drug-sellers.40 We can also add to the dossier of sources that are neutral towards the pharmakopōlai a passage from the Aristotelian Oeconomica, in which the drug-sellers, together with the jugglers/conjurers (thaumatopoioi) and the seers (manteis), are called upon by the city of Byzantium to pay a high tax (⅓) when the city was in financial trouble.41 The interpretation of this passage is not straightforward, as it is unclear whether in normal circumstances these people managed not to pay their taxes or whether they were exempt from taxes. When one moves away from the topos in which the pharmakopōlai serve as points of comparison for bad orators or bad historians, there are very few sources that are really negative towards them. The first is a passage of Cicero’s In Defence of Cluentius, in which Oppianicus kills his mother with the help of the pharmacopola Clodius.42 The second relates to an individual qualified as a pharmakotribēs (drug-crusher) rather than as a pharmakopōlēs. In Demosthenes’ Against Olympiodorus, a certain Moschion, a slave who is a drug-crusher, steals a huge sum of money from his master Comon.43 Finally, as already mentioned, Scribonius Largus criticises the bad pharmacopola for misusing poisons. Let us now turn to the unmediated sources relating to ancient drug-sellers, the epigraphic and papyrological evidence. We will consider these in chronological order.

Unmediated Sources

Our earliest epigraphic evidence on the pharmakopōlai is an inscription from Cyrene (SEG 20.716) that was found in the temple of Apollo. It dates to

39  Galen, Comp. med. sec. loc. 2.2 (12.587 K); 9.4 (13.281 K); Comp. med. per gen. 4.14 (13.751 K). 40  Galen, De antidotis 1.4, 5 and 10 (14.24, 30 and 53 K); Comp. med. sec. loc. 7.2 (13.37 K). On the links between medicine and perfumery in Antiquity, see Totelin 2008. 41  Aristotle, Oeconomica 1346b22. 42   Cicero, Clu. 40. 43   Demosthenes 48.13–15.

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the second half of the fourth century BCE.44 It rewards a certain Timagoras for the service he provided in an embassy, then goes on to list various people, identified by their various occupations (singer to the flute, drug-seller, general, rhetor, victorious Olympic wrestler), geographical origin (from Oresthasion), social relations (friends of Philon, son of Epiclees) or physical characteristics (lame), who have helped settle a sula. Nicias the pharmakopōlēs from Megalopolis (a city in Arcadia) is mentioned in relation to a sum of 700 mnai. The interpretation of this inscription is debated—it is extremely complicated. What is at stake is a seizure (sula). Usually pirates committed seizures, but in some cases, cities or individuals too were responsible. I here follow Andrew Lintott’s interpretation of the inscription: the Cyreneans were victims of seizures, and the murders committed by Teisilaos of Kleitor (Arcadia) are part of the original seizure. The Cyreneans sent embassies to various Greek cities to settle their claims. They accepted sums of money in settlement of the seizure. Lintott adds: It is possible that Cyrenean traders had taken orders in Greece, accompanied by a down-payment, for the products of their city, but had then failed to deliver the goods. Nicias the apothecary would have been interested in the silphium; others, especially in the famine years in the late fourth-century, may have had a more prosaic need for grain. In frustration, the Greek buyers would have seized anyone or anything Cyrenean they could lay their hands on. The embassy was sent to settle these private disputes, but also to clear the name of the city: in view of the sums involved, it is unlikely that they paid all, or even most, of the cost out of their own pocket.45 This interpretation, whereby failure to ‘deliver goods’ is the cause of the seizure against the Cyreneans, is plausible. It is true that the Cyreneans in the fourth century BCE made huge profits from the trade in silphium, which was used both as a spice and as a medicine.46 In that context, a drug-seller would indeed have been the right person to play a role in the settlement of the sula. However, this interpretation is not substantiated by the professions of the other people involved in the settlement of the sula (flute-player, rhetor, general, Olympic wrestler). Nevertheless, it is interesting to see a pharmakopōlēs thus involved

44  See Appendix Three for this text. 45  Lintott 2004, 350. 46  The literature on ancient silphium is immense, see Amigues 2004 as a starting point.

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in inter-city diplomacy, and handling the large sum of 700 mnai (70,000 drachmai, nearly twelve talents). The second piece of unmediated evidence is a private papyrus letter (P.Lond. II.356 = Trismegistos 25625),47 sent in the first century by Procleius (based at Alexandria) to Pecusis, asking him to sell good pharmaka to his friend Sotas, who will then bring them to Alexandria: Procleius to his dearest Pecusis, good health. You will do well if, at your own risk, you sell the good among those remedies of which my friend Sotas tells you he has need, so that he can bring them to me at Alexandria. For if you do otherwise and give him stale produce which won’t sell in Alexandria, be warned that you will have to settle the costs with me. Say hello to all your family.48 Admittedly, Pecusis is not called a ‘pharmakopōlēs’, but he sells drugs. His ‘friend’ warns him that sending poor quality drugs will have consequences. It is not clear whether we have here an allusion to adulteration (which was very common) or rather to the freshness of drugs.49 If the drugs were not ‘sushi-grade’ (ultra fresh) when they departed from Pecusis’ place of residence (unfortunately unknown), they would not have sold at all at Alexandria. The only published papyrus that explicitly mentions pharmakopōlai is a letter from the pharmakopōlēs Aurelius Neoptolemus, son of Dioscorus, based in Oxyrhynchus (P.Oxy. XXXI.2567 = Trismegistos 16891). It dates to 253 CE.50 This pharmakopōlēs writes to three people, all lessees of the alum monopoly. These are officials, based in Alexandria, who ensure the rightful taxes are paid on alum and other minerals, all state monopolies.51 They appear to be newly in charge, and our pharmakopōlēs, on the order of another official (the administrator of Hermes), sends them an inventory of his goods, stating that he has all the necessary receipts. All the goods listed in the inventory are used in pharmacology and other practices such as dyeing. The quantities are rather large, as they are given in talents—a talent weighing between 25 and 30 kg.

47   (accessed June 2015). 48  See Appendix Three for the original text of this papyrus. 49  On adulteration of drugs in Antiquity, see Riddle 1985, 74–77. 50  See Appendix Three for the text and translation of this papyrus. 51  See Barns et al. 1966, 109–111, for commentary on the papyrus and references to other papyri referring to the alum monopoly.

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My final document is an inscription from Brescia (CIL 5.4489 = Inscr.It 10.5.280). It dates to second-third century CE, and is part of a series of inscriptions from that city of Northern Italy recording endowments to various collegia, that is, to professional associations.52 Two of these associations are named in the present inscription: that of the artisans and that of the pharmacopolae. The inscription comes from a sarcophagus, which a husband dedicated to his wife, Valeria Ursa. She had purchased a small estate, which was endowed to the collegia. In return the collegia were responsible for celebrating the memory of Valeria on the anniversary of her birth and on the Parentalia and Rosalia. This is the only known inscription that records the college of pharmacopolae of Brixia. Clearly this was an association to which money and estates could be entrusted. Again, we see drug-sellers in charge of estates—not the dishonest peddlers of the literary evidence. Conclusions If one takes the surviving evidence at face value, it is easy to label the pharmakopōlai as dishonest merchants, people who are part of a popular and/or folkloric tradition ‘at the margins of rational medicine’. The position of the ‘margins’, however, depends on where one stands: to these ‘servants of medicine’ a physician such as Galen, with his complicated theories and claims to the moral high ground, might have appeared very marginal indeed.53 Pace Galen and Dioscorides, not everyone in the ancient world could afford the time and money to travel to places where they could gather their own drugs.54 Most people had to rely on pharmakopōlai. They stood firmly at the centre of the agora or marketplace, where they sold a variety of goods. They dealt with the parts of medicine linked to the beginning and end of life, those areas that the Hippocratic Oath and Scribonius Largus present as sitting outside the ‘profession’ of medicine. But the Oath’s position might itself have been rather marginal. As with every type of merchant, some pharmakopōlai were dishonest 52  On the economic significance of this inscription, see e.g. Kehoe 1997, 85. 53  I am alluding here to Galen, De diebus decretoriis 1.10 (9.823 K), where Galen claims that Hippocrates called the physician, and not the pharmakopōlēs, ‘assistant of Nature’. 54  At De simplicium medicamentorum temperamentis ac facultatibus 9.2 (12.169–175 K), Galen tells the long story of how he travelled to Lemnos to get the true earth of Lemnos instead of counterfeited goods. Dioscorides, in his preface (esp. paragraph 5), stresses the importance of observing and gathering one’s own plants.

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and sold counterfeited or ineffective drugs. But for all the negative evidence, we have several pieces of information presenting the pharmakopōlai as taxpayers, trustees, and diplomats. Since some ingredients required in drugs were quite expensive (especially those that were exotic), drug-sellers must have needed capital to start their business, capital that was then probably passed from father to son. Their ability to deal with such capital might be one of the reasons why pharmakopōlai were sometimes entrusted large sums of money by states or individuals. It is therefore important, when studying ancient drug-sellers, not to use the words ‘popular’ or ‘folkloric’ in a negative sense, or even in a romantic sense, whereby these drug-sellers somehow practice a more wholesome type of herbal medicine than learned physicians. Nevertheless, it is legitimate to consider the pharmakopōlai as popular medical practitioners. Indeed, unlike physicians and some rhizotomoi such as Crateuas, they do not appear to have written pharmacological treatises55—they seem to have transmitted their knowledge orally. In that respect, they may have been closer to the vast majority of the ancient population than highly literate physicians like Hippocrates and Galen.

Appendix One: Some Literary Sources on the Pharmakopōlai (in Chronological Order)

Aristophanes, Clouds 766: pharmakopōlai sell crystals. Aristophanes, Plutus 884: mentions Eudemus (not called pharmakopōlēs). Eudemus identified as a pharmakopōlēs in the scholia, where the comedians Eupolis (fifth century BCE) and Ameipsias (late fifth century BCE) are mentioned. Aristophanes, Amphiaraus fr. 28 K-A: pharmakopōlai keep snakes in baskets. Theopompus, Althaia fr. 1 K-A: mention of pharmakopōlēs’ chest from Megara. Diogenes Laertius, Lives of Philosophers 6.42: The philosopher Diogenes (fifth century BCE) has a conversation with the pharmakopōlēs Lysias on whether the gods exist. Aeschines, Against Ctesiphon 3.162: Aristobulus the pharmakopōlēs, father of Aristion of Plataea who lived with Demosthenes. Aristotle, Enquiry into Animals 622b34: pharmakopōlai keep spiders. Aristotle, Enquiry into Animals 594a23: pharmakopōlai keep spiders and snakes.

55  Riddle makes this observation (1985, 5).

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Aristotle, Oeconomica 1346b22: pharmakopōlai paid a tax of 1/3 to Byzantium; they are listed with jugglers/conjurers (thaumatopoioi) and seers (manteis). Theophrastus, Enquiry into Plants: Thrasyas of Mantinea: 9.16.8: has invented a drug that causes ‘an easy and unpainful death’ made of hemlock and opium-poppy; his student Alexias (not qualified as pharmakopōlēs) is experienced (empeiros) in the art of medicine; 9.17.1: he is a very skilful (deinotatos) pharmakopōlēs; he consumes hellebore without being purged but was beaten at his own game by a shepherd. Theophrastus, Enquiry into Plants: Eudemus: 9.17.2: Eudemus is a famous (eudokimos) pharmakopōlēs; he did not manage to take hellebore without being purged, even though he set himself the challenge. Theophrastus Enquiry into Plants: Aristophilus of Plataea: 9.18.4: this pharmakopōlēs knows about plants that increase sexual potency. Demosthenes, Against Olympiodorus 13–15: Moschion, the pharmakotribēs, is part of an estate bequeathed to Comon. Moschion steals 1000 drachmai and 70 mnai from his master. Alexis (fourth century BCE), the comedian, wrote a play Crateuas the Pharmakopōlēs (fragments not particularly relevant for our purpose). Mnesimachus (fourth century BCE) wrote a play entitled Pharmakopōlēs. Cicero, In Defence of Cluentius 40: Oppianicus murders his mother with the help of the pharmacopola Clodius. Decimus Laberius (mime author, first century BCE), Cretans fr. 25: a pharmacopola falls in love with a monkey. Horace, Satire 1.2.1: pharmacopolae and other ‘professionals’ attend the funeral of Tigellius. Galen, De diebus decretoriis 1.10 (9.823 K): Hippocrates called the physician, and not the pharmakopōlēs, ‘assistant of Nature’. Galen, Composition of Medicines according to Places 2.2 (12.587): A remedy that the pharmakopōlai use. Galen, Composition of Medicines according to Places 9.4 (13.281): Remedy of Antonius the pharmakopōlēs. Galen, Composition of Medicines according to Types 4.14 (13.751): Remedy of Mantias the pharmakopōlēs. Ptolemy, Tetrabiblos 4.4.4: pharmakopōlai and other sellers are born under the influence of Venus. Pseudo-Lucian, Lovers 39.15: pharmakopōlai keep their products in small boxes.

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Appendix Two: The story of Callō/Callōn, Diodorus Siculus, Histories 32.11

Παραπλησία δὲ ταύτῃ τῇ διαθέσει συνετελέσθη περιπέτεια τριάκοντα ἔτεσιν ὕστερον ἐν τῇ πόλει τῶν Ἐπιδαυρίων. ἦν γάρ τις Ἐπιδαυρία, κόρη μὲν εἶναι δοκοῦσα, γονέων δὲ ὀρφανή, Καλλὼ δ’ ὄνομα. αὕτη τὸν ἐπὶ τῆς φύσεως ἀποδεδειγμένον ταῖς γυναιξὶ πόρον ἄτρητον εἶχεν, παρὰ δὲ τὸν καλούμενον κτένα συριγγωθέντος τόπου ἐκ γενετῆς τὰς περιττώσεις τῶν ὑγρῶν ἐξέκρινεν. εἰς δὲ τὴν ἀκμὴν τῆς ἡλικίας παραγενομένη συνῳκίσθη τινὶ τῶν πολιτῶν. διετῆ μὲν οὖν χρόνον συνεβίωσε τἀνδρί, τὴν μὲν γυναικείαν ἐπιπλοκὴν οὐκ ἐπιδεχομένη, τὴν δὲ παρὰ φύσιν ὁμιλίαν ὑπομένειν ἀναγκαζομένη. μετὰ δὲ ταῦτα φλεγμονῆς αὐτῇ συμβάσης περὶ τὸν κτένα καὶ δεινῶν ἀλγηδόνων ἐπιγενομένων συνεκλήθη πλῆθος ἰατρῶν. καὶ τῶν μὲν ἄλλων οὐδεὶς ὑπισχνεῖτο θεραπεύειν, φαρμακοπώλης δέ τις ἐπαγγελλόμενος ὑγιάσειν ἔτεμε τὸν ἐπηρμένον τόπον, ἐξ οὗπερ ἐξέπεσεν ἀνδρὸς αἰδοῖα, δίδυμοι καὶ καυλὸς ἄτρητος. πάντων δὲ τὸ παράδοξον καταπλαγέντων ὁ φαρμακοπώλης ἐβοήθει τοῖς λειπομένοις μέρεσι τῆς πηρώσεως. τὸ μὲν οὖν πρῶτον τὸ αἰδοῖον ἄκρον ἐπιτεμὼν συνέτρησεν εἰς τὸν οὐρητῆρα, καὶ καθεὶς ἀργυροῦν καυλίσκον ταύτῃ τὰ περιττώματα τῶν ὑγρῶν ἐξεκόμιζε, τὸν δὲ σεσυριγγωμένον τόπον ἑλκώσας συνέφυσε. καὶ τοῦτον τὸν τρόπον ὑγιοποιήσας διπλοῦν ἀπῄτει τὸν μισθόν· ἔφη γὰρ αὑτὸν παρειληφέναι γυναῖκα νοσοῦσαν, καθεστακέναι δὲ νεανίσκον ὑγιαίνοντα. ἡ δὲ Καλλὼ τὰς μὲν ἐκ τῶν ἱστῶν κερκίδας καὶ τὴν ἄλλην τῶν γυναικῶν ταλασιουργίαν ἀπέθετο, μεταλαβοῦσα δὲ ἀνδρὸς ἐσθῆτα καὶ τὴν ἄλλην διάθεσιν μετωνομάσθη Κάλλων, ἑνὸς στοιχείου ἐπὶ τῷ τέλει τοῦ Ν προστεθέντος. Another sex-reversal happened in the same conditions thirty years later in the city of Epidaurus. For there was an Epidaurian, called Callō, who appeared to be a girl, orphaned of both parents. Now she possessed the passage which Nature provides to women, but it was unperforated, and she had from birth, next to the so-called ‘comb’ (vulva), a perforation through which she excreted liquid residues. Upon reaching maturity, she became the wife of one of the citizens [of Epidaurus]. For two years she lived with this man, and since she was not able to submit to normal female intercourse, she was forced to endure unnatural intercourse. [Passage translated at page 74] Callō put aside her loom-shuttles and other female wool-working implements, she changed into male clothes and changed her name to Callōn, by adding a single letter, N, at the end.

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Appendix Three: Epigraphical and Papyrological Sources Relating to the Pharmakopōlai (in Chronological Order)



SEG 20.716, Inscription from Cyrene, Fourth Century BCE Lines 13–31 ποτ̣ε-̣ [γράφεν] δ̣ὲ π̣ οτ̣ὶ �̣ [τ]ὰς ἀπονμὰς καὶ τοὶ τὰ σῦλα ἐγκαλέσαντες [κ]αὶ τὸ πλῆθος τῶγ χρημάτων καὶ τοὶ συμπρεσβεύσαντες ἀπὸ τᾶς ἁμᾶς πόλιος Αἰγλάνωρ Ἀλεξάνδρω ἐς Κλείτορα τᾶς Ἀρκαδίας ὑπὲρ {²vacat}² τῶν ἐν Τρυγείωι ἀπολομένων ὑπὸ Τεισιλάω, καὶ τό τε σῦλον ἐλύσαμες ὀκτὼ ταλάντων καὶ φυγὰν Κλειτόριοι κατέγνον Τεισιλάω καὶ τὰ χρήματα ἐδάμευσαν καὶ χηρω̣[θ]έντα αὐτὸν ὑπὸ Στυμφαλίων ἔγδοτον ἔδωκαν, Στυμφάλιοι δὲ ἀπέκτηναν· ἐς Μεγάλαν Πόλιν σὺν Καρνήδαι τῶι Σπονδάρχω σῦλα τὰ ποτ’ Ἀπολλόδωρον τὸν αὐλωιδὸν μνᾶν (80), ποτὶ Νικίαν τὸμ φαρμακοπώλαν μνᾶν (14)· ἐν Τεγέαι ποτὶ Δαμαιθίδαν τὸν Ὀρεσθάσιον μ(νᾶν) (20)· ἐν τῶι ἱαρῶι τῶ Διὸς τῶ Λυκαίω ποτὶ Χάρωνα τὸγ χωλὸν μ(νᾶν) (20)· ἐν Ἆλι ποτὶ τὸς περὶ Φ̣ ίλωνα οἳ ἐ�γ̣ ένοντο φιλόπαιδα τ̣[αλάν]των δέκα πέντε· ἐμ Μεσσάναι πο̣τὶ Δεινίαν μ(νᾶν) (10 +) . . c.5 . . ποτὶ Θωροπίδον τ̣ὸν [στ]ραταγὸν μ(νᾶν) (2)· ἐγ Κορίνθωι ̣ [σὺν—— —] τῶι Ἐπικλεῦς ποτὶ Σιμωνίδαν [τ]αλ̣ άντων τρι[ῶν————————] [ποτὶ] Δαμάτριον τὸν ῥήτορα μ(νᾶν) (2)· ἐμ Μάλωι———————— [. . . ὀλυμ]πιονίκα̣ν παλαιστὰν τριῶν τ[αλάντων————————] [. . . c.10 . . . ἰ]σχυ[ρ]ὸν δυῶν ταλάντων————————————

Translation: Lintott 2004, 349: There are added to the assignments both (the names of) those who invoked the sula and the amount of money and those who participated in the embassy from our city. Aiglanor son of Alexandros (went) to Kleitor in Arcadia on behalf of [. . .] who were killed by Teisilaos in Trygeion, and we discharged the seizure for eight talents, and the people of Kleitor condemned Teisilaos and confiscated his property, and, when he was arrested by the Stymphalians, they surrendered him (to Stymphalian jurisdiction) and the Stymphalians executed him. At Megalopolis, with the help of Carnedas the son of Spondarchos, [we discharged] the sula with Apollodoros the singer to the flute for 4000 mnai, with Nikias the apothecary for 700 mnai; at Tegea with Damatridas the man from Oresthasion for 1000 mnai; in the temple of Zeus Lykaios with Charon the lame for 1000 mnai; at Elis with the friends of Philon son of Philopaidas for 15 talents; at Messene with Deinas for 500 mnai; at Argos with Thoropidas the general for 100 mnai; at Corinth with the help of Lysis the son of Epiklees with Simonidas for three talents; at Athens with Damatrios the rhetor for 100 mnai; in Melos [with . . .]menes, the victorious Olympic wrestler for three talents.

Pharmakopōlai: A Re-Evaluation of the Sources



P.Lond. II.356, First Century CE Προκλήιος Πεκύσει τῶι φιλτάτωι χαίρειν καλῶς ποιήσεις ἰδίωι κινδύνῳ τὸ καλὸν πωλήσας ἐξ ὧν ἐάν σοι εἴπῃ φαρμάκων ἔχειν χρείαν Σώτας ὁ φίλος μου ὥστε ἐμοὶ κατενεγκεῖν αὐτὸν εἰς Ἀλεξάνδρειαν. ἐὰν γὰρ ἄλλως ποιήσῃς ὥστε σαπρὸν αὐτῷ δοῦν̣αι τὸ μὴ χωροῦν ἐν τῇ Ἀλεξανδρείᾳ γείνωσκε σαυτὸν ἕξοντα πρὸς ἐμὲ περὶ τῶν δαπανῶν. ἄσπασαι τοὺς σοὺς πάντας. ἔρρωσσο v Πεκύει [ἀπό]δως



P.Oxy. XXXI.2567, 253 CE Αὐρηλίοις Ἀρουντίῳ Ἡρακλεια̣ν̣ῷ καὶ Ἱέρακι τῷ καὶ Δημητρίῳ καὶ Θέω νι μισθωταῖς μονοπωλίου ἀσχολή ματος στυπτηρίας 5 παρὰ Αὐρηλίου Νεοπτολέμου Διοσκό ρου ἀπʼ Ὀξυρύγχων πόλεως φαρμα κοπώλου. κατὰ τὰ κελευσθέντα ὑπὸ Αἰλίου Σαβείνου τοῦ κρατίστου ἐπιτρόπου Ἑρμοῦ ἀπογράφομαι 10 ἐνπροθέσμως ἃ παρέλαβα παρὰ τῶν προγενομένων μισθωτῶν τοῦ ἀσχολήματος τὰ ὑπογεγραμ μένα εἴδη. στυπτηρίας μὲν Ψωβτιακῆς ὁλκῆς (τάλαντα) β� 15 σχ̣ ιστῆς δὲ ὁλκῆς μνᾶς λ μελαντηρίας τάλαντα ιβ μίλτου τάλαντα ζ

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Totelin μ̣ ι ̣συδίων ἄρτους υν [ ]̣ ̣ π̣ ορφυρου τάλαντα ε 20 ὤ�̣ χρας ὀασειτικῆς (τάλαντα) γ [ἁλ]υκῆς τάλαντα ε [ ̣ ]̣ λ̣ ηρας τάλαντα ε [ ̣ ]̣ λ̣ ίσματος μέτρα β [ὧν] πάντων τ̣ὴ�̣ ν̣ τειμὴν 25 [πλή]ρη μετε̣βα̣λ̣ ό̣μ � ην κατὰ τ̣ὸ̣� [ἔ]θ̣ος ἀκολούθως οἷς ἔχω σ̣ υμβόλοις (ἔτους) γ [αὐ]τοκρατόρων καισάρων Γαίου [Οὐι]βίου Τρεβωνιανοῦ Γάλλου 30 [καὶ] Γαίου Οὐιβίου Ἀφινίου Γάλλου [Οὐε]λδουμιανοῦ Οὐολουσιαν[ο]ῦ [εὐσ]εβῶν εὐτυχῶν σεβαστῶν [Πα]χὼν κγ. —— (hand 2) [Αὐρή]λιος Ἀμμώνιος πραγμ̣ α̣35 [τευ]τ̣ὴς Ὀξυρυγ’χείτου ἔσχον [τού]τ̣ου τὸ ἴσον

To Aurelius Arruntius Heracleianus and Aurelius Hierax, also named Demetrius, and Theon, lessees of the monopoly of the alum industry, from Aurelius Neoptolemus son of Dioscorus, pharmakopōlēs from the city of Oxyrhynchus. Following the order of Aelius Sabinus, the most excellent administrator of Hermes, I declare promptly the goods which I have received from the previous lessees of the industry, which are listed below: Alum from Psobthis (Capital of the Little Oasis): weight of 2 ½ talent; split alum: weight of 30 mnai; black pigment: 12 talents; red ochre: 7 talents; copper ore: 450 loaves; (. . .) porphyry: 5 talents; ochre from the oasis: 3 talents; salt: 5 talents; . . .: 5 talents; . . .: 2 measures. I have remitted/exchanged the full price of all these, as is usual, in accordance with the receipts which I have. Year 2 of the Emperors Caesars Gaius Vibius Trebonianus Gallus and Gaius Vibius Afinius Gallus Veldumianus Volusianus, Pachon 23.

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CIL 5.4489 = Inscr.It. 10.5.280, Second-Third Century CE, from Brescia Valeriae Ursae quae vixit / mecum annos XXX men(ses) III d(ies) VIII / quae coll(egio) fabror(um) agellu(m) Aeseianum suum / mancipavit se viva ex demid(ia) port(ione) sua s(upra) s(cripta) ita ut ex red/itu{m} eiusde(m) agelli q(uot) a(nnis) sili(a)e coniugi suo id est pri(die) K(alendas) Mar(tias) / di{a} e natalis eius item pr(idie) K(alendas) Mart(ias) di{a}e natalis sui sing(ulis) / ex d(enariis) L per magistros celebrent(ur) item diebus Parentalio/rum et Rosalior(um) in sing(ulos) ex d(enariis) X[X]V [pr]o[f]us(iones) in p[er] petu(um) [fie]rent / item quae (e)t coll(egio) farmac(opolarum) publicor(um) agellu(m) [3] IVE[3]ianu(m) / suum mancipavit se viva ut ex redit(u) eiusde(m) agell(i) q(uot) a(nnis) / sili(a)e coniugi suo id est VIII K(alendas) N(ovembres) di{a}e natali(s) eius item pr(idie) K(alendas) Mar(tias) / di{a}e natalis sui ut ex d(enariis) L per magistr(os) celebrentur item diebus / Parentalior(um) et Rosal(iorum) in sing(ulos) ex d(enariis) XXV in perpet(u)um fier[e]nt // M(arcus) Ulpius / Fortuni/us coniu/gi castis/simae.

Chapter 3

Asclepius: A Divine Doctor, A Popular Healer Olympia Panagiotidou

The Asclepius Cult: Diffusion and Popularity

Asclepius was the healing god par excellence of Graeco-Roman antiquity. His cult is first documented on the Greek mainland in the fifth century BCE, when the Asklepieion of Epidaurus was established.1 From then onwards, sanctuaries were built to honour Asclepius in many cities, offering an alternative healing option to the people who suffered from various illnesses or diseases. This paper intends to explore the popularity of the Asclepius cult, and the particular social, cultural, and cognitive processes that mediated the spread of the reputation of Asclepius’ healing power in the Graeco-Roman world. Greek authors unanimously regard Thessaly as the region in which the cult of Asclepius arose, but the Epidaurian Asklepieion gradually developed into the cult’s most popular healing centre.2 The inscriptions dated from the early fourth century BCE record various cases of patients who travelled from Aigina, Argos, Halieis, Epeiros, Messene, Sparta, Herakleia, Hermione, Kaphyiai, Keos, Kirrha, Pherai, Thebes, and Troezen, and from more distant places—Chios, Knidos, Lampsakos, Mytilene, Thasos, and Torone—, to Epidaurus,3 reflecting the pan-Hellenic reputation of the sanctuary. Under Epidaurian influence, early sanctuaries were devoted to Asclepius in Messene,4 Arcadia,5 Athens,6 and Corinth,7 and flourished during the classical period (fifth-fourth century

1  The Asclepius sanctuary in Tricca was earlier than the Epidaurian Asklepieion, but has not been found by archaeologists; Julius Ziehen (1892, 195–197) provides some evidence about it. A stoa building found by Kastriotis (1918, 65–7) is dated in the late Hellenistic period. 2  Martin and Metzger 1976, 62–66; Papachatzis 2002, 205; Riethmüller 2005, I, 279–324. 3  Dillon 1994, 243; 1997, 73–80; Wickkiser 2008, 41. 4  The excavations from 1987 onwards revealed the earlier phases of the Asclepius sanctuary in Messene in the Peloponnesus. 5  Ginouvès 1959; Martin and Metzger 1976, 66. 6  Girard 1881; Martin and Metzger 1949, 316–350; Travlos 1971, 127–137; Papachatzis 2002, 304; Lefantzis and Jensen 2009. 7  Roebuck 1951; Lang 1977; Martin and Metzger 1976, 64–65; Papachatzis 2002, 80.

© trustees of columbia university in the city of new york, ���6 | doi ��.��63/9789004326040_004

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BCE). In the fourth century BCE, in Pergamon,8 Lebena on Crete,9 and on the island of Cos,10 Asklepieia were also built that evolved into great healing centres that attracted visitors from places near and far for almost one millennium. From the Hellenistic era onwards, Asclepius enjoyed increased reverence. Numerous temples were devoted to him in many Hellenistic cities, while his reputation spread widely in the Graeco-Roman world. In the Peloponnese, in addition to the earlier sanctuaries in Epidaurus, Corinth, Messene and Arcadia, Asklepieia were built in Cyllene,11 Argos,12 Helieia,13 Gortys14 and Sicyon.15 Temples were dedicated to Asclepius in Attica16 and Phocis17 as well as in many cities of Macedonia.18 It is estimated that during the fourth and third century BCE about 200 Asklepieia were erected on the Greek mainland,19 and hundreds of temples were devoted to Asclepius beyond.20 In Greek insular areas, Asklepieia were established, among others, on Euboea,21 Thasos,22 Delos,23 Paros24 and Anaphe.25 In Asia Minor, temples

8  Deubner 1938; Ziegenaus and De Luca 1968; Habicht 1969; Bean 1979, 58–59; McDonagh 1989, 222–225; Hoffmann 1998; C. Jones 1998; Petsalis-Diomidis 2010, 151–220. 9  Melfi 2007. 10  Martin and Metzger 1976, 66, 92, 108; further Herzog 1928; Kerényi 1959, 50–53; SherwinWhite 1978. 11  Pausanias VI, 21, 4. Virtually all the ancient testimonia about Asclepius are collected in Edelstein and Edelstein 1945. 12  Pausanias II, 21, 1. 13  Pausanias VI, 26, 5; V, 7, 1. 14  Pausanias VIII, 26, 6; X, 32, 12. 15  E.g. Pausanias II, 10, 2. 16  E.g. Scholia in Aristophanem, Ad Plutum, 621. 17  Pausanias X, 34, 6. 18  Especially on the Asklepieia in Macedonia see Lioulias 2010. 19  Riethmüller (2005, II, 9–315) estimates that 171 Asklepieia were built in Greek mainland during that period. 20  Riethmüller (2005, II) records 732 temples built beyond Greek mainland and provides relevant bibliographical and literary references. 21   I G XII, 9, 194. 22   I G XII, 8, 265. 23   I G XI, 2, 161 A, 72–73. 24   I G XII, 5, 119. 25   I G XII, 3, 248.

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of Asclepius were erected in Bithynia,26 Mysia,27 Lydia,28 Caria,29 Cilicia,30 Media31 and Scythia.32 Asclepius also reached Phoenicia and temples were established to his honour in Berytus33 and Sidon.34 In the early third century BCE Asclepius was invited to Rome because of a plague which inflicted the city and mowed the population for three years. After a consultation of the Sibylline Books, the Romans evoked the divine physician from Epidaurus, and a temple was erected in his honour in 291 BCE on the peaceful island in the curve of the Tiber River.35 Later temples were devoted to Romanized Aesculapius in various places in Rome and its suburbs.36 Beyond Rome, sanctuaries of Asclepius are documented in Fregellae37 and Tarentum38 in Italy, and in Syracuse39 and Acragas40 in Sicily.41 Although most of the Asklepieia are located in the eastern provinces of the Roman Empire and only a few are documented in Italy and Sicily, scattered evidence indicates that Asclepius’ reputation reached the west and that he was worshipped in the Latin provinces.42 Inscriptions and reliefs found in four Gallic provinces shows that Asclepius was known and honoured in at least twenty-one sites in these regions.43 A lex sacra found at Thuburbo Maius 26  Pausanias III, 3, 8. 27  Aelius Aristides, Oratio L, 3. 28  Pausanias VII, 5, 9; Aelius Aristides, Oratio XLVII, 17. 29  Vitruvius, De Architectura, VII, Praefatio, 12. 30  Philostratus, Vita Apollonii, I, 7; Libanius, Orationes, XXX, 39; Eusebius of Caesarea, De Vita Constantini, III, 56; Sozomen, Historia Ecclesiastica, II, 5; Zonaras, Epitome Historiarum, XIII, 12 C–D. 31  Arrian, Alexandri Anabasis, VII, 14, 5–6. 32  Stephanus Byzantius, Ethnica, s.v. Ἃγιον. 33  Strabo XVI, 2, 22; Damascius, Vita Isidori, 302. 34  Strabo XVI, 2, 22; Philo Byblius, Fr. 2, 20. 35  Valerius Maximus I, 8, 2; Anonymus, De Viris Illustribus, 22, 1–3; Ovid, Metamorphoses, XV, 622–744; Livy, Periocha, XI; see Orlin 1997, 106–108; Riethmüller 2005, I, 233–236, II, 431–432, no. 586; Renberg 2006/7, 88–89, 91–105; Glinister 2006, 21–23. 36  On these sites see Renberg 2006/7, 90–91, 105–114; for a collection of the inscriptions related to Asclepius’s cult in Rome see his pages 137–159. 37  On the Asklepieion of Fregellae see Coarelli 1986; Crawford et al. 1986; Morehouse 2012, 39–44. 38  Julian, Contra Galilaeos, 200 B. 39  Polyaenus, Stategemata, V, 2, 19. 40  Polybius I, 18, 2; Cicero, Verrine Orationes, II, IV, 93. 41  See Renberg 2006/7, 113. 42  See Renberg 2006/7, 88. 43  Renberg 2006/7, 126–129.

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in Africa44 is considered to derive from an unknown sanctuary of Asclepius, and displays significant similarities with the one found in the Pergamene Asklepieion.45 Inscriptions dedicated to Asclepius were also found in other places in Roman Africa,46 indicating that the divine physician was worshipped in these regions.47 Although there is inadequate evidence for the national origins and the social and economic status of the individuals who frequented Asklepieia, people from many places and ranks of society would have worshipped Asclepius.48 Sanctuaries were devoted to him within the cities or towns, outside the walls or even in rural regions and attracted the local populations.49 In addition to his temples, people worshipped Asclepius along with other deities in the latter’s sanctuaries, while they also used to pray in private and appeal to his aid in everyday situations.50 In particular, in the West, temples of Asclepius were mainly built in regions where a significant Greek population was present.51 In Rome, most of the inscriptions devoted to Asclepius were in Greek or ordered by Greeks. In Gaul as well the majority of the inscriptions were dedicated by Greeks and members of the Roman administration.52 In addition, the god became particularly popular among the Roman slaves. According to Suetonius’ testimony,53 masters used to abandon sick and old 44   ILAfr 225. The inscription refers to a podium which was erected for Asclepius by L. Numisius Vitalis in the second century AD; see Kleijwegt 1994, 210–211. 45   IPerg VIII, 161, II, 12–14. The leges sacrae from these regions determine specific restrictions, involving sexual abstinence and deprivation of certain foods, which supplicants should observe before attempting dream communication with Asclepius. On the inscription from Thuburbo Maius see Kleijwegt 1994; Renberg 2006/7, 138. 46  Among other places inscriptions were found in Calama (ILAlg I 176; CIL VIII 5288), Theveste (ILAlg I 3066), Madaurus (ILAlg I 2031), Thubursicu Numidarum (ILAlg I 1220), Lambaesis (CIL VIII 2579a, 2589, 2590, 2624; AÉ 1967, 571; 1973, 630; 1989, 870), Carthage (CIL VIII 25516; AÉ 1968, 553 a), Mustis (AÉ 1968, 586, 595, 596, 609; 1973, 641) and Balagrae in Cyrenaica (SEG XX 759; see Kleijwegt 1994, 209–210). 47  On the discussion whether African Asclepius was a Hellenic or a Hellenized semitic deity see Kleijwegt 1994, 209–210. 48  Renberg 2006/7, 121. 49  Edelstein and Edelstein 1945, II, 233; Oberhelman 2014, 49; on the public and private sites of Asclepius worship in Rome and its suburbs see Renberg 2006/7. 50  See Renberg 2006/7, esp. 108, 111, 112, cat. no. 18, 30. 51  See Renberg 2006/7, 109–110. 52  Renberg 2006/7, 129, citing Bourgeois 1991, I, 52–54, and the inscriptions: CIL XII 2215, 2386, 3042; CIL XIII 3636, 6621, 6695 (?), 7994, and the Reii inscription. 53  Suetonius, Divus Claudius, 25.

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slaves on the Tiber Island, leaving Asclepius to take care of them. Those who managed to recover were deemed to be free from their former servitude. Therefore, Asclepius was widely worshipped as a benefactor deity by slaves, freedmen and freedwomen in Rome54 as well as in other regions of the Roman Empire.55 Asclepius also acquired significant popularity in the ranks of the Roman army,56 and was worshipped in temples built in military camps and stations.57 In Rome, inscriptions were commissioned by military personnel, active members or veterans, who wished to honour Asclepius.58 His popularity in the Roman army is further indicated by the inscriptions and dedications made by soldiers in northern Britannia and in Moesia Inferior,59 as well as in the Gallic provinces.60 Thus, the cult of Asclepius was widespread throughout the Hellenistic world and the later Eastern provinces of the Roman Empire in which the Greek element was predominant. In the Latin West Asclepius was worshipped mainly by foreigners and members of the lower social ranks. However, dedications made by Roman citizens of Italian heritage61 as well as by members of the upper classes, although fewer in number,62 show that individuals might turn to Asclepius regardless of their origins and social status. Asclepius became popular as a benefactor and saviour god who was appealed to by people for their families’ and own well-being.63 However, he was foremost a divine physician who mainly responded to individuals with various health problems. The healings offered at his sanctuaries were nominally free and ministered to the sick regardless of their social class, economic 54  On the dedications to Asclepius made by imperial slaves and freedmen see Renberg 2006/7, 123, esp. cat. nos. 5, 14, 18, 22, 37. 55  See Renberg 2006/7, 124. 56  Edelstein and Edelstein 1945, II, 253. 57  On Asclepius cult sites at military complexes in Rome see Renberg 2006/7, 115–119. 58  On a collection of these inscriptions see Renberg 2006/7, 116, esp. cat. nos. 12, 13, 20, 24, 25, 26, 27, 28, 32. 59  On the inscriptions from Britannia and Moesia Inferior see Gordon and Reynolds 2003, 260. 60  Renberg 2006/7, 129. 61  See Renberg 2006/7, 124, esp. cat. no. 1, 2, 7, 16, 23, 27, 28, 30, 33, 34. 62  According to Tassini (1995–1996, 277–299), the majority of the inscriptions dedicated to Asclepius in the Latin West were commissioned by freedmen (23 percent), soldiers (21 percent) and slaves (10 percent) and far fewer by equestrians (4.6 percent) and senators (3.5 percent). 63  See Edelstein and Edelstein 1945, II, 104, 182; Renberg 2006/7, 135.

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status or gender.64 Even paupers could seek cures at the Asklepieia,65 since Asclepius did not demand expensive thank-offerings.66 In particular, the local Asklepieia offered sick people the opportunity to ask for the god’s aid without the expense and risks of traveling to the remote, great Asklepieia.67 Themistius in his Orationes, written in the fourth century CE, underlines the significance of the alternatives offered by the local sanctuaries: If we were ill in body and required the help of the god, and he was present here in the temple and the acropolis and was offering himself to the sick, just as even of old he is said to have done, would it be necessary to go to Tricca and sail to Epidaurus on account of their ancient fame, or to move two steps and get rid of our illness?68 The local Asklepieia however did not replace Asclepius’ great sanctuaries in Epidaurus, Pergamon, Lebena and on Cos, which were widely accepted as the places where the healing powers of Asclepius were much more evident and effective.69 Patients who could afford the journey travelled to the great Asklepieia in order to sleep in the abaton of the temples, expecting to receive a healing dream or vision from the god in the ritual of incubation. As the healing inscriptions indicate, men, women, and young children along with their parents resorted to these sanctuaries seeking recovery. Asclepius was particularly popular among the educated of the era. Literary men,70 poets,71 orators72 and philosophers73 were among his clientele. Even prominent Roman officials visited the great Asklepieia. In 167 BCE Aemilius Paulus visited the temple of Asclepius in Epidaurus which was rich in votive offerings.74 The Emperor

64  Edelstein and Edelstein 1945, II, 117–118. 65  Aelian, Fragmenta, 100; see Edelstein and Edelstein 1945, II, 173–180. 66  Herondas, Mimiambi, IV, 1–95. 67  Dillon 1997, 76; Edelstein and Edelstein 1945, II, 234; cf. Renberg 2006/7, 108. 68  Themistius, Oratio XXVII; see further Edelstein and Edelstein 1945, II, 233–234. 69  Dillon 1997, 76; Edelstein and Edelstein 1945, II, 234. 70  Suidas, Lexicon, s.v. Θεόπομπος: “ . . . Asclepius was also the protector of cultured people . . .”; see further Edelstein and Edelstein 1945, II, 205–208. 71  E.g. Antiphanes (Atheneus XI, 70, 485b); Apuleius (Florida, 18). 72  E.g. Aeschines the Rhetor (Anthologia Palatina, VI, 330); Aelius Aristides (Sacred Tales). 73  E.g. Proclus (Marinus, Vita Procli , 30); Polemon of Smyrna (Philostratus, Vita Sophistarum, I, 25, 4); Hermocrates (Philostratus, Vita Sophistarum, II, 25, 5). 74  But was no longer so in his day by Livy’s time (Livy XLV, 28, 2).

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Caracalla visited the Asklepieion of Pergamum ‘desiring to avail himself of the treatment of Asclepius.’75 The healing inscriptions as well as the anatomical votive offerings unearthed at the great Asklepieia manifest the popularity of the cult among people who encountered various health problems and resorted to his temples even from remote regions of the Graeco-Roman world—the Asclepius cult was popular in the sense that it evolved into a prevalent healing cult, and was widely appreciated by people of the era.

Asclepius: Between Professional and Folk Medicine

In the Graeco-Roman world there were various modes of health care that coexisted, reflecting the precepts and values of the society in which they developed.76 Arthur Kleinman defines health care as ‘a local cultural system composed of three overlapping parts: the popular, the professional, and the folk sector.’77 These parts—or sectors in Kleinman’s terms—do not constitute isolated modes of healing, but usually overlap and intersect one another, creating medical pluralism and determining the alternative healing options and medical traditions in various historical, cultural, and social contexts.78 The doctors who had been trained in the art of medicine comprised the professional sector. Already in the Homeric poems, there are ‘doctors’ skilled in treating battle wounds.79 Trained doctors gradually acquired an even more prominent position among other kinds of healers, and from the fifth century BCE an increased need for professional physicians in Greek cities is implied.80 In that period, the emergence of Hippocrates and the establishment of the Hippocratic medical school on Cos by his students were considered to be the most significant milestones for the development of Greek medicine. The reputation of Hippocrates as the founder of medical art spread widely, promoting the authority of professional doctors. The Hippocratic corpus, which was written by more than one author but bore Hippocrates’ name, became the most famous collection of medical works; it included discussion of the most vivid 75  Herodian IV, 8, 3. 76  Oberhelman 2013b, 1–2. 77  Emphasis in the original; Kleinman 1980, 50. 78  Oberhelman 2013b, 5. 79  Homer, Iliad, IV, 193–218; V, 902–904; IX, 514–515, 804–848; Odyssey, 17, 382–386; see further Wickkiser 2008, 12–14. 80  Wickkiser, 2008, 16; see further Cohn-Haft 1956; Pleket 1983; Jouanna 1999, 77–78.

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medical issues of that era. Although the medical treatises included in the corpus were quite early separated from their original authors, they comprise the first texts in which doctors express their own opinions about their profession, reflecting the wider context in which medicine developed as an art.81 The various kinds of healers who had not received special training in professional medicine but had gone through an informal apprenticeship and acquired practical knowledge, as well as those who claimed their ability to heal through an appeal to the divine, represented the folk sector.82 Root-cutters and drug-sellers sold various plants and herbs, had practical knowledge and were consulted by the sick.83 Other kinds of healers, purifiers, magicians, and priests used to travel from city to city, much as professional physicians did, and claimed that they could alleviate suffering by influencing the deities.84 The Hippocratic authors strove to distinguish the skills of good doctors from itinerant healers; they condemned these healers, whom they accused of impiety on account of their claim that they could manipulate gods in order to cure human illnesses.85 Although the itinerant healers observed symptoms and recommended specific diets and baths for recovery, they attributed the cause of disease to the gods, and presented cures as the results of divine intervention.86 The author of On the Sacred Disease rejects the divine origins of epilepsy, and aggressively attacks those practitioners who claimed that the gods caused the disease:87 My own view is that those who first attributed a sacred character to this malady were like the magicians, purifiers, charlatans and quacks of our own day, men who claim great piety and superior knowledge. Being at loss, and having no treatment which would help, they concealed and sheltered themselves behind superstition, and called this illness sacred, in order that their utter ignorance might not be manifest . . . They claim superior knowledge, and deceive men by prescribing for them purifications and cleansings, most of their talk turning on the intervention of 81  Nutton 2004, 62–63. 82  MacNamara 2003–2004, 2–3. 83  Lloyd 1983, 119–135; MacNamara 2003–2004, 5; Oberhelman 2013b, 8. 84  Oberhelman 2013b, 7–8. 85  E.g. On the Sacred Disease, 3 and 4 Jones; for the whole of this paragraph see van der Eijk 2005, 46–48, 60–62 and Wickkiser 2008, 24, 30–32. 86  E.g. On the Sacred Disease, 2 Jones; see MacNamara 2003–2004, 11. 87  This attack against magicians and purifiers persists in the work; e.g. 2.6–7; 11.5; 12.2; 13.13; 17.1–10; 18.1–2.

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gods and spirits. Yet in my opinion their discussions show, not piety, as they think, but impiety rather, implying that the gods do not exist, and what they call piety and the divine is, as I shall prove, impious and unholy. For if they profess to know how to bring down the moon, to eclipse the sun, to make storm and sunshine, rain and drought, the sea impassable and the earth barren, and all such wonders, whether it by rites or by some cunning or practice that they can, according to the adepts, be effected, in any case I am sure that they are impious, and cannot believe that the gods exist or have any strength, and they would not refrain from the most extreme actions. Wherein surely they are terrible in the eyes of the gods . . .88 This perception of disease is quite common in the Hippocratic corpus. Hippocratic doctors recognized the divine as an inherent element in both health and illness; the elements that enter and exit the human body, like air, water, sunlight, etc., can cause diseases that are divine to the extent that they are parts of the universal divine order.89 Thus, restoration to health can be achieved through regulation of the internal balance of the body following specific rules of diet, exercise, and hygiene, and modulating the external environment.90 Beyond the explanations of health problems offered by doctors and the magical techniques used by itinerant healers, more popular, practical ideas about illnesses and treatments circulated among ordinary people. According to Kleinman, the popular sector constitutes the greater and most influential part of the health care system of any society.91 In the Graeco-Roman world, various ideas about health and medical problems would have been available in the contexts of family, community, and social networks.92 People who got ill might consult their relatives and friends about the nature of their illness, and the possible ways of healing. Many illnesses would have been self-diagnosed, self-assessed, and cured by the ordinary means suggested by people’s friends, 88   On the Sacred Disease, 2–4 Jones, with his translation. 89   On the Sacred Disease, 18 Jones: ‘This disease styled sacred comes from the same causes as others, from the things that come to and go from the body, from cold, sun, and from the changing restlessness of winds. These things are divine . . .’. See further Nutton 2004, 65. 90   On the Sacred Disease, 21. 91  Kleinman 1980, 50. 92  People would have practiced a kind of popular medicine which would have been based on the accumulated knowledge and shared beliefs in the therapeutic benefits and uses of various herbs and plants. Pliny the Elder collected a great amount of popular remedies in his monumental work Historia Naturalis (XII–XXVII); see Stannard 1982.

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relatives, or acquaintances. If these means failed to cure an illness, the sick person might have looked for alternative healing options within his or her surroundings. The immediate social networks—mostly the family—constituted the pool from which people might have learned remedies, drawn ideas, traced choices, and evaluated healing alternatives. Thus it is in the popular sector in which people made the decision to resort to professional, folk, or other options. And it is the popular sector to which people returned in order to evaluate offered treatments, influencing and modulating in turn the popular ideas about the health-providers and the applied practices and techniques.93 In this framework, the Asclepius cult constituted a form of religious healing alternative that stood at an intermediary position between the professional and folk sectors, while the major ideas about the divine physician were formulated in the popular sector since religion was an integral part of everyday life.94 The deities appeared to have innate healing powers, which they had acquired without training. Some local heroes were also popular for their healing skills, and the cures were performed at their sanctuaries.95 Among them, Asclepius acquired a prominent position as the supreme divine doctor. The citizens of the cities used to visit the local temples of Asclepius in order to attend the daily rituals, to meet their friends and acquaintances, and to pray for their own health and their family’s well-being. Asclepius was present in the local communities, connected with the joys and troubles of the people.96 The belief in Asclepius’ healing power developed in the wider religious context of the ancient Greek world in which the gods appeared to have healing abilities among multiple superhuman powers. In the mythical saga, Apollo was the father of Asclepius. Already in the age of Homer, Apollo was presented as having healing powers, along with his competence in divination, poetry, and archery.97 According to the myth of Asclepius,98 Apollo had rescued his son from his mother’s—Coronis’—womb, while she was burnt in fire for her misconduct with a mortal man. The god delivered his son to the centaur Chiron who raised the child, training him in medical art. Asclepius’ medical skills crossed the line of human medicine when he resurrected people destined 93  Kleinman 1980, 50–53; Oberhelman 2013b, 3–4; see Edelstein and Edelstein 1945, II, 165; cf. Epictetus, Dissertationes, IV, 8, 28–29, Aristophanes, Ploutos, 400–414, 633–747. 94  Rose 1959, 9; Ferguson 2003, 148–151; Mikalson 2010, 123–204; cf. Oberhelman 2013b, 5. 95  Wickkiser 2008, 50–53. 96  Edelstein and Edelstein 1945, ΙΙ, 234. 97  Homer, Iliad, I, 43–67. 98  Pindar, Pythian Ode, III, 1–58; Ovid, Metamorphoses II, 542–648; Apollodorus, Bibliotheca, III, 10, 3, 5–4, 1.

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to die. Resurrection of the dead entailed the transgression of human limits, causing Zeus to crush Asclepius. In revenge Apollo killed the Cyclopes, the constructors of Zeus’ thunderbolts. Finally, Zeus brought Asclepius back from Hades, and deified him. From then onwards, Asclepius never again resurrected people from death. The mythical saga indicates popular ideas about Asclepius, and the points at which his healing abilities intersected the folk and professional medical sectors. The itinerant healers promised to appeal to the divine in order to heal their clients. Asclepius was a god himself, and he demonstrated his will to heal everyone who appealed to his divine intervention. Furthermore, the myth presented Asclepius as the deified healer who, contrary to other deities, was trained as a doctor—a specialist in curing human illnesses. His medical skills were not inherent and inexplicable, but followed the progress of human medicine. This image of Asclepius seemed to correspond to the model of the ideal doctor as it was formed under the influence of Hippocratic medicine, which developed in parallel with the Asclepius cult. This intersection between the medical treatments offered by professional doctors and the healing practices used by Asclepius in the cult context is further reflected in the Hippocratic corpus. Hippocratic physicians did not completely eliminate the help of the gods in the cure of human diseases. Although they rejected the treatments offered by purifiers, magicians, and other kinds of itinerant healers, they recognized the potentially salutary effects of praying to the gods as complementary to their own healing methods. The author of On the Sacred Disease admits that visiting the temple of a god can contribute to the elimination of the pollution that a person had inflicted on him- or herself. Prayers and sacrifices are specified as the appropriate ways to ask for divine help, instead of the magical methods used by the itinerant healers (like incantations and charms): they should have brought them to the sanctuaries, with sacrifices and prayers, in supplication to the gods. As it is, however, they do nothing of the kind, but merely purify them. Of the purifying objects, some they hide in the earth, others they throw into the sea, others they carry away to the mountains, where nobody can touch them or tread on them. Yet. if a god is indeed the cause, they ought to have taken them to the sanctuaries and offered them to him.99

99   On the Sacred Disease, 4 (but there are some uncertainties in the text); cf. Regimen 4.87: ‘Prayer is appropriate and entirely good, but a man must call upon himself at the same

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Asclepius in particular enjoyed the respect of human practitioners, who recognized him as their divine ancestor. From the time of the establishment of the Asclepius cult, doctors were interested in forging a close relationship with him, and were called after him Asclepiades. Evidence from the fourth century BCE indicates that doctors used to offer sacrifices to Asclepius, devoting offerings to his sanctuaries.100 Gradually the relationship between the divine physician and mortal doctors was promoted by mythical sagas that associated Hippocrates with Asclepius.101 In the Roman period many doctors underlined their connections with Asclepius, serving the ordinary cult at the Asklepieia.102 In the second century CE, Galen, the most famous doctor after Hippocrates, declared his relationship with Asclepius, and perhaps served the Asklepieion of Pergamon for some time.103 Aelius Aristides, the orator who suffered from various chronic illnesses, used to consult doctors and Asclepius as well as other deities, since he apparently believed that divine and human medical methods could both heal diseases.104 The relationship between Asclepius and doctors was also indicated by the typical signs of medical art. The image of Asclepius was depicted on the medical kits and rings of doctors, and the sacred snake of the god entwined around a wooden staff became the symbol of the medical profession.105 Asclepius was also presented in the healing inscriptions of the Asklepieia as a doctor who used the known medical methods and practices in order to cure his supplicants.106 Thus, there was a reciprocal interest in promoting a relationship between doctors and Asclepius that had mutual benefits for both sides. The dedications of doctors increased the economic prosperity and architectural expansion of the Asklepieia, while the popularity of Asclepius enhanced the reputation of the physicians, increasing their authority and attracting new clients.107 The flourishing of the Asclepius cult and the Hippocratic corpus were the p ­ roducts time that he lays hold of the gods’ (trans. Wickkiser); Wickkiser 2008, 32, n. 6, 122; see van der Eijk 2005, 62–63. 100  Aleshire 1989; Samama 2003, no. 011; Nutton 2004, 111; Wickkiser 2008, 54–55. 101  Hippocrates, Pseudepigraphic Writings, Letters 2, 10, 17, 25; Strabo 14.2.19; Nutton 2004, 211, 281. 102  Sherwin-White 1978, 283–285; Aleshire 1989, 59, 74, 87–88; Wickkiser 2008, 55–56. 103  Galen, De Libris Propriis, 2 (XIX, 18–19K); cf. De Methodo Medendi 10.4 (X, 609K); SchlangeSchöningen 2001, 233–235; Nutton 2004, 216–229; Wickkiser 2008, 57; Mattern 2013, 25–27. 104  Aelius Aristides, Oratio XLVIII, 31–35; XLVII, 57; Behr 1968, 44; Temkin 1991, 184–187; Nutton 2004, 276–279; Wickkiser 2008, 57; Mattern 2013, 27–28. 105  Wickkiser 2008, 57; Mikalson 2010, 223–224. 106  Wickkiser 2008, 54. 107  Wickkiser 2008, 54, 57.

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of the same development that aimed to differentiate the art of medicine from the magical practices used by the itinerant healers. In this framework Asclepius became the symbol of divine healing as well as of the effectiveness of medical practices, contrary to magical healing methods.108 However, although Asclepius shared the same goals with doctors, beliefs about him were mainly formed in the popular sphere. People believed that Asclepius was a superhuman healer specializing in curing the sick. They further believed that his abilities surpassed the skills of his mortal counterparts. He was a god who enjoyed the worship of the people, and his cult used the means of other healing deities and cults in order to promote his reputation, and to propagate his superhuman healing powers. Various mythical sagas narrated stories about the divine physician. The inscriptions displayed in the sanctuaries were read by visitors who might later narrate the healing stories to their friends and relatives, propagating the belief in the powers of Asclepius.109 Material evidence was diffused beyond the god’s sanctuaries, and made Asclepius’ presence even more prominent in everyday life. Votive plaques, images, and relief representations of Asclepius were displayed in the temples of other deities, in the private houses of doctors, and at other places within the cities, familiarizing people with the divine ­healer.110 Coins bearing his image were minted in various Hellenistic and Roman cities, and were used in daily financial transactions, promoting Asclepius’ ­reputation.111 The ancient written testimony outlines his prominent position and the recognition of his cult by his contemporaries.112 Asclepius and his sanctuaries were specifically mentioned in the comedies of Aristophanes and

108  Nutton 2004, 112–114. 109  Not all supplicants would have been able to read the inscriptions. However, the healing stories recorded in the inscriptions would have been transmitted by word of mouth, and circulated among the people of the Graeco-Roman world. About the literacy of Greeks and Romans see Harris 1989; Thomas 1989. 110  Edelstein and Edelstein 1945, II 214–218. 111  Hart 2000, 11–12; Nutton 2004, 275–276. 112  Wickkiser, 2008, 38; Aeschines, Against Ctesiphon, 66–67; Apuleius, Florida, 18; Apologia, 55; Aristotle, Res Publica Atheniensium, 56.4; Augustine, De Civitate Dei, III, 17; Herondas, Mimiambi, IV, 1–95; Iamblichus, De Vita Pythagorica, 27, 126; Pausanias II, 27, 6; Plato, Ion, 530a; Xenophon, Memorabilia, 3.13.3; Q. Serenus Sammonicus, Liber Medicinalis, Prooemium, 1–10; Theocritus, Epigram 8; Theophrastus, Characters 21.10; etc. People used to swear by Asclepius’ name: Menander, Boeotia, fr. 91, Samia, 94–95; Galen, De Compositione Medicamentorum secundum Locos 3 [XIII, 272K]; Julian, In Heraclium Cynicum, 234 D; Statius, Silvae, III praef.; Theophilus of Antioch, Ad Autolycum, III, 2.

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Menander as well as of the Roman playwright Plautus, indicating that the idea of healing at his temples was quite popular.113

Tracing Choices, Making Decisions

In the Graeco-Roman era, someone inflicted with an illness could find a wide range of healing options in his or her surroundings. Patients could simultaneously consult professional physicians and Asclepius114—and perhaps other kinds of healers as well. Their choices would have been based on popular ideas and beliefs about the various kinds of health providers. In particular, the improved reputation of doctors made them a reasonable option for people who could afford medical treatments—wealthy citizens could consult professional physicians in order to find relief from their health problems. Public doctors were also appointed by some cities in order to offer their services to suffering citizens.115 However, Hippocratic doctors used to deny treatment in certain cases in which their own art would have proved insufficient. The ability to diagnose an illness and provide the possibility for cure was considered to be an index of good training and skill. Physicians were expected to be able to recognize the limits of their art, and to admit that ‘the practice of medicine is powerless in some cases’.116 In those cases, the appeal to divine intervention could be the next resort for people who would have been disappointed by professional medicine.117 The feelings of despair caused by the failure of human doctors and the hopes reposed in Asclepius are explicitly mentioned in the story of Aeschines the Rhetor: Having despaired of the skill of mortals, but with every hope in the divine, forsaking Athens, blessed with children, coming to your sacred grove, Asclepius, I was healed in three months of a festering wound which I had had on my head for a whole year.118

113  Aristophanes, Ploutos, 633–747; Menander, Papyrus Didotiana, I.9–II; Plautus, Curculio, I, 1, 61–62; II, 1, 216–273; III, 1, 389–390, V, 3, 699, 885–886. 114  E.g. Aelius Aristides, Oratio XLVIII, 31–35, XLVII, 57; Anthologia Palatina, VI, 330. 115  On public doctors see further Cohn–Haft 1956; Pleket 1983; Jouanna 1999, 77–78; Nutton 2004, 153–155. 116  Wickkiser 2008, 26; On The Art of Medicine 8, 14; cf. Prognostic I = 2.110 L. 117  e.g. Aelian, Fragmenta, 89, 100. 118   Anthologia Palatina, VI, 330 (trans. Edelstein and Edelstein).

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In particular, Asclepius was the divine physician whose superiority in medical art was recognized by his mortal counterparts, and he was willing to offer his treatments to everyone who approached him as supplicant. He was interested in his supplicants’ troubles, and had the power to rescue them from their sufferings; people could resort to his temples, where he performed his treatments. These popular ideas about Asclepius were mainly established through social interaction.119 A wide range of social mechanisms, including conditioning and instrumental learning, enables humans to learn from others.120 Even the observation of other people’s choices and actions provides social information about specific objects, places and agents. When people observe others visiting specific places, the same neural systems that are associated with non-social reward-expectation are activated, increasing the neural signs of valuation.121 In this light, when people observed patients traveling to the great Asklepieia and receiving cures, they attributed greater value and significance to these places, and had greater expectations for visiting the sanctuaries themselves. Social learning contributed to the reputation of the Asclepius sanctuaries as significant healing centres, and motivated people from places near and far to travel to the great Asklepieia to find cures. This belief was further promoted by the attitude of professional doctors towards Asclepius. The opinions of experts constitute a source of information that is perceived as valuable, and may influence common sense. This bias is grounded on the pre-established belief that experts know the non-social qualities of specific objects, places, and practices, and can provide valuable evaluations based on their knowledge.122 Particularly in conditions of uncertainty and despair, people’s tendency to adopt others’ beliefs and to ask for expert opinions is enhanced.123 Therefore, the recognition of Asclepius’ superiority by his mortal counterparts, and the observation of the god’s supplicants visiting and returning from his temple, claiming that they had received cures, conferred high value on the Asklepieia and increased patients’ expectations for recovery. 119  Roepstorff et al. 2010, 1057; on the perceptual and rational associations between external conditions and events, and the representations of the world in the human mind see further Shanks 2010. 120  Siegel 2002; Schultz 2008; Frith and Frith 2012, 289. 121  The dopamine system signals the reward that might be expected by acquiring a desired object or visiting a particular place, mediating social influences on valuation; see Schultz 2006; Campbell–Meiklejohn et al. 2010, 1168; Frith and Frith 2012, 293. 122  Campbell-Meiklejohn et al. 2010, 1168–1169. 123  Bulbulia 2006, 93.

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Thus, the popularity of Asclepius’ cult was facilitated by multiple social influences that would have modulated the valuation systems and reward-­ expectation networks within people’s brains. Through continual social interaction between people with each other and also with experts, and further between individuals and the collective norms and ideas flowing in the social surroundings, visiting the Asclepius sanctuaries evolved into a particular pattern of practice that was established in both the people’s minds and the external representational world. Patterns of practice develop in every society, mediating between culture and innate human capacities, and generating particular social and cultural institutions, behaviours, precepts, and ideas through continual interaction between people with each other and with their surroundings.124 In this view, people who were afflicted with a disease might have used other people’s reactions when they faced similar problems, and derived the possible pathways that might lead them to recovery. The social information flowing in the patients’ surroundings and the influence of this information on the individual would have contributed to the rapid spread of Asclepius’ reputation, and to the attraction of more and more supplicants to his sanctuaries.125 Human ability for meta-representation and meta-cognition would have enabled the transmission of the healing narratives, and their installation in material, semantic, and symbolic representations. In this light, a disease that an individual experienced would have been framed by the pattern of the Asclepius cult, and the previous experiences of other people who had visited the Asklepieia.126

Possibility of Healing and Supplicants’ Responsibility

Arriving at the great Asklepieia, the patients received multiple contextual stimuli that were intended to convince them about the correctness of their decision to visit the sanctuaries, and the potentiality of healing by the god. Entering the temenos, they were in a serene landscape that included a holy grove and natural springs. There they could walk around and meet others praying in front of the altars or offering thanksgiving for being cured. They also caught a whiff of the sacrifices offered to the god, while they heard the paeans chanted to his honour. They could consult with other supplicants as well as with the temple sacristans who oversaw the rituals in the sanctuary.127 They could see 124  Roepstorff et al. 2010, 1051. 125  Roepstorff et al. 2010, 1056–1057. 126  See Roepstorff et al. 2010, 1056–1057. 127  E.g. Herondas, Mimiambi, IV, 1–95.

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the anatomical votive offerings hanging on the walls and other places within the temenos, as well as the healing inscriptions devoted by patients who had been healed by Asclepius in the past—the material witnesses of the healings performed by the god. The inscriptions mention the names of the patients, the impairments from which they suffered, and the specific treatments applied by the god. Asclepius, for example, healed ‘Timon, wounded by a spear below his eye. This man, sleeping here, saw a dream. It seemed to him the god ground up an herb and poured it into his eye, and he became well.’128 The god also operated on ‘a man from Torone, who suffered from leeches. When he was sleeping, he saw a dream. It seemed to him that the god opened his chest with a knife, took out the leeches and gave them to him in his hands, and sewed his breast together. When day came he left having the animals in his hands, and had become well. He had drunk them down after being tricked by his stepmother, who had thrown them into a potion that he drank.’129 In other cases, Asclepius also appears to spill drugs into his supplicants’ eyes, to perform surgeries—cutting open the patient’s belly or breast in order to take items from their bodies, or to drip the fluids of their bodies in order to restore their appropriate bodily conditions.130 In this way, the other patients’ testimonies attested the effectiveness of Asclepius’ healing power, and forged learning associations between resorting to the Asklepieia and finding recovery. The supplicants would sleep in the abaton of the temple, expecting to receive similar treatments from the god that might restore them to health. These expectations, however, did not entail that all supplicants experienced a healing dream or visionary treatment by 128   I G IV² 1, 122, XL = Herzog 1931, B40, p. 24 = LiDonnici 1995, B20, p. 114 = Prêtre and Charlier 2009, XL, p. 72. 129   I G IV² 1, 121, XIII = Herzog 1931, A13, p. 14 = LiDonnici 1995, A13, p. 94 = Prêtre and Charlier 2009, XIII, p. 28. 130   I G IV² 1, 121, IV, IX, XVIII, 122, XL = Herzog 1931, A4, A9, A18, B40, pp. 10, 12, 14–6, 24 = LiDonnici 1995, A4, A9, A18, B20, pp. 88, 94, 100, 114 = Prêtre and Charlier 2009, IV, IX, XVIII, XL, pp. 24, 26, 30, 72; IG IV² 1, 122, XXIII, XXV, XXVII = Herzog 1931, Β23, Β25, Β27, pp. 16, 18 = LiDonnici 1995, B3, B5, B7, pp. 102, 104, 106 = Prêtre and Charlier 2009, XXIII, XXV, XXVII, pp. 64, 66; IG IV² 1, 121, XIII = Herzog 1931, A13, p. 14 = LiDonnici 1995, A13, p. 94 = Prêtre and Charlier 2009, XIII, p. 28; IG IV² 1, 122, XXIII, XXXII = Herzog 1931, B23, B32, pp. 16, 20 = LiDonnici 1995, B3, B12, pp. 102, 108 = Prêtre and Charlier 2009, XXIII, XXXII, pp. 64, 68; IG IV² 1, 121, XII, 122, XXV, XXX, XXXII = Herzog 1931, A12, B25, B30, B32, pp. 14, 18, 20 = LiDonnici 1995, A12, B5, B10, B12, pp. 94, 104, 108 = Prêtre and Charlier 2009, XII, XXV, XXX, XXXII, pp. 28, 66, 68; IG IV² 1, 122, XXI = Herzog 1931, B21, p. 16 = LiDonnici 1995, B1, p. 100 = Prêtre and Charlier 2009, XXI, p. 64.

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Asclepius. Possibly, many incubants would have left the abaton without having received any divine dream or vision and without any health improvement. At this point, the inscriptions were intended to assign responsibility for the failure to be healed to the patients, not to Asclepius’ inefficiency. Perhaps they had not adequately purified their bodies and souls, or they had not precisely defined their demands.131 In this way, the cult managed to ensure the reputation of Asclepius. If patients were not cured during incubation, they themselves were responsible for that and they could not blame the divine healer for their own insufficiencies. In any case, those who had visited the Asklepieia and underwent the ritual of incubation would have had many stories to narrate to their friends and relatives, when they were back home. Their experiences in the sanctuaries, including the healing narratives which they had heard about—or read on the inscriptions—their discussions with other supplicants or the temple sacristans, and their participation in the cult rituals and practices would have been subject of storytelling. In this way, people’s stories from the sanctuaries would have been the main source of information about the Asclepius cult, offering the grounds for the evaluation of the healings performed at his temples and for the formation of popular beliefs in his powers. Conclusion The ideas and conceptions about the Asclepius cult were mainly formed in the popular sector, determining people’s choices and actions when illnesses ensued. The major ideas and beliefs about Asclepius were drawn from the common pool of popular principles and precepts about the gods and human medicine, health, and illness that were transmitted mainly through multiple social interactions. Furthermore, the reputation of the divine physician, the evaluation of the healing practices applied at the Asklepieia, and the assessment of the health outcomes were promoted by people’s personal experiences at the sanctuaries. Storytelling was a common form of communication through which the healing narratives about Asclepius were conveyed. Even the observation of others visiting the Asklepieia when they were afflicted by illness traced a possible pathway to recovery that people could follow when they confronted similar health problems. Other factors might have gone into the decision to resort to 131  E.g. IG IV² 1, 121, II = Herzog 1931, Α2, p. 8 = LiDonnici 1995, A2, p. 86 = Prêtre and Charlier 2009, II, p. 22.

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Asclepius, such as the availability of a sanctuary or the affordability of travel to one of the god’s great sanctuaries. However, if these external conditions were met, visiting an Asklepieion was a prominent choice among other healing alternatives. Thus, the Asclepius cult developed into a particular religious and cultural system that became part of the wider medical system. The reputation of the religious healing offered at his temples, though it was mainly established in the popular sector, overlapped ideas about the professional and folk sectors. Resorting to the Asclepius sanctuaries did not eliminate the valuation of the art of medicine exercised by professional doctors, and asking for Asclepius’ aid did not exclude the possibility of consulting a folk healer. On the contrary, all these alternatives co-existed, and comprised the medical pluralism of the Graeco-Roman world.

Chapter 4

Anatomical Votives: Popular Medicine in Republican Italy? Rebecca Flemming Introduction One of the most prolifically surviving ancient engagements with the human body is represented by the vast quantity of anatomical votives found—as part of larger votive arrays—at sacred sites across republican (or Hellenistic) central Italy; greatly outnumbering their rough Greek equivalents.1 Thousands, tens of thousands of predominantly terracotta body parts once offered to the gods have been recovered and recorded from locations in southern Etruria, Latium, northern Campania, and various adjacent areas (see fig. 1).2 Many, many more have escaped record, or been mentioned only in the most cursory manner. One visitor to Veii in 1909 reported, for instance, that he saw a ‘heap of such offerings piled up . . . there were all possible members . . . ’, but few of these items seem to have emerged into the public domain.3 Even today, the roughly six thousand votive wombs and swaddled infants found during excavations of the Italic Temple south of the forum at Paestum in the late 1980s have not yet been published.4 Keeping track of both sites and finds, not to mention the exact relationship between the two, is therefore tricky. Counts and catalogues are inevitably imprecise and incomplete, but around 150 locations in central Italy are known to have produced votive body parts thus far; in numbers ranging from a handful to thousands, and including much uncertainty in between.5 Even where reports are reasonably detailed, types of ex-voto are more likely to be listed than 1  See e.g. Forsén 2004 for a summary of the Greek anatomical votive phenomenon, which displays both similarities to and differences from the Italian material; and see also Hughes 2008 for a more generally comparative approach. 2   Hence the rather cumbersome sobriquet ‘etrusco-laziale-campano’/‘Etruscan-Latial-­ Campanian’ (or E-L-C for short) votive practice, after Comella 1981. 3  Robinson 1923, 340, citing Prof. Frank Jewett Mather, Jr. 4  Greco 1988, 79. 5  See Turfa 2006a, 63.

© trustees of columbia university in the city of new york, ���6 | doi ��.��63/9789004326040_005

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U U M R Vulci I Tuscana B A R I Tarquinii A Grasceta Falerii Novi Gravisca Caere Pyrgi Rome Veii Nemi/Aricia L A Lavinium T I Fregellae Satricum U M Antium

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TYR R HE NI AN SEA Figure 1 Map of central Italy showing the main sites referred to in this chapter. Source: Ancient World Mapping Center, adapted by Alessandro Launaro and Rachel Aucott.

actually enumerated. Still, to give some sense of scale, one of the richest and best recorded arrays of anatomical offerings comes from the small sanctuary at Ponte di Nona, just east of Rome, which yielded a total of 8,395 terracotta votives during excavations in the 1970s, of which 6,171 were identifiable.6 The overwhelming majority (96.11%) of these were body parts, with feet the largest contingent (2,368), and heads next in line (985). The site can also be used to illustrate wider issues of chronology and identification relating to Italian votive practice. The indications are that the sanctuary was fully functioning in the late fourth century BCE, but most of the pottery and coins found in the same deposits as the terracottas are of third- and second-century date, and the place seems to have fallen out of religious use in the first century BCE. There is no evidence that speaks directly to the identity of the deity, or deities, to which the temple was dedicated. Many other sacred sites in central Italy from around the same time remain similarly anonymous, 6  Potter and Wells 1985. These are in addition to those collected in the nineteenth century, and those sold on the illegal antiquities market thereafter.

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though anatomical votives have also been found at larger, better-known locations, such as the sanctuary of Diana at Nemi (staying in Latium, and roughly in the vicinity of Rome).7 The timespan at Ponte di Nona also corresponds well with other finds, for while the ex-votos cannot themselves be dated, they are consistently associated with places that flourished as ritual centres over all or part of the period from the fourth to the first centuries BCE; none can be placed definitely outside this period.8 This should not, however, be assumed to demonstrate the sudden rise and/or demise of the practice of offering terracotta body parts to the gods, or indeed other material ex-votos.9 Rather, the profile of activity at Ponte di Nona may be more typical, where, if the number of visitors making such offerings is judged by datable pottery and coin finds, there was a slow increase to a peak between 250–150 BCE, dwindling thereafter. Still, though various details remain hazy, large quantities of these objects are undoubtedly widespread across central Italy from the fourth to the first century BCE. Terracotta is a relatively cheap and durable material, so the indications are that these items were generally accessible; participation in this votive practice must have extended well beyond the elite. Indeed, several stronger arguments have been made in respect to the demographics and politics—the social and cultural positioning—of this phenomenon. Most influentially Mario Torelli and Patrizio Pensabene have suggested that offering anatomical ex-votos is the more or less exclusive province of the rural equivalent of the Roman plebs.10 For them, the phenomenon follows the rise and fall of the free smallholding population of the central Italian countryside, whose displacement after the Second Punic War plays such an important part in the traditional narrative of Roman republican history. This narrative has itself come under sustained criticism in recent decades, so it is unsurprising that its attendant votive model has been similarly critiqued, variously challenged, adapted, and modified in the scholarship since.11 In any case, this practice must count as ‘popular’, that basic point is not in dispute, and, assuming that the religious engagement with the human body relates 7  The sanctuary of Diana is of course, attested in a range of literary sources, not just archaeologically (see, with some caveats in relation to healing, e.g. Green, 2007). 8  There are no obvious developmental signs on the objects themselves (though the styles of some heads can be connected to changing sculptural styles), and their archaeological context has usually either been insufficiently well recorded or is stratigraphically problematic (the larger deposits were buried together after clear outs of the sacred spaces). 9  As does seem to be assumed, at least in relation to demise, in Potter and Wells 1985, 40; but see e.g. Glinister 2006, 30–31, and Turfa 2006a, 65. 10  See esp. Torelli 1973; Pensabene 1979 and 1980, 46–51; and also e.g. Steingräber 1980. 11  See e.g. Söderlind 2002, 361, and 2005, 362–363, for variations on the peasant theme; and e.g. Arthur 1991, 46–47; Glinister 2006, 27–28, and Schultz 2006, 97–102, for more critical approaches.

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to health and healing, then it would also qualify as medical. ‘Popular medicine’ is more often defined in contrast to professional, learned, and usually officially sanctioned medicine, rather than as encompassing forms of cure which are just common or particularly associated with peasants or belonging to the people in a political sense; still, there is sufficient potential overlap between all these delineations that the central Italian activities involving votive body parts certainly could qualify under this rubric. This chapter, therefore, examines these claims in more detail. It scrutinises the anatomical votive phenomenon in central Italy more carefully in an attempt to get to grips with the question of what kind of popular medicine it really represents (if any). The question of the relationship between these objects and human health and healing, their basic ‘medicality’, is dealt with first of all as part of a wider evaluation of the religious patterns in which they fit. Then questions of cost and clientele will be explored: is it possible to discover which social groups made such offerings, or, at least, which might have been able to in terms of the accessibility of sanctuaries and ex-votos? In conclusion, these issues will be analysed in their chronological frame. To what extent are either of these themes implicated in the growth and then decline in offering votive body parts in central Italy?

Votives and Medicine

Votives are material objects which have been offered to the gods. They are religious artefacts which represent a certain kind of interaction between the human and the divine. Broadly speaking, this kind of interaction is a pretty fundamental one in the world of the ancient Mediterranean. The key patterns of understanding and action which produced and distributed the surviving votive deposits that include anatomical items both pre- and post-date the period under scrutiny here, and were more widely shared across Italy and beyond.12 The basic sequence is that a human suppliant approaches a god, optimally in a particularly sacred space, with a request, a prayer, for help, together with a commitment that, if assistance is provided, and the desired outcome achieved, the suppliant will dedicate an offering to the provident deity in thanks and praise.13 In later Roman evidence, this commitment takes the form of a specific vow, which is where the weight of the transaction seems

12  See e.g. Turfa 2006b. 13  Outlined in e.g. Rüpke 2007, 154–165; and, more flexibly, Scheid 2003, 99–101.

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to fall; hence the terminology of the ‘votive’, or ‘ex-voto’ (from votum, ‘vow’).14 Whether earlier practice followed exactly the same model across central Italy, and how formalistically, is less certain.15 Still, the basic contours of the exchange are clear, though the details may vary: a request for divine support is made, and something is offered in return. The dedicated object—that which was promised, vowed, or just offered in thanks—is then a public commemoration of divine favour. It is a material celebration of the power and beneficence of the god, a visible marker of a particular human’s success in dealing with divinity, and of gratitude for the deity’s response. Votives are displayed in the relevant temple or sanctuary— placed on and around altars, leant against (perhaps fixed to) walls, covering all available surfaces, and hanging from beams and fittings.16 They remain after the d­ edicant has departed, and greet each new suppliant, engaging all visitors to the sacred site, keeping the link with the divine open after the event and maintaining an enlarged community of the favoured, one which clearly invites further growth and more iterations.17 Address to divinity is encouraged, empowered in such a setting, just as the sanctuary itself (the cult) also takes strength and substance from its accumulations of objects and materials: items with meanings in the interlocking worlds of the human and divine as they are focalised in these places. As already mentioned, many such ancient offerings, probably most of the items once dedicated, have long since vanished; but plenty survive, in a diverse range of shapes, styles, and sizes, and a more restricted set of materials. Terracotta increasingly dominates the Italian scene as the fourth century BCE goes on, greatly adding to, displacing, and amending the previous metal and ceramic traditions, before itself giving way to written votive styles on stone in 14  The role of the vow, emphasised by the standard epigraphic formula on early imperial votives—v(otum) s(olvit) l(ibens) m(erito)/‘fulfilled the vow willingly and deservedly’—is dissected in particular detail in Derks 1998, 215–239, and 2014, 59–65, as well as de Cazanove 2008. The Greek vocabulary is more flexible and diffuse. 15  Very few early votives are inscribed, and what writing there is records simply the deity to which the object has been offered and/or the name of the dedicant, occasionally with verbs of giving or dedicating. 16  As mentioned, most of the major deposits result from organised clear-outs of the votive clutter—clutter which remained divine property, after all—to make room for more. But, some sites have yielded votives still in situ, e.g. Lavinium (see Castagnoli et al. 1975) and the objects themselves are designed for display in various ways. They have bases and p ­ edestals, or holes for hanging (e.g. a votive breast from Gravisca: Comella 1978, Tav. XXX fig. 154). 17  The individual and communal work of votives is particularly well illuminated in PetsalisDiomidis 2010, 238–275.

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the course of the first century BCE. The durability of terracotta, its low intrinsic value, and its non-reusability all count in its archaeological favour; but some metal and pottery ex-votos survive from this period too.18 The different sorts of things offered and their formal variety show that many kinds of gifts—perhaps all gifts—were pleasing to the gods (see fig. 2). There are, however, two themes relating to the transaction with the divine itself that are most visible across the rich votive deposits from the fourth to the first centuries BCE, themes arising from the form and content of the human–god interaction respectively. In the first category come the myriad ex-votos which represent deities, suppliants, and religious personnel; that is, which evoke and commemorate the ritual practice itself. In the second are placed the human body parts, animals, and fruits, as well as other items which are interpreted as referring to the specific help requested. These body parts are predominantly external. Feet, hands, heads, phalluses, eyes, ears, and female breasts are all very well represented, with a selection of other somatic segments, such as the midriff, or lower leg, and other single items, such as a tongue, finger, or female genitals, rather rarer. Though these come in a range of sizes and are presented in different ways, they tend to share a similar style, influenced by Hellenistic sculpture. That is, they take a rather idealised form, and though some scholars have identified pathological features in some cases, this is controversial, and certainly not the overall approach.19 Distinctive to the Italian votive tradition are the images of internal organs which are also offered in considerable numbers to the gods.20 Wombs dominate this set of terracottas, but there are also plenty of hearts and a smattering of other parts, not always identifiable, as well as the so-called ‘polyviscera’ (multiple organ displays in a range of formats and configurations). As this latter point emphasises, with the exception of the heart, the bodily interior is dedicated to the divine in more diverse forms than the exterior—the uteri and ‘polyviscera’ being most divergent in representational approach.21 These tend to be more schematic and emblematic than sculptural and ideal, and there have again been debates about pathology in a minority of cases. It is also worth

18  See e.g. Turfa 2006b, and it is often assumed that wax, and perhaps wood, offerings are now lost (e.g. Scheid 2003, 100). 19  On the general scholarly move away from pathological interpretations see e.g. Recke 2013, 1075–1076. 20  The point is made e.g. in Forsén 2004, which lists a handful of possible exceptions. 21  For further discussion of the wombs see Flemming forthcoming a.

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noting that although the vast majority of animal votives are whole, there are a few bovine and equine hoofs to be found too (see fig. 3).22 It is these votive body parts, in this larger grouping of ex-votos that relate to the content of the transaction with the divine, which can be classed as broadly medical; that is, pertaining to human health and healing—having those things as their goal, just as the art of medicine does.23 To be more specific, these terracottas are about engaging the gods in the body in a focused and ongoing way. This may be for the cure or recovery of the particular part (or parts) represented; for support and success in a specific use of it; or for its continued and increased vitality and effectiveness more generally—judging between these possibilities is not feasible. All count as medical, however. Deities are being asked to perform a range of health-maintaining and health-promoting services; to provide support in various specific physical enterprises such as childbearing, as well as assistance in retaining and building somatic fitness and function more broadly. The shape of the offering promised in return for that performance, its permanent marker, contributes to the endeavour in multiple ways. Some further caution is required, however: an even greater degree of openness and uncertainty persists. The foot, for example, might also be connected to travel (a frequent focus of divine vows), and the eyes and ears might be taken in a more conceptual way, as accentuating an address to the deity about s­ omething else, by emphasising the wish to be heard or seen by the god. Moreover, it is debated whether the very popular terracotta heads, or half-heads, should be thought of as ‘anatomical’, or as standing for the whole person, or both; a point which has some particular significance given that they are the most studied of these objects. Then there are the ‘polyviscera’; how are these offerings of multiple internal organs to be understood? Terracotta animals, similarly, might follow a request for healthy and fecund livestock, or, like the vegetable items less frequently found, might represent sacrificial objects themselves, and so should perhaps (or sometimes) be re-categorised under the previous heading. These are, of course, interpretative problems inherent in approaching material objects of this kind without accompanying literary evidence.24 In 22  E.g. at Lavinium: Castagnoli et al. 1975, 335 and fig. 403; Fregellae: Coarelli et al. 1986, 144 and Tav. XCIII, 3–4; Tessennano: Costantini 1995, 70 and Tav. 29c. 23  The point is explored in previous surveys of the material, e.g. Fenelli 1975 and Turfa 1994. 24  There are a few vague references to votive practice in literature which (of course) postdates the materials. The least vague and closest in time, belongs originally to Varro, but is cited by Augustine (Civ. Dei 6.9). The claim is that model male and female parts are dedicated in temples to Liber and Libera respectively, in relation to the emission of male and female seed; though exactly what ‘part’, and in what form, is not specified, nor whether

Figure 2

Sepia photograph of a selection of votives and other items from Lord Savile’s original glass plate negatives of the excavations at Nemi in 1885. Source: Nottingham City Museums and Galleries.

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Figure 3 Selection of anatomical (and other) votives, including both external and internal body parts; from Tessennano (Vulci). Source: The Mediterranean Museum, Stockholm.

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t­ hemselves, their meanings are quite open, there are a number of possibilities; but, though this may be slightly frustrating for the modern scholar, it is crucial to their historical functionality. This focussed but flexible, polyvalent but not unbounded, transaction with the divine was clearly appealing. It makes the artefacts particularly effective; they work better than words because of this under-determination. The label ‘medical’ must thus be applied in a loose and non-exclusive way. It seems likely that many (if not most) of these votives do represent requests for the cure of a sprained wrist or eye-disease, or continuing manual capability or good vision, and so on, but even this range may be exceeded in the divine address made. Gods and objects are encompassing in their capacities. It is also worth stressing the non-specialist, inter-linked approach here. The way in which all aspects of human existence are placed together before the gods, with some particular emphases but few exclusions, is conceptually and practically important. The point is inherent in the anatomical ex-votos themselves, as has just been outlined, and it is also underscored by the fact that they are always found as part of a broader votive array. Body parts may dominate the deposit, as they do most strongly at Ponte di Nona, but no more. There are always figurines too, and other non-anatomical objects, in a range of materials. Often they are, indeed, outnumbered, and Jean Macintosh Turfa has sought to draw a distinction between those sites that hold substantial volumes of somatic votives, encompassing a range of parts, including internal organs, and those with which only a few of the less specific models such as heads or feet are associated.25 She implies that the former are clearly more identified with healing than the latter—that they might even be labelled as ‘healing sanctuaries’. Though, again, this should not be understood as an exclusive, maybe not even the primary, designation; much more went on at these locations, and in much the same manner, across the spectrum of possible requests. Anatomical votives are offered in the same way as other votives—there are no indications that there were any additional ‘healing’ rituals or other practices involved, as Turfa also emphasises. The gods addressed are usually generalists too, and the structure of the sites indistinct. In most cases the identity of the deity (or deities) an early sanctuary was dedicated to is unknown, as has been alluded to; and there are no other archaeological features which mark out the places where larger (or smaller) deposits of terracotta body parts were found. A list of the divinities named on individual anatomical votives, moreover, or known to be the overall patron this is emission for the purposes of procreation (though the Varronian context is broadly familial). 25  Turfa 2006a, 64.

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of (or otherwise represented in) a particular site at which such items were offered, would include: Diana, Minerva, Hercules, Vea/Demeter, Apollo, Turan/ Aphrodite, Uni/Hera, Ceres, Selvans, Mars, and Mater Matuta.26 All have their own realms, of course, but it is clear that healing—the capability to intervene in the human body more broadly—was an intrinsic divine power; one that was accessed in exactly the same way as other forms of divine support. Specialist healing gods were relatively late arrivals on Italian shores, and of limited influence in the republican period. Asclepius, the premier divine healer of the Greek world, was brought to Rome from Epidaurus in 291 BCE, with a temple established on the Tiber Island.27 There is literary mention of a building dedicated to the same god at Antium, but the only other archaeologically attested site from this period is the major temple complex at Fregellae, constructed in the early second century BCE.28 In both cases, there are ­anatomical ex-votos from these locations, from the wider urban and sanctuary areas of Rome and Fregellae, which pre-date these developments. The offering of votive body parts is already in full flow, and these new temples participate in the existing practice and add to its volume, but there is no indication that they change it in any way. There are, it should be said, wider medical developments at Rome and beyond at this time. Pliny the Elder reports that the first ‘medicus’ (professional physician) came to Rome, also from Greece, a bit more than half a century after his divine counterpart, and though his story should not be taken at face value by any means, there are other indications that specialist medical practitioners become more a part of the scene at Rome and beyond through the second century BCE.29

How Popular was Votive Medicine?

Having established the ‘medicality’, broadly construed, of the anatomical votive phenomenon in republican central Italy, attention now turns to the question of its popularity. There have already been some indications that these objects represent a popular practice, in at least a weak sense. Terracotta body parts are a feature of a very wide range of sacred sites, meaning that no one would 26  See Turfa 2004 and 2006b. The Greek/Etruscan (or Roman) equivalents are not straightforward, see e.g. Krauskopf 2013. Statues of, and offerings to, deities other than the main god of a sanctuary are commonplace in the ancient world. 27  Livy Per. 11; Ovid, Met. 15.622–744; Valerius Maximus 1.8.2. 28  On Fregellae see Coarelli et al. 1986, which includes an essay on Asclepius in republican Italy (Degrassi: 145–152) and see also on the same topic Musial 1990. 29  Pliny, NH 29.12–13; and see discussion in Flemming forthcoming b.

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have been very far away from the opportunity to make such an offering to the gods, and they are prolific artefacts. The vast majority are mould-made from a readily available material, and of moderate size (not excessive in their use of that resource), so mass-produced in ancient terms and, indeed, massively surviving. The obvious conclusion to draw from their numerousness and economy is thus that many people did take advantage of this opportunity to make such offerings to the gods for health and healing. This section will examine these basic premises more closely—that both the geographical distribution of the sanctuaries with anatomical ex-votos and the objects themselves imply accessibility to a broad section of the population. It will then ask whether the evidence supports any of the arguments made for this votive tradition counting as ‘popular’ in a stronger sense. Are there signs that it was dominated by social strata below the elite, in a more or less self-conscious or indeed exclusive manner? The problem of relating artefacts and sites returns, of course, but, even within the existing evidential constraints, it is possible to say something about the inclusive nature of the distribution pattern in question. Substantial votive deposits, including anatomical items, have been found at rural, extra-mural (suburban or peri-urban), urban, and extra-urban sanctuaries; they come from coastal locations and inland, shrines associated with groves, caves, cemeteries, and lakes, to mention just a few possibilities.30 Precise definitions and classifications are debated, but presence across all typological divisions can be easily demonstrated. So, for instance, Tessennano and Nemi are both in the countryside, in the territory of Vulci (Etruria) and Aricia (Latium) respectively.31 The Italic Temple at Paestum (in northern Lucania) and the temple misidentified as belonging to Minerva Medica on the Aventine in Rome are both well within city boundaries (though the latter was outside the pomerium, Rome’s sacred boundary).32 The Campetti sanctuary is just beyond the walls of Etruscan Veii, whereas that of the Thirteen Altars is a bit more distant from Latin Lavinium (and has a federal function).33 If the former would generally be labelled ‘extramural’ and the latter ‘extra-urban’, however, the sanctuary at Gravisca, further 30  The variety is emphasised in e.g. Edlund 1987 and Turfa 2006a, 63–68. 31  The finds from both sites have been split up: Costantini 1995 publishes the portion of the Tessennano material which remains in Italy, and see Unge Sörling 1994 for a survey of the material in Stockholm. For Nemi, only the material in Nottingham has been fully published, in Blagg et al. 1983. 32  Paestum: Greco 1988; ‘Minerva Medica’: Gatti Lo Guzzo 1978. Her identification of the site has been repeatedly challenged since: see now Häuber 2014, 110–138 and 556–570 for full discussion. 33  Campetti: Comella and Stefani 1990; Lavinium: Castagnoli 1975.

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north on the Tyrrhenian coast, can be counted under both headings. It is close enough to the harbour city of Gravisca itself to be ‘extra-mural’, but ‘extraurban’ in relation to Tarquinii (about 8 km away), the larger political entity to which both the port and its temples were attached.34 These examples, already selected to illustrate geographical spread, could be multiplied and diversified in terms of size, significance, and situation. The basic point is a simple one, however, that votive practice associated with health and healing was integral to the religious structures and activities of central Italy from the fourth to the first century BCE. Though terracotta body parts are not found at all identified sacred sites, their absences seem incidental rather than significant: they do not follow any discernible pattern.35 Moreover, while some people would have had to travel further than others to make offerings for their physical well-being, and would have had greater choice about which deity to address, nobody would have had to travel very far; opportunities would have been available to anyone who participated in the ritual life of their local area. Turning to the objects themselves, there are also many indicators of general accessibility. Much remains uncertain, of course, particularly about the practical details of what might be called the ‘votive economy’. The broad assumption is that there were stalls of some sort outside any sanctuary at which a range of artefacts that might be offered to the divine were available for purchase; most were manufactured locally, but perhaps some more exotic items were also included. While the approach to a large urban or suburban temple might provide the widest choice to the suppliant, even the smallest rural shrine would have been associated with some votive merchandise. The acquisition of an exvoto to give to the gods was, therefore, an essentially commercial transaction, requiring that those going to address a divinity had some purchasing power— a little surplus and a means of exchange. Indeed, the permanent gift is not the only expense involved. Libations would need to be poured, cakes offered, sacrifices made, on however small (or large) a scale; there is an overall investment of time, effort, and money implied. On this model it is the suppliants’ purchasing power which drives the whole process of votive manufacture, given the desire for divine assistance. It is consumer demand that makes it worthwhile for local producers to add a set of anatomical ex-votos to their repertoire, perhaps even specialise in their manufacture; to develop a sales network and so forth. Localism, cheap and accessible materials, and the overlap with other products all facilitate this undertaking, 34  Gravisca: Comella 1978. 35  Despite suggestions to the contrary, there are Roman and Latin colonies which lack votive deposits in addition to those (such as Paestum and Fregellae) which have them in ­abundance—see Gentili 2005, 372–373, and Glinister 2006, 25.

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making it practically more straightforward and keeping costs down. It is not just that the same techniques are deployed and the same equipment used, but also that the miniature vases which dominate some early deposits, for example, or separate heads or feet, share specific features, even moulds, with their larger or more complete counterparts.36 This picture is pretty speculative in places, however. A few moulds have been found in and around sacred sites, and also some kilns.37 In Satricum, kiln, moulds, and votives were discovered roughly together in association with the temple of Mater Matuta; ‘terracotta workshops’ have also been identified in the vicinity of the Manganello sanctuary at Caere and the temple area at Fregellae.38 Analysis of clays also favours local production, or small-scale regional manufacture. Martin Söderlind suggests, for example, that a centre at Tuscana provided terracottas to the rural sanctuary of Tessennano (about 9 km away) and other sites nearby.39 Indeed, there is some wider distribution of moulds, mould-types, and the objects they engender.40 The presence of stalls setting out these wares by the entrance to the sanctuary would, therefore, make sense in this context, as the obvious way in which these goods would be brought to their prime market. Much later, inscriptions record the sale of sacrificial cakes outside temples in early imperial Pompeii, for instance, but earlier evidence is lacking.41 Local production in terracotta from moulds that were heavily re-used would also have served to keep costs and prices down. The cheapness of votives made this way should not be exaggerated. The clay has to be processed before use and firing is inherently risky; the anatomical ex-votos were usually painted, backs and bases were often handmade, and other kinds of reworking also occurred.42 Still, these are generally modest objects, roughly life-size or smaller in their partial representations, which were produced in bulk to sell in volume; implying that they were intended to be within the reach of much if not most of the population. Exactly how they purchased them (probably without ­coinage) is unclear, but only a small surplus would be required, and investment

36  Best studied in respect to heads, see e.g. Söderlind 2002. 37  Moulds: Pyrgi, Tarquinia, Satricum and Cales (Turfa 2004, 364–367), and Falerii Novi (Hofter 1985, 132 n. 542). Kilns: see general discussion in Curri and Sorbelli 1973. 38  Satricum: Mengarelli 1898, 168; Manganello: Mengarelli 1935; Fregellae: Coarelli 1986, 90 and 92. 39  Söderlind 2002, esp. 275–308. 40  The studies, again, focus on heads: see Comella 1981, 793, and Söderlind 2002. 41   C IL 4.1768–1769, and see Holleran 2010, esp. 208–210, more generally. Votives are still sold in proximity to the temples, shrines, and churches at which they are offered today. 42  As described in detail in Söderlind 2002, 241–273.

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in personal and familial health and well-being is always important.43 A wider exchange economy was developing, locally and regionally (as well as internationally), and these artefacts must have formed part of this emerging pattern.44 It is, however, precisely these same points, as they gesture towards mass production and participation (at least in ancient terms), which have formed barriers to inclusivity in some scholars’ minds.45 These are items aimed at sections of society below the elite, surely. Elite concerns with social distinction and display would not have allowed them to offer small, cheap objects to the gods, especially if the local peasantry was doing exactly the same. The anatomical votive phenomenon can claim a more potent popularity as a result of this exclusion, of the communal lines thus drawn. The argument is, again, ­speculative, but plausible; except that the surviving sets of ex-votos do show variation and differentiation in size, style, fineness, and material, and hint at wider variety still. It seems that what persists represents a substantial segment of a once more extensive votive population, one that perhaps originally encompassed wax artefacts at one end of the spectrum, and those in precious metals at the other end; both less durable than terracotta (and bronze) in different ways.46 Everybody would then have participated in the same ritual activities around health and healing in the same way, but each according to their means; a characteristically Roman form of communal action, articulating both hierarchy and inclusion.47 The extant variety of anatomical votives should also be emphasised. There are some very large terracotta ex-votos—especially amongst swaddled infants and the more embodied polyviscera—and some very small—miniature heads and feet, for example, as well as a fuller range of the somewhat less than ­life-size (or, at least, adult life-size).48 There are diverse styles on display, and 43  For a summary of monetisation in Rome and Italy see e.g. von Reden 2010, 47–55. Coinage production and spread substantially increases after the Hannibalic War, but remains patchy and limited in various ways. 44  This certainly included the production of goods—animals for sacrifice, flowers for garlands, incense—for a religious market, as it were: see Cato, De Ag. 8.2 and Varro, RR 1.16.3. 45  So e.g. Turfa 1994, 224–225, holds that such an ‘inexpensive commodity’ would probably not have been offered to the gods by ‘aristocrats’ (or slaves), for example. 46  Wax is a guess, based on subsequent practice; in addition to the bronze anatomicals which do survive, silver items are listed in Greek temple inventories, including of late Hellenistic date, and probably representing Roman or Italian offerings, e.g. two silver uteruses dedicated to Artemis in the Isideion on Delos in 145/4 BC (Van Straten 1981, no. 25e: 128). 47  As exemplified in the census: see Livy 1.42.4–44.2. 48  Whether swaddled infants should be classified as ‘anatomical’ is dubious, but the largerthan-life size of some of them is indisputable; and whether some small items should be thought of as relating to the child body rather than to cost is also uncertain.

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differences in quality. At Ponte di Nona Tim Potter noted that while some items were ‘clumsily and crudely modelled’, in other cases, most particularly the heads, the level of craftsmanship was good to outstanding.49 The exceptional pieces may, indeed, represent personal commissions, individual orders from ‘more affluent patrons’; and the whole ensemble demonstrates that suppliants enjoyed a wide range of choice of object and ‘no doubt price too’. There is, of course, a sense in which some stylistic issues cut across qualitative assessments. Care should be taken not to overplay conformity with an established and preferred Hellenistic aesthetic as the essential criteria in judging what counts as high end (or more mediocre) productions. Thus, for example, a type of schematic wheel-thrown head, best known from the small sanctuary at Grasceta dei Cavallari on the border between the territories of Tarquinii and Caere, has been described as ‘crudely formed’ and ‘awkward’ by some scholars; but is construed as evincing a distinctive and intentional ­‘indigenous style’ by Kevin D’Arcy Dicus.50 More skill and effort was required in their manufacture than for the most perfectly Hellenistic head made from a mould, he points out. These artefacts must represent a particular project in relation to divine action in their own right, rather than some kind of imitative failure. Which is certainly true, even if labelling the enterprise ‘indigenous’ is more debatable, and the point could be made more widely that neither cost nor fineness are the only factors to be taken into account when selecting and fashioning offerings to the gods. Traditional simplicity has its valence too, in ritual as in other contexts, and the broader religious uses of terracotta in central Italy are also worth noting, as Fay Glinister has emphasised.51 It was not such poor stuff that cult statues and the elaborate decorations of temple roofs could not be formed out of it, after all. Maybe the votive items borrowed some of the prestige of these earlier terracotta constructions. If the baseline is thus raised, however, if terracotta is inexpensive but not ‘cheap’ (in any pejorative sense)—an entirely appropriate fabric to use for religious purposes, rather than a last resort; it is still the range within the span of the votives in this material (and beyond) that is most important in indicating social inclusivity. Differences of human status could be marked in offerings to the divine, and no doubt were, within a broadly shared concern with health and well-being—a shared concern that was acted on in essentially the same way across the social spectrum; the same ritual was performed by everyone. A further point about inclusivity should also be made, which is that both female and male bodies and body-parts are well represented—images of female and 49  Potter and Wells 1985, 28–29. 50  D’Arcy Dicus 2012, esp. 158–203. 51  Glinister 2006, 28.

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male deities, offerands, and cult personnel (not always entirely distinguishable) abound in sanctuaries dedicated to both goddesses and gods. Of course, prayers, vows, and offerings can all be made on behalf of someone else, but all the indications are that both women and men frequented the same sacred sites, participated in the same ritual activities, and addressed the divine in the same way, even if the content of their requests may have varied.52 If Turfa is correct in identifying the object dedicated to Minerva by a woman probably named Senenia at the sanctuary of the Thirteen Altars outside Lavinium as a heart, this would prove the point.53 This is then popularity in the weak sense: a phenomenon that was widespread, accessible, and inclusive, rather than politically charged or socially distinctive. It is nonetheless significant for that—perhaps, indeed, more ­significant. It might be objected, however, that this is to overlook matters of chronology, which have been a key part of the scholarly debates so far. The temporal fit with wider political developments has been part of the proof offered for a more sociologically specific reading of the votive material. Are there alternative explanations for why such a generalised practice aimed at such a vital human concern came to a halt? This is also the juncture where other medical models are sometimes brought into the story. Perhaps anatomical ex-votos were replaced by coins paid for the cures of Greek doctors—divine healing was supplanted by human healing; though this too has been disputed.54 Still, such an argument would open up a space for a more traditional form of popular medicine to take shape, in contrast to a learned or otherwise ‘high’ version of the medical art. Indeed, without such a contrast, the question is surely raised whether the phrase ‘popular medicine’ makes any sense. These issues will both be dealt with in the conclusion.

Chronological Conclusions

The proposition so far is thus that, across central Italy, from the late fourth to the early first century BCE, men and women of all classes were accustomed to address the divine about matters of health and well-being and disease and cure using votive body parts. Predominantly in terracotta, but also in bronze and perhaps other materials, it is these objects—their distribution and production, volume and diversity, connections and circumstances—on which this 52  Schultz 2006, esp. 95–120. 53  Turfa 2004, no. 303; Fenelli 1984, 336: sen[]nia.menrva/me[]isa. 54  Suggested by e.g. Blagg 1983, 46, and Potter in Potter and Wells 1985, 40; disputed by e.g. Schultz 2006, 100.

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conclusion rests; through which a form of popular medical practice has been identified. The chronological limits of this phenomenon are puzzling, however, given that health is always a crucial human concern, and the argument has been that anatomical ex-votos fit neatly in a set of deeply embedded religious understandings and actions. Why then this rise and fall? Even if developments were not sudden, as often assumed, there is clear temporal change that requires explanation. The chronology, moreover, ties in with important events in central Italy, and with a wider set of political, economic, and cultural shifts over the same area (and beyond), as has been alluded to along the way. All these dynamics have been evoked, moreover, in interpreting the growth and decline of votive body parts, as has also been mentioned. Before examining this question more closely, it is worth clarifying what does change in the religious and medical realms as they intersect around this practice and what does not, to avoid confusion about what exactly needs to be explained. For, as has been mentioned, the habit of making material offerings to the gods goes back long before the emergence of votive body parts in Italy and continues long after. It is the forms of the ex-votos along with their quantity and distribution (at least as archaeologically discernible) that change, not the basic activity, nor the understandings underlying it. Moreover, there is no reason to think that divinities were not routinely addressed about human health and healing in the earlier context, and they certainly continued to be throughout the Roman imperial era. Human and/or divine figures are a prominent part of the previous votive traditions, in different metallic versions, for example, and could certainly encompass an exchange with the gods about the cure of or care for the suppliant (and their family); as also much else.55 The written ex-votos that increasingly dominate in Italy and beyond from the first century BCE onwards—the inscribed altars, tablets, bases, and other items designed to hold text—include healing- and health-based transactions amongst those they record; though the content of the divine action is often not specified, the emphasis falling rather on the fulfilment of the vow.56 Nor is this the end of the line for the anatomical votive, as wood and stone versions appear in 55  These include both fine bronze statuettes and figurines in essentially sculptural styles and a range of more schematic metal figures, from Etruria, Umbria, Rome, and Latium in the 6th–5th cent. BCE; some of which are definitely divine, some definitely human, and many indeterminate. See Colonna 1970 and Cristofani 1985 for surveys. Glinister 2006, 13–14, also emphasises the continuities of cult practice from the archaic into the Hellenistic period. 56  On the general rise of the written votive and its replacement of the anatomical approach, see e.g. Schultz 2006, 100–102, and Flemming forthcoming b; CIL 6.68 and 580 are both examples of vows for health or healing from Rome.

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Roman Gaul shortly after their disappearance from Italy, and the Greek tradition also revives, with added text, later in the imperial period.57 Suggestions that mortal medicines replaced immortal cures are, thus, problematic, though both mortal physicians and specialist healing deities, such as Asclepius, do become more prominent and popular in Rome and Italy over the late republican and especially imperial periods.58 Curative options were expanded and refined in a non-exclusive and often collaborative way, though competition between the providers of medical services also flourished ­increasingly as time went on.59 In addition it should be stressed that the semantic under-determination of anatomical ex-votos renders them compatible with almost all ideas about how healing might be accomplished, and, indeed, none. They represent a celebration of divine engagement with the body—an engagement that might be imagined as having proceeded roughly as a human practitioner would (but unconstrained by the same limits of practical possibility), that might be imagined completely differently, or that might not be imagined at all.60 It would all look the same. The terracotta body parts make the physicality of the process clear, but beyond that there is little commitment. Even the argument that is sometimes made about a contrast between the fragmentary nature of votive cure and the essentially holistic concepts and practices of ancient learned medical traditions, evinced from the Hippocratic writings onwards, is not so clear cut.61 It could be said that the parts offered to the gods imply the whole—there is focus here, but not separation. Something is at stake in choosing a foot, for instance, rather than a human figurine, but it is about targeting—bringing greater attention to bear on the relevant area within the wider somatic framework of life, which has thus receded into the background but remains indispensable. It might be suggested, indeed, that this added focus drives the development of the anatomical votive itself. The chronology is fraught, but it seems that heads were the first bodily fragment to appear, occupying an uncertain space between whole and part, between representing the person of the suppliant and an important piece of that person.62 While the initial move was probably the former, it is not hard to see why the latter might soon have followed; the 57  At, for example, the sanctuary at the source of the Seine, in Gaul, see Deyts 1983 and 1994, and across the Greek world, see e.g. Forsén 1996. 58  Flemming forthcoming b. 59  It is important to stress that competition can be essentially collaborative, if all agree on the terms, and place themselves within the same game. 60  See e.g. Wickkiser 2008, 42–61. 61  See discussion in Hughes 2008. 62  At Lavinium and Veii: Comella 1981, 772–775.

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idea of engaging the divine more directly in the bit of the body most in question could have spread quickly from there—a spread facilitated by the turn to terracotta as a material out of which offerings to the gods could be (and mostly were) made, and encouraged by a range of economic political, social, and religious shifts that occurred in central Italy into and through the fourth century BCE.63 There was generally—though neither equally nor evenly—a growth of exchange and purchasing power, of community participation and population, and of regional integration over this period. These processes became ­increasingly Rome-centred through the century and beyond, but, though patterns of Roman power and votive practice intersect and overlap, this is only ever partial; other factors are at work too, before and during Roman domination. The expansion of identifiable sacred sites across central Italy in the fourth century, and their continuing development (including the growth of votive activity), was thus facilitated and framed by wider regional changes. There is a similarly broad set of circumstances involved in the retreat of the anatomical ex-voto, which forms part of a general reconfiguration of the religious landscape over the late second and into the first century, itself driven by multiple factors. The late republic witnessed a fall in the number of sanctuaries in the area; though those that do survive are mostly bigger, grander, and more architecturally developed than their predecessors.64 They are also more urban. The decline of rural sanctuaries, especially after the Social War, has been exaggerated, as has the decline of the Italian peasantry more broadly. More recent scholarship has demonstrated the complex fortunes of central Italian temples in the late republican and Augustan periods as part of an importantly diverse set of political, cultural, and economic developments in Italy over the last two centuries BCE.65 The cult at Nemi, for instance, flourishes, but that at Tessannano dwindles; most of the other extra-urban sites mentioned so far follow this latter trajectory (irrespective of local particularities), while those in cities become more monumental, albeit at different speeds and in different styles. Religion is caught up in the ‘municipalisation’ of Roman Italy, but that process is itself uneven, and other dynamics are in operation too. It is certainly possible that the urban drift and drive of religion in Roman Italy and the shift to written votives are essentially linked, not just temporally roughly coincident. There are plausible reasons for convergence, why 63  Others have argued for Greek origins, but this is problematic (though possible), see e.g. Glinister 2006, 16–17. 64  Though, given that finds of terracotta votives play an important role in identifying sacred sites, the danger of circularity in some of these discussions must be recognised. 65  See e.g. Stek 2009, esp. 17–34.

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­ rbanisation and literacy might go together; which could fit into wider patu terns of political, economic, and cultural change in the second and first centuries BCE. It could also be that the focus on the vow is more specifically Roman in origin, and its leading role in the standardisation of the manner in which transactions with the divine took material form, across all Italy, reflects key aspects of these changes too. There is always more going on, of course. Elements of these kinds of habitual shift—alterations in the shape and substance of objects which remain functionally stable—will always escape explanation; but whatever the full story is, it is reasonably obvious that in the new votive framework s­pecificity will be delivered differently. The question is whether these moves served to restrict access to the divine for healing involving ex-votos. Those living in the countryside would have to travel further and invest more time in visiting a temple, and the new kind of votive was probably more expensive and culturally different—crucially written. On the other hand, it could be argued that all these shifts are rather marginal; that the essential breadth and inclusiveness of votive practice as it incorporated divine address about health and cure continues. Cheaper and less durable types of ex-voto may not have survived, and individual literacy is not necessary for participation in a literate votive culture after all: commitment to the power of the written word may be more universal. Certainly the medical options are expanding at this time. A larger number and more diverse range of human health practitioners are present in Rome and Italy in the first century BCE; a learned medicine is making its presence increasingly felt amongst the elite.66 The definitional strategies of this ‘high’ tradition include some explicit and implicit distancing from a set of more embedded approaches to health and healing; but there is nothing particularly religious about these moves, and some of them entail a reframing rather than a rejection of previous curative practices anyway. Moreover, votive activities can easily be aligned with this more dedicated and theoretical kind of medicine, through address to Asclepius, for example, though they could also take a different path. The situation remains complex, therefore, lacking clear cut divisions and oppositions despite these developments. A certain kind of medical practitioner, with more expensive drugs and most time-consuming remedies, will be increasingly out of the reach of the general populace—a certain set of theoretical debates will most probably pass them by, but that is not to say that some of the same basic ideas about illness and cure are not shared across the board; the same principles are acted on, just in divergent material registers. It may well be, then, that the weakness of the term ‘popular medicine’ when applied to the Roman world persists, though that makes its contents more rather than less important. 66  Flemming forthcoming b.

Chapter 5

Between Public Health and Popular Medicine: Senatorial and Popular Responses to Epidemic Disease in the Roman Republic Caroline Wazer The Romans were conducting the festival called in their language the ‘bedspread’ (sc. lectisternium) in response to the bidding of the Sibylline oracle. For a kind of pestilence sent by the gods and incurable by human skill had led them to consult the oracle.1 —Dionysius of Halicarnassus, Roman Antiquities, 12.9.1

Long, long ago a plague walked through the city And Roman air was death; one saw pale bodies Sink into wasting sickness everywhere. Spent with continual round at funerals, And knowing that physicians could do nothing, Men looked to heaven for a sign of cure.2

—Ovid, Metamorphoses, 15.626–630, trans. Horace Gregory

The two passages quoted above, which refer to epidemics that struck the city of Rome in 399 BCE and 293 BCE respectively, both describe collective responses to health crises that affected the Roman populace. In both cases, we also know from Livy that the turn to supernatural healing was a formal decision by the Senate that involved a complex official procedure.3 The Roman Senate treated epidemic disease as a religious problem for over four centuries, starting in 1  ἑορτὰς ἦγον οἱ Ῥωμαῖοι τὰς καλουμένας τῇ ἐπιχωρίῳ γλώττῃ στρωμνὰς ὑπὸ τῶν Σιβυλλείων κελευσθέντες χρησμῶν. νόσος γάρ τις λοιμώδης γενομένη θεόπεμπτός τε καὶ ὑπὸ τέχνης ἀνθρωπίνης ἀνίατος εἰς ζήτησιν αὐτοὺς ἤγαγε τῶν χρησμῶν. Translations by the author unless otherwise noted. 2  Dira lues quondam Latias vitiaverat auras, pallidaque exsangui squalebant corpora morbo. Funeribus fessi postquam mortalia cernunt temptamenta nihil, nihil artes posse medentum, auxilium caeleste petunt mediamque tenentes. 3  399 BCE: Livy 5.13–14; 293 BCE: Livy 10.47.

© trustees of columbia university in the city of new york, ���6 | doi ��.��63/9789004326040_006

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the early fifth century BCE and apparently ending in the middle of the first.4 Over the course of this period, Greek medicine increasingly became a part of Roman private life.5 Aside from a failed experiment with a publicly sponsored Greek physician in 219, however, the Roman government paid little official attention to Greek medicine until the fall of the republic, when Greek-style doctors were awarded certain special privileges.6 Even then, Greek physicians were not directly consulted by Roman authorities regarding anything we might call public health, nor did epidemiology in the modern, statistically-grounded sense ever develop.7 While the Roman Senate largely ignored Greek medicine during the republic, it could not completely ignore certain aspects of the collective health of the Roman people. It is clear from the historical record that the senate frequently claimed the authority to end outbreaks of infectious disease in Rome through religious means, as in the two cases cited above. Various infectious diseases were endemic at Rome and a certain level of illness in the city was normal, but occasionally a disease had unusually high mortality, infected enough people, and disrupted everyday life to such a degree that the normal methods of healing were conspicuously ineffectual.8 In these cases, the Senate was quick to step in to mediate with the gods on behalf of the state. In this paper, I explore the republican Senate’s treatment of instances of epidemic disease as prodigies—as religiously significant public events. Of special interest are several cases in which the senatorial remedies appeared to fail. Before turning to the source material for the republic, I examine Roman medical writing, mostly of significantly later date, in order to elucidate the reasons 4  All dates are BCE unless otherwise noted. 5  There are various appearances of physicians in literary sources discussing the early republic (e.g. Dionysius of Halicarnassus, Ant.Rom. 10.53.1, Ovid, Met., 15.13, Valerius Maximus 2.4.5); more convincing are the provision in a fourth century Lex Aquilia that concerns the malpractice of physicians and the existence of the word medicus in the works of Plautus. Amphitryon refers to medicinis (doctors’ offices) as if there were several in the centre of Rome (Plautus, Amphitryon 4.5). See Nutton 2004, 166–167. 6  For the failed experiment of 219: Pliny, Naturalis Historia 29.6.12. Special privileges: Suetonius, Divus Iulius 42, Augustus 59. 7  See Nutton 2000, esp. 71: there was ‘little or no connection between the practitioners of ancient medicine and public health’ in general in the Roman world. 8  In the Republic, these normal methods of healing could include consultations with a physician or other healer such as a midwife; individual religious healing such as is found at Asclepieia and various other sites associated with a healing cult (as attested by votive dedications at Nemi, Portonaccio, and other Italian sanctuaries); and perhaps self-directed folk medicine along the lines of that described by Cato the Elder in De agricultura 158–160.

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why religious interpretations of epidemics remained so prevalent in the historical record even as the numbers of Greek and Greek-trained physicians in Rome swelled. After providing an overview of major republican epidemics and the senatorial and popular reactions to them, I discuss two epidemics that took place in the second half of the first century, one just after the assassination of Julius Caesar and one in the early years of Augustus’ reign, both of which illustrate the ways in which the Roman treatment of epidemic disease was as much a political and a religious phenomenon as it was a medico-magical one.

A Note on Methodology

In recent years a group of medieval historians, led primarily by Guy Geltner and Carole Rawcliffe, has argued for a broader historical definition of public health in pre-modern fields.9 Their argument has two major tenets. First, it holds that the intention to improve health and reduce disease in a population should be divorced from the efficacy of those programs, and the inefficacy of a program should not negate the historical importance of the social and political conditions that led to its implementation. Second, Geltner and Rawcliffe contend that the tendency of public-health historians to use only medical texts and legislation as evidence when studying pre-modern public health is misguided. Instead of these ‘prescriptive and normative’ sources, which give a skewed and incomplete picture of the ‘healthscape’ of a particular time, they argue that historians must incorporate ‘descriptive and practical’ sources like diaries, letters, court documents, and contemporary histories or chronicles in order to understand what people and governments actually did in response to disease.10 Studying the medieval period, Geltner and Rawcliffe have access to relatively vast quantities of archival material, including town registers, diaries, and government accounts, all of which they use to revise the traditionally bleak picture of medieval public health into a more nuanced healthscape that includes some individuals and municipalities that cared very much about the physical wellbeing of their inhabitants. Historians of the Roman period will no doubt find Geltner and Rawcliffe’s work stimulating and will see parallels in the moral and supernatural aspects of the conception of disease, and also in the roles of governmental bodies like Geltner’s curia viarum. Still, many of the kinds of institutional archival ­material

9  The following position is set forth in Geltner 2012, Geltner 2013, and Rawcliffe 2013. 10  Geltner 2013, 395.

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they use simply do not exist in substantial quantity for the Roman period.11 Roman historians do however have access to Roman literature, histories, and letters, all of which can and should be further integrated into our understanding of what health and healthcare meant in ancient Rome. Much of the available evidence for actual health practices in the Roman period concerns individuals seeking to improve their own health, and not the collective health of groups of people.12 One significant exception is the body of evidence most recently examined by Danielle Gourevitch in her study of the Antonine Plague, which includes epigraphic records of appeals to oracles on behalf of entire cities in Asia Minor.13 In a much-cited article, Alex Scobie used poetry and historical anecdotes to draw conclusions about the sanitary condition of Rome.14 Still, our understanding of public health in Rome— that is, public action undertaken expressly for the improvement of citizens’ health—comes almost entirely from prescriptive sources like didactic texts and legislation.15 In this paper I use descriptive sources, primary among them Livy’s histories, but also Cassius Dio and Dionysius of Halicarnassus, to study the republican Roman response to one major public health threat of antiquity: urban outbreaks of infectious disease. For various reasons detailed below, epidemic disease did not fit comfortably within ancient disease paradigms, and so our picture of the ancient response to epidemics is limited if we rely only on medical texts.

11  Frontinus’ De aquis, because it includes technical discussion of the history of the operation of one public office closely tied to health in the public consciousness, is the Roman text most similar to the archival material used by Rawcliffe and Geltner, although Frontinus’ underlying political motives complicate a positivist use of the text (see Peachin 2004). Aside from Frontinus, our understanding of the duties of various magistrates charged with matters of public health, broadly speaking, comes from a hodgepodge of historical, literary, and epigraphic sources of varying dates and quality. In her 1992 survey of Roman city administration, Robinson mines ancient sources ranging from the Digest to Ovid. The result is a treasury of useful citations for both prescriptive legislation and actual practices, but there are rarely enough sources from any one period to compare the two. 12  For example, the individual propitiatory healing inscriptions examined in Chaniotis 1995. 13  Duncan-Jones 1996, Gourevitch 2013b. 14  Scobie 1986; but see criticisms of Scobie’s selective use of non-medical texts in Laurence 1997 and Morley 2005. 15  For a survey of this type of evidence, see Scarborough 1981.

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Epidemics and Roman Medicine

From modern interpretations of ancient descriptions of clusters of symptoms, we understand that Romans experienced a wide range of infectious diseases, from tuberculosis to leprosy.16 The disease landscape of classical antiquity was however in many places, including the western seaboard of Italy, dominated by malaria.17 Malaria in humans is caused by several different parasitic protozoa, which in turn are spread by various species of mosquito.18 Three of these strains of malaria, Plasmodium vivax, P. malariae, and P. falciparum, were present in the Mediterranean in historical times. All strains present characteristic fevers that correspond neatly to the various classifications of fever reported by Greek and Roman medical writers, and heavily influenced their conception of disease.19 The Roman medical writer Celsus20 wrote that while the ultimate cause of disease was always an imbalance within the patient himself, certain environmental conditions like extreme heat could weaken the body and make it more susceptible to an epidemic disease.21 His advice for protecting oneself in an epidemic (he uses the term pestilentia) recognizes both the presence of an outside cause and the ultimate responsibility of the patient’s own body for its susceptibility to disease. Best of all was to get far away from the outbreak; if this was impossible, Celsus recommended a regimen of limited activity and moderation in food and drink in order to best preserve the patient’s health.22 16  Jackson 1988, 179–185. 17  On the concept of dominant pathogens in history, see the literature on pathocenosis starting with Grmek 1989. On malaria in the Roman period, see Sallares 2002. 18  Sallares 7–22, provides a comprehensive overview of the various types of malaria and their vectors in the Mediterranean. 19  All types of malaria produce a quotidian (daily) fever in the first infection. In relapses of survivors of a first infection, which can occur anywhere from a few weeks to several years after the primary infection, the less lethal P. malariae produces what ancient writers referred to as a quartan fever (meaning fever recurring every third day), while the mild P. vivax and dangerous P. falciparum produce tertian (every other day) fevers. It is possible for a human to host several types of malaria at the same time, which likely contributed to the importance of the quartan/tertian distinction in ancient medicine. 20  While it has been argued that Celsus was a practicing physician, he never calls himself a medicus and medicine was only one of several subjects about which, as an encyclopedist, he knew a great deal. For an expansion of this argument, see Nutton 2004, 166 and 374 n. 66. 21  Celsus 1.9.6; see also 2.1.9 for the belief that autumn was an especially pestilential season. 22  Celsus 1.10.1–4.

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For a patient with a pestilential fever, Celsus could recommend no single course of action.23 The physician was to consider bloodletting, one of the usual treatments for fever, and proceed according to the strength of the patient. For weak patients (including children), the physician was to try other fever remedies like clysters (enemas) and mild fasting, despite Celsus’ warning that these treatments were ‘practically useless’ (utile minime) in pestilential fevers.24 In the medical books of his Naturalis Historia, Pliny the Elder included several folk recipes for protection against pestilence, but nothing in the way of treatment for those who did become sick.25 Like Celsus, Pliny’s sources were more confident in their ability to stave off infection than in their ability to treat someone who had fallen ill during an epidemic. More illuminating is Pliny’s epidemiological study of a disfiguring skin disease called lichen or mentagra.26 Though not fatal, lichen was understood to be a new disease at Rome when it struck in the first century, and one directly associated with Rome’s imperial expansion. Pliny was most interested in the epidemiology of the disease: according to him, it spread among high-ranked men as a result of their custom of kissing each other. Women and people of the lower classes were unaffected. Traditional physicians treated the disease by cauterizing the lesions, which disfigured the patients further and was often ineffectual. Accordingly the patients turned to Egyptian healers ‘who devoted all their attention to this complaint only’.

23  Celsus 3.7. 24  Celsus 3.7.1. 25  To avoid falling sick during a pestilence, Pliny recommended filtering air with Delphic laurel (HN 23.80), drinking an artificial wine called bion (HN 23.26), eating aron (HN 24.92), and drinking myrrh (HN 24.97). 26  Pliny HN 26.3: ‘Non fuerat haec lues apud maiores patresque nostros et primum Ti. Claudi Caesaris principatu medio inrepsit in Italiam quodam Perusino equite Romano, quaestorio scriba, cum in Asia adparuisset, inde contagionem eius inportante. nec sensere id malum feminae aut servitia plebesque humilis aut media, sed proceres veloci transitu osculi maxime, foediore multorum, qui perpeti medicinam toleraverant, cicatrice quam morbo. causticis namque curabatur, ni usque in ossa corpus exustum esset, rebellante taedio. adveneruntque ex Aegypto, genetrice talium vitiorum, medici hanc solam operam adferentes magna sua praeda, siquidem certum est Manilium Cornutum e praetoriis legatum Aquitanicae provinciae HS CC elocasse in eo morbo curandum sese. accidit quoque saepius, ut nova contra genera morborum gregatim sentirentur. quo mirabilius quid potest reperiri? aliqua gigni repente vitia terrarum in parte certa membrisque hominum certis vel aetatibus aut etiam fortunis, tamquam malo eligente, haec in pueris grassari, illa in adultis, haec proceres sentire, illa pauperes!’

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Pliny’s description of lichen is clear evidence that the conception of contagion existed alongside the formally more rigid conception of disease that looked to the interaction of individual constitutions with the intrinsic properties of a place.27 Although this latter idea dated back at least to Hippocrates, the classic Roman articulation is Vitruvius’ advice on selecting land for a new city.28 Vitruvius began this section as follows: In setting out the walls of a city, the choice of a healthy situation is of the first importance. It should be on high ground, in neither a foggy nor rainy region; its aspects should be neither hot nor cold, but temperate in both respects. The neighbourhood of a marsh must be avoided, for in such a site the morning air, uniting with the fogs that rise in the neighbourhood, will reach the city with the rising sun; and these fogs and mists, charged with the exhalation of the marsh beasts, will diffuse an unhealthy effluvia over the bodies of the inhabitants, and render the place pestilent.29 Rome itself is described as both healthy and unhealthy in ancient texts. When Cicero called Rome ‘a healthy place in a pestilential region’,30 he was referring specifically to the hills on which the elite lived, which were too high and windy to support a thriving mosquito population. The valleys, including the valley in which the Forum Romanum lay, were malarial in the summers despite the drainage effects of the Cloaca Maxima. Horace and Juvenal (speaking somewhat metaphorically, but likely riffing on popular ideas about unhealthy locations) both refer to the capital as a pestilential place.31 In any case the seasonal pattern of disease in Rome would have affected different social groups differently. Native Romans, infected for the first time as children, would have built up some natural immunity to the local strains of malaria. Immigrants, including many slaves who moved to Rome as adults, would probably have suffered the heaviest mortality. The wealthy, who lived on the relatively mosquito-free hills, could also escape to summer villas in healthier locations and potentially 27  On the concept of contagion in ancient medicine, see Nutton 1983 and Leven 1993. 28  Vitruvius, De architectura, 1.4.1–12. 29  Vitruvius, De architectura, 1.4.1: ‘In ipsis vero moenibus ea erunt principia. primum electio loci saluberrimi. is autem erit excelsus et non nebulosus non pruinosus regionesque caeli spectans neque aestuosas neque frigidas sed temperatas, deinde si vitabitur palustris vicinitas. cum enim aurae matutinae cum sole oriente ad oppidum pervenient et his ortae nebulae adiungentur spiritusque bestiarum palustrium venenatos cum neula mixtos in habitatorum corpora flatu spargent, efficient locum pestilentem’. 30  Cicero, De re publica 2.11: ‘locum . . . in regione pestilenti salubrem’. 31  Horace, Epist. 1.7.8–9, Juvenal, Sat. 4.56–7.

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avoid yearly re-infection. While the hills would not necessarily provide any protection to the elite during outbreaks of diseases other than malaria, leaving the city and waiting out an epidemic, as Celsus recommended, was a reliable option for those with the financial resources. The Roman medical writer most famously associated with epidemic disease is Galen, who lived through the so-called Antonine Plague in the second half of the second century CE. Galen’s account of the symptoms are crucial to the now largely accepted identification of the plague as smallpox.32 Though Galen wrote about his successful treatment of plague patients in later outbreaks of the disease, his initial reaction was one of panic.33 When the plague reached Italy from the east in 166 CE, Galen fled Rome, where he had lived for three years, for his hometown of Pergamon.34 Possibly informed by this experience, Galen wrote that the fear and uncertainty he felt regarding pestilence was common to all who encountered it.35 Throughout Roman medical texts runs the common theme that stopping an epidemic disease was something outside the domain of a traditional physician. This remained the case even when no supernatural etiology was suspected, such as when a disease was understood to be the result of a pestilential place or air, or of human-to-human transmission.36 When a physician did treat a victim of an epidemic disease, as Galen did in several cases, it was only on an individual scale, and even then the physician had little faith in his usual remedies.

Roman Epidemics in Histories of the Republic

While epidemics were a difficult fit in mainstream Roman medicine, they were a major concern of city dwellers and local governments throughout antiquity. The ancient tradition of cities seeking oracular advice for an epidemic is most famously represented in the outbreak of the Athenian Plague at the beginning of the Peloponnesian War in the fifth century, as recounted in Thucydides.37 32  See Gourevitch 2013b, 66–74, for an up-to-date bibliography on the identification of the Antonine Plague. 33  Later treatment of patients (probably in 174 CE): Galen, De methodo medendi V 12 = K. X 360–367. 34  Galen, De libris propriis 1 = K. XIX 15. 35  Galen, De febrium differentiis I 3 = K. VII 279. 36  For example, the epidemics recorded by Livy in 463 (3.6–8), 428 (4.30), and 399 (5.13–15). 37  Thucydides 2.47–54.

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Alongside this religious aspect to the epidemic, Thucydides also describes how the epidemic was used as a political tool by Pericles’ enemies.38 Centuries later, several cities in Asia Minor turned to oracles for instruction when the Antonine Plague first struck in the middle of the second century CE, as we know from inscriptions.39 Although Thucydides only tells how one individual epidemic was interpreted and addressed by the Athenian state, his text (along with Plutarch’s description of the same epidemic in his Life of Pericles) has been cited as evidence for contemporary Athenian popular and political ideas about epidemic disease.40 In contrast, accounts of twenty-seven separate epidemics in the city of Rome are preserved, mostly in the writings of Livy and Dionyius of Halicarnassus. Many of these accounts include short descriptions of popular and political reactions. Cassius Dio also records two Roman epidemics, one in the very late republic and one in the early Augustan period, which I will discuss at the end of this paper as they merit special attention. The epidemics considered are as follows:41 472 BCE: Dion. Hal. 9.40.1–4 463: Livy 3.6–8, Dion. Hal. 9.67, 9.69.1, Orosius, Hist 2.12.2–3 451: Livy 3.32, Dion. Hal. 10.53.1–10.54.2 436: Livy 4.21.2–6, Oros. Hist. 2.13.11 433: Livy 4.25 38  Thucydides 2.54.2: the oracle’s response is interpreted by Pericles’ enemies to mean that Pericles invited the plague when he pushed for war against the Dorians; in Plutarch’s Life of Pericles 34.3–4 Pericles is also criticized for worsening the plague by overcrowding the city. 39  Gourevitch 2013b, 85–95. has a comprehensive overview of all epigraphic possible attestations of the Antonine Plague, including both well-supported cases and more conjectural ones. See also Graf 1992, Lo Cascio 2012. 40  Longrigg 1992 and Mikalson 1984. 41  I compiled this list with reference to the one in Northwood 2006, 86, with some substantial changes. I omitted any epidemic that did not occur within Rome itself (so, for example, I did not consider the epidemic in 466 that struck Roman soldiers campaigning against the Aequi), as these do not seem to have ever been of religious concern to the Senate. Northwood also limited his line of inquiry to Livy, so the two epidemics that appear in Cassius Dio do not appear on his list, nor does the first epidemic covered by Dionysius of Halicarnassus. Several of the listed epidemics also appear in Orosius’ Historiae adversus paganos, Zonaras’ Epitome historiarum, and Julius Obsequens’ Liber prodigiorum, but as these much later writers provide no information beyond what is in Livy’s text, I do not consider them below as separate sources except when Livy’s text is missing, as in 266 (for which Augustine is also a source), 165, and 142.

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428: Livy 4.30, Dion. Hal. 12.6 412: Livy 4.52 399: Livy 5.13–14, Dion. Hal. 12.9 392: Livy 5.31, Dion. Hal. 13.4 384: Livy 6.20–6.21 365: Livy 7.1–7.3, Oros. Hist. 3.4.1–3 348: Livy 7.27.1–2 334: Livy 8.17 331: Livy 8.18 296: Livy 10.31, Zonaras 8.1.4, Oros. Hist. 3.21.7–8 293: Livy 10.47, Zonar. 8.1, Oros. Hist. 3.22–4.5 266: Augustine, CD 3.17, Oros. 4.5.7 249: Livy, Per. 49 208: Livy 27.23.5–7 187: Livy 38.44 181: Livy 40.19, 26 180: Livy 40.37.1–3, 42 174: Livy 41.21.10–13, 42.2.3–7, Julius Obsequens 10 165: Obsequens 13 142: Obsequens 22 44: Cassius Dio 45.17.8 22: Cassius Dio 54.1.1–2 The twenty-seven epidemics included in this study date from 472 to 22. The sources explicitly describe sixteen as portents or prodigies—communication from the gods of the state indicating that the Romans had done something offensive to them.42 Procedurally, this meant that the Senate passed them on to a college of priests, usually the decemviri sacris faciundis, to be interpreted and properly expiated.43 Among the rest of the epidemics, seven were addressed by means of other religious or ritual action by the Senate, apparently without the help of the decemviri or another college. Only in three of the epidemics mentioned in Livy did the Senate not attempt expiation.44 Epidemics thus form an

42  Rasmussen 2003 is the most comprehensive study of the various subclasses of portents interpreted during the republic, and the various priestly colleges that interpreted them. 43  On the development of the decemviri sacris faciundis, see Boyce 1938. 44  Those of 453, 412, and 384 were not expiated.

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important class of events that could be interpreted as a prodigy in republican Roman religion.45 The major historians’ accounts differ in focus. Livy provides substantially more evidence by volume, describing twenty-two cases. His focus is above all on the status of each epidemic as an official prodigy and on the senatorial response, which usually took the form of religious expiations intended to bring the epidemics to an end. Dionysius on the other hand only describes five cases, four of which also appear in Livy. Whereas Livy’s accounts of epidemics are mostly procedural, Dionysius’ are vivid in detail, include symptoms, and focus on the social disruption caused by the epidemics. The earliest reported republican epidemic took place in 472. According to Dionysius of Halicarnassus, who is the only source for this epidemic, the victims of the disease were primarily pregnant women, who miscarried and then died. Dionysius describes both public and private religious reactions, neither of which seemed to have any effect.46 The epidemic was finally brought to an 45  Various arguments have been put forth regarding the reliability of the entire corpus of prodigies and expiations present in Livy and his epitomizers. The most vocal detractor was Elizabeth Rawson (Rawson 1971), who argued that we must be sceptical of the value of the lists of prodigies because they may have come not from a central list kept by the Senate, because many came from various local communities not yet under Roman rule at the time of their reporting. According to Rawson’s argument, the early Roman antiquarians and historians who later collected these records may have misunderstood who reported and who reacted to such prodigies, and so falsely attributed these actions to the Roman Senate when in fact they should have been attributed to local authorities. The argument hinges on a passage in Livy (43.13) in which the Senate refused to interpret a portent reported in Fregellae because the city lay outside the ager Romanus. Since Rawson, several historians have raised the counter-argument that the presence of portents reported outside Rome’s territory does not preclude the possibility of a centralized list, or even the possibility of those portents being interpreted within Rome. According to MacBain (MacBain 1982), the Senate’s refusal of the Fregellae portent in Livy 43.13 was politically motivated rather than a matter of rule, and reflected strained relations between Fregellae and Rome. Instead, MacBain argues that Rome generally took an active interest in the religious life of the ager peregrinus during its period of expansion within Italy, and that the Roman Senate did regularly interpret portents for other communities. Regarding epidemics as prodigies, Northwood recently analysed the pattern of epidemic and grain scarcity (which frequently appear together) in Livy, concluding that ‘[i]ndividual pestilences and grains scarcities will always be open to suspicion, but the overall pattern ought not to be. Fabrication may be present [in Livy’s accounts of such events], but it is not the dominant feature’ (Northwood 2006, 81–92). 46  Dionysius of Halicarnassus, Ant.Rom. 9.40.2: ‘. . .καὶ οὔτε λιτανεῖαι πρὸς ἕδεσι καὶ βωμοῖς γινόμεναι θεῶν, οὔτε καθαρτήριοι θυσίαι περί τε πόλεως καὶ οἴκων ἰδίων ἐπιτελούμεναι παῦλαν αὐταῖς ἔφερον τῶν κακῶν.’

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end when the pontiffs discovered that a Vestal Virgin had been unchaste. After the execution of the Vestal Virgin and her two lovers, the epidemic ended. The next epidemic took place in 463 and was described by both Livy and Dionysius.47 Dionysius reports very heavy casualties across all social classes, noting that the Senate was especially heavily hit, with both consuls and many other magistrates dying.48 Unable to mobilize an army because of the number of sick and dead, the Senate sent word to its allies the Hernici that Rome would be unable to send help against the Aequi and Volscians because ‘through the sudden anger of gods, the city of Rome was being ravaged by disease’.49 This epidemic was in other words understood to have been caused by a break in the pax deorum, which made it an issue of state concern.50 As such, state action took the form of religious propitiation; all Romans, rich and poor, male and female, were ordered to report to the temples and pray for the pity of the gods in the first recorded supplicatio.51 At this point the authorities directing the religious response to epidemic disease appear to have been the consuls themselves, and the public religious action was loosely organized. The epidemic of 451 is described by both Livy and Dionysius as especially calamitous, and disruptive to both military activity and to agriculture.52 While Livy’s description is very short and includes no senatorial or popular response, Dionysius’ account includes a description of popular panic. At first the sacrifices and expiations were in line with state religion, but when the epidemic continued, the people began to experiment and ‘unseemly practices not customary with [the Romans] were introduced into the worship of the gods’. When the new rituals also failed to end the epidemic, Dionysius claims that the people ‘abandoned even the observance of religious rites’.53 Dionysius’ description of the popular reaction to this epidemic is also noteworthy because it is 47  Livy 3.6–8, Dionysius 9.67, 9.69. 48  Dionysius 9.67.2. 49  Livy 3.6.5: ‘ . . . urbem Romanam subita deum ira morbo populari . . .’. 50  For a synopsis of senatorial procedure regarding the annual reportage and expiation of prodigies, see Pina Polo 2011, as well as Rasmussen 2003. 51  Livy 3.7: ‘et per ignota capita late vagata est vis morbi, inopsque senatus auxilii humani ad deos populum ac vota vertit. Iussi cum coniugibus ac liberis supplicatum ire pacemque exposcere deum, ad id quod sua quemque mala cogebant auctoritate publica evocati omnia delubra implent. Stratae passim matres, crinibus templa verrentes, veniam irarum caelestium finemque pesti exposcunt. Inde paulatim, seu pace deum impetrata seu graviore tempore anni iam circumacto, defuncta morbis corpora salubriora esse incipere . . .’. 52  Livy 3.32, Dionysius 10.53.1–10.54.2. 53  Dionysius 10.53.5–6: ὅσον μὲν οὖν χρόνον τοῖς πολλοῖς ἐλπίδος τι ὑπῆν ὡς τοῦ θεοῦ σφίσιν ἐπικουρήσοντος, ἅπαντες ἐπί τε θυσίας καὶ καθαρμοὺς ἐτράποντο: καὶ πολλὰ ἐνεωτερίσθη Ῥωμαίοις οὐκ ὄντα ἐν ἔθει περὶ τὰς τιμὰς τῶν θεῶν ἐπιτηδεύματα οὐκ εὐπρεπῆ. ἐπεὶ δὲ

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not restricted to religious action, but includes an account of the difficulties Romans faced in caring for the sick, due to the extremely contagious nature of the disease, and in disposing of the dead, of which there were too many to cremate. Dionysius does not describe any senatorial attempts to address these aspects of the epidemic, such as quarantine or an organized program of corpse removal.54 Livy’s accounts of the epidemics of 436 and 433 show some development in the state response to epidemic disease.55 In both cases men and cattle died, endangering both manpower and the food supply. In the epidemic of 436, for the first time the religious response was coordinated by a specific college of priests, the duumviri sacris faciundis. The next year, in 435, the epidemic continued and military action was suspended. The Roman populace (along with its livestock) was ravaged yet again in 433, and again the duumvirs organized the religious response ‘to appease the wrath of the gods’. This time, however, the Senate took secular action as well, setting aside grain in anticipation of a famine.56 It is not surprising that this provision shows a clear understanding of a common indirect effect of epidemic in an agricultural community: illness or death among the farmers led to missed planting seasons or harvests, which disrupted the agricultural cycle and could mean famine. Rather, it is notable that the Senate here took on responsibility for protecting the city of Rome from the possibility of famine. Livy tells us that this preventative measure was employed again in 412.57 Also during the course of the 412 epidemic, one of the consuls, Gnaeus Iulius Mento, vowed a temple to Apollo Medicus (Apollo the Doctor), for the first time recognizing a foreign cult for the express purpose of safeguarding the citizens’ health.58 During the epidemic of 428, which Dionysius of Halicarnassus describes as a painful and deadly skin affliction, no senatorial expiation is recorded.59 The popular reaction was characterized by a rejection of traditional Roman rituals in favour of foreign ones introduced by ‘pretend fortunetellers’. In response, ἐπέγνωσαν οὐδεμίαν αὐτῶν ἐπιστροφὴν ἐκ τοῦ δαιμονίου γινομένην οὐδ᾽ ἔλεον, καὶ τῆς περὶ τὰ θεῖα λειτουργίας ἀπέστησαν. 54  Dionysius 10.53.1–3. 55  Livy 4.21.2–6, 4.25. 56  Livy 4.53.3: ‘Famem quoque ex pestilentia morbo implicitis cultoribus agrorum timentes in Etruriam Pomptinumque agrum et Cumas, postremo in Siciliam quoque frumenti causa misere. . . . Eo anno vis morbi levata neque a penuria frumenti, quia ante provisum erat, periculum fuit’. 57  Livy 4.52. 58  Livy 4.25. 59  Livy 4.30, Dionysius 12.9.

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‘the aediles were instructed to ensure that only Roman gods were worshipped, and only in the established way’.60 For the rationale behind this forceful senatorial response to the organized popular reaction to the epidemic, a helpful point of comparison is the Bacchanalia crisis of 186, in which the Senate outlawed unauthorized participation in Bacchus cults in Rome and its territories.61 In 399, the Senate again looked for an end to an epidemic in religion.62 This is itself unsurprising, but here for the first time Livy suggests that not all epidemic diseases were treated as evidence of a rupture in the pax deorum.63 In this case the duumviri claimed to have discovered by means of the Sibylline books that the gods desired the Romans to perform a new ritual, the lectisternium, in response to the epidemic. The lectisternium, a ritual feast for cult statues of various gods, went on to become a commonly prescribed expiation. It was used again in 365 in response to an epidemic, in 326 for an unspecified reason, and in 218 and three separate times in 217 in response to various nonepidemic prodigies.64 Livy’s description of the epidemic of 392 provides a brief example of the decision-making process of the Senate in an epidemic that was not treated as a prodigy.65 This epidemic caused serious disruption to the functioning of the state. Military activity was stopped, at least until the city itself was attacked, a censor died, and both consuls were forced out of office by a senatus consultum, 60  Livy 4.30.9–11: ‘nec corpora modo adfecta tabo, sed animos quoque multiplex religio et pleraque externa invasit novos ritus sacrificandi vaticinando inferentibus in domos, quibus quaestui sunt capti superstitione animi, donec publicus iam pudor ad primores civitatis pervenit cernentes in omnibus vicis sacellisque peregrina atque insolita piacula pacis deum exposcendae. Datum inde negotium aedilibus, ut animadverterent ne qui nisi Romani di neu quo alio more quam patrio colerentur’. 61  Livy 39.17–18, CIL I2.581 = ILS 18. See also North 1979, Cancik-Lindemaier 1996, Takács 2000, and Orlin 2010. 62  Livy 5.13–14, Dionysius 12.9. 63  This was remarked but not expounded upon by Northwood 2006, 84 n. 19. 64   Lectisternia were also celebrated without the involvement of the Senate, as during the reign of Marcus Aurelius (SHA Marcus Aurelius 13.2). 65  Livy 5.31: ‘Eodem anno novum bellum cum Volsiniensibus exortum; quo propter famem pestilentiamque in agro Romano ex siccitate caloribusque nimiis ortam exercitus duci nequivit. Ob quae Volsinienses Sappinatibus adiunctis superbia inflati ultro agros Romanos incursavere; bellum inde duobus populis indictum. C. Iulius censor decessit; in eius locum M. Cornelius suffectus—quae res postea religioni fuit quia eo lustro Roma est capta; nec deinde unquam in demortui locum censor sufficitur—consulibusque morbo implicitis, placuit per interregnum renovari auspicia. Itaque cum ex senatus consulto consules magistratu se abdicassent, interrex creatur M. Furius Camillus, qui P. Cornelium Scipionem, is deinde L. Valerium Potitum interregem prodidit’.

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officially because of their illness.66 The interrex, M. Furius Camillus, went on to appoint six consular tribunes with the ostensible reasoning that not all of them would fall sick at once.67 The extended epidemic of 365–363 is remarkable both for its length and for the various official attempts made to stop the disease.68 From the beginning, there were heavy casualties both among the magistrates and among the common people. When the epidemic entered its second year, the Senate began attempting ‘to secure the peace of the gods’ with traditional rituals. When these failed, the people again turned to foreign religion, as in 428, but now apparently with the cooperation of the Senate. This time, Livy is more forthcoming about the nature of the imported rites: the Roman people sent for ritual performers from Etruria, who sang, danced, and acted out bawdy scenes. This experimental attempt to appease the gods again failed, and the next year the Senate tried yet another rite, appointing a ritual dictator to ‘drive a nail’, presumably into the doorpost of the temple of Capitoline Jupiter.69 The epidemic of 293 resulted in the Senate deciding to bring the Greek healing god Asclepius to Rome70 after ordering a consultation of the Sibylline Books, a normal course of action when interpreting a prodigy. No details about the epidemic itself are given, however, except that it ‘raged in the city and country districts alike’.71 Because of the on-going Third Samnite War, the Senate was unable to send an embassy to Asclepius’ sanctuary at Epidaurus until 291. The experience of this embassy in Greece and its triumphant return home, bearing the god in the guise of a snake, was memorialized by numerous ancient writers.72 In Rome, Asclepius was worshipped both in a sanctuary on 66  393 and 392 were in fact the only two years between 408 and 367 in which consuls were elected. Otherwise, consular tribunes headed the state. Until the passage of the Lex Licinia Sextia in 366, members of the plebeian order was barred from holding a consulship, but not a consular tribunate. The replacement of consular elections with elections of consular tribunes thus allowed members of the plebeian order to access the highest offices. 67  In fact, six consular tribunes had been the norm since 405. 68  Livy 7.1–3. 69  Livy 7.3.4: ‘repetitum ex seniorum memoria dicitur pestilentiam quondam clavo ab dictatore fixo sedatam. Ea religione adductus senatus dictatorem clavi figendi causa dici iussit; dictus L. Manlius Imperiosus L. Pinarium magistrum equitum dixit’. 70  Livy 10.47. 71  Livy 10.47.6: ‘Multis rebus laetus annus uix ad solacium unius mali, pestilentiae urentis simul urbem atque agros, suffecit’. 72  Livy, Per. 11, Ovid, Metamorphoses 15.644–745 and Fasti 1.290–294, Strabo 12.567e, Valerius Maximus 1.8.2, Pliny, HN 29.16 and 29.72, Arnobius 7.44, Augustine, CD 3.12a and 10.16g, Orosius 3.22.5.

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the Tiber island, which infamously became a spot to abandon sick slaves by the reign of Claudius, and in various cult sites throughout the city.73 Livy’s Books 11–20, which cover the years 292–219, are lost. The Periochae and other sources record an epidemic in 249, which resulted in the declaration of ludi saeculares.74 Augustine and Orosius refer to another pestilence in this period, probably in 266, in response to which shrines were restored at the order of the decemviri.75 After Livy’s narrative resumes in 219, no epidemics are recorded in Rome until 208, in the middle of the Second Punic War.76 In that year, both Rome and its hinterland were struck by a serious but usually not fatal disease that threatened agricultural output.77 In response, the Senate ordered prayers at shrines around the city and the celebration of games.78 Despite the religious treatment of the epidemic, it was not declared to be a prodigy and so was not referred to the decemviri. No epidemic, defined as a prodigy or otherwise, is reported until the 180s, when three occurred. That of 187 was treated as a prodigy and referred to the decemviri.79 The religious expiation consisted of a three-day intercessio and special sacrifices. Two more experimental expiations follow this relatively simple one. In response to the epidemic of 181, the prescribed expiations (again intercessiones) for the first time extended to all of Italy.80 The epidemic of 180 was also expiated by means of an intercessio, with the addition of gilded statues dedicated to the three state deities associated with health: Apollo, Asclepius, and Salus.81 The epidemic of 142 is recorded only very briefly in Obsequens 22 and Orosius 5.4.8, as Livy’s text breaks off in 167. This is unfortunate as the circumstances of the epidemic and its expiation are intriguing. After some prodigies, 73  Renberg 2006; on the abandonment of sick slaves, see Suetonius, Claudius 25.2 and Major 1994. 74  Livy, Per. 49; see also Censorinus DN 17.8, Festus 441.3, and Schol. ad Hor. Carm. Saec. 8. 75  Augustine, CD 3.17, Orosius 4.5.7. 76  Livy does describe in detail an interesting epidemic that struck Roman and Carthaginian troops in Syracuse at 25.26, but mentions no religious action taken, presumably because of the distance from Rome. 77  Livy 27.23.5–7. 78  Livy 27.23: ‘eius pestilentiae causa et supplicatum per compita tota urbe est et P. Licinius Uarus praetor urbanus legem ferre ad populum iussus ut ii ludi in perpetuum in statam diem uouerentur’. 79  Livy 38.44. 80  Livy 40.19. 81  Livy 40.37.1–3. See also Marwood 1988, 13, who takes this as proof that Salus was undoubtedly a state goddess of health by 180, and no longer only personified the broader concept of ‘safety’.

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including possibly a separate pestilence (as in Obsequens), a hermaphrodite was thrown into the sea. Obsequens says this happened at Luna, while according to Orosius the prodigy and expiation took place at Rome.82 Immediately following this act of attempted expiation, ‘there was such an epidemic that everywhere bodies were thrown into public places, which could not be buried.’83 Orosius used this episode as evidence for his argument against the effectiveness of pagan religion, claiming that when the execution of the hermaphrodite failed to bring an end to the epidemic, the Roman people realized that expiations in general were useless.84 Orosius was clearly writing from an anti-pagan perspective, and he was incorrect that the Romans ceased to interpret prodigies and prescribe expiations after 142. He did however capture one facet of the traditional senatorial approach to epidemic disease: action was not taken until the situation became quite serious, at which point an epidemic was likely to become self-limiting. A crucial aspect of the senatorial prodigy lists is their virtual disappearance from Roman historiography after Livy. Cicero’s De haruspicum responso and De divinatione attest to the continued importance of senatorial declarations and interpretations of prodigies in the late republic.85 Starting with biographies of Augustus, however, reported prodigies took on a personal character that did not require the involvement of the Senate or of priestly colleges.86 J.A. North, in a 1986 review article on recent scholarship on the intersection of religion

82  Luna was a Roman colony founded in 177. It is possible that the prodigy and expiation both took place in Luna, with the interpretation taking place at Rome. See above, n. 42. 83  Obsequens 22: ‘Tanta fuit Lunensibus pestilentia ut iacentibus in publicum passim cadaveribus, qui funerarent defuerint’. 84  Orosius 5.4.10–11: ‘Expiatio illa crudelis et uiam mortibus hominum morte hominis struens tandem Romanis inter miserias suas erubescentibus, quam misera et uana esset, innotuit. ante enim in suffragium praeueniendae cladis est habita, et sic pestilentia consecuta est; quae tamen sine ullis sacrificiorum satisfactionibus tantummodo secundum mensuram arcani iudicii expleta correptione sedata est. quam si artifices illi circumuentionum haruspices sub ipsa ut adsolent declinatione morborum forte celebrassent, procul dubio sibi dis et ritibus suis reductae sanitatis gloriam uindicassent. ita misera et ad sacrilegia male religiosa ciuitas mendaciis, quibus liberari non poterat, ludebatur’. 85  See Rasmussen 2003, 183–198, on Cicero and public divination. 86  See the list of prodigies related to Augustus in Suetonius, Augustus 94–7. While Suetonius claims that the prodigy at 94.3 went through the official senatorial procedure, the rest were not public prodigies and were often very personal (e.g. dreams interpreted by the dreamer or his friends). See also the last two entries (71 and 72, dated to 17 and 11) in Julius Obsequens’ Liber prodigialis, which focus on the royal family.

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and politics in the republic, summed up the decline of evidence for senatorial responses to prodigies in the historical sources as follows: In my view the disappearance of prodigy-lists from historians cannot be taken just as an accident of recording practice, but as recognition of the declining importance of a traditional mode of dealing, accompanied by the transfer of the conception into a new mode, eventually supportive of the new regime and the new ideas.87 The ‘traditional mode of dealing’ that North refers to was part of a specifically republican approach to religion: Where other societies have prophets, diviners, or holy men, republican Rome characteristically had rather large committees of priests bound by rules and keeping minutes . . . [Senatorial prodigy procedure] provided a way of coping with threats of danger, which involved many individual ritual roles; this avoided the risk of concentrating power on any one man, either in the role of expert practitioner or of beneficiary of the word from the gods.88 The interpretation of epidemics as prodigies can be understood as a particular political system’s reaction to the uncertainty caused by epidemic disease. Cassius Dio records the reactions to two epidemics, one in 44 and one in 22, that lend support to North’s reading. The first of these epidemics took place shortly after the assassination of Julius Caesar, when Antony and Dolabella were consuls. Following a series of ill omens, an epidemic spread across Italy.89 In response to the epidemic (and not the other omens, as Dio makes clear), the Senate ordered the reconstruction of the Curia Hostilia, the most recent reconstruction of which had been demolished earlier that year.90 There is no mention of a priestly college; instead, the Senate seems to have interpreted the prodigy itself. 87  North 1986, 256. 88  North 1986, 257. 89  CassiusDio, 45.17.8: ἐπεγένετο μὲν οὖν καὶ λοιμὸς ἐπ᾽ αὐτοῖς πάσῃ ὡς εἰπεῖν τῇ Ἰταλίᾳ ἰσχυρός, καὶ διὰ τοῦτο τό τε βουλευτήριον τὸ Ὁστίλιον ἀνοικοδομηθῆναι καὶ τὸ χωρίον ἐν ᾧ ἡ ναυμαχία ἐγεγόνει συγχωσθῆναι ἐψηφίσθη. 90  The Curia went through several reconstructions in the first century. It was expanded by L. Cornelius Sulla in 80 (Pliny, HN 34.26), and then rebuilt by his son Faustus in 52 after it was burned down following the death of P. Clodius Pulcher (Cassius Dio 40.49.2–3,

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Twenty-two years later, in 22, the public reaction to the second epidemic reported by Dio likewise reflected the contemporary political situation: A pestilence raged throughout all Italy with the result that no one tilled the land, and I believe that the same was the case in foreign lands. The Romans, therefore, toiling because of the disease and the famine, believed that these ills had befallen them for no other reason than that they did not have Augustus for consul at this time also.91 The epidemic and famine sparked a series of anti-senatorial riots by the Roman people, who feared that Augustus’ decision not to stand for consul that year was the result of a senatorial conspiracy to oust him from power.92 The rioting citizens apparently still believed that epidemics could be interpreted as prodigies, but no longer accepted the Senate’s exclusive authority to interpret the prodigy and bring the epidemic to an end. Indeed, despite the large numbers of recorded epidemics that took place during the empire, none were referred to a priestly college again, except in a learned fantasy by the writer of the Historia Augusta.93 Discussion It is clear that epidemic disease was frequently a pressing concern of the republican Roman Senate. Epidemics had the power to cripple the military, and if they interrupted any part of the agricultural year by causing heavy casualties in the countryside, the repercussions could be felt for years to come in the form of grain scarcity. The Senate did not, however, have a one-size-fits-all response to epidemic disease. In many cases, epidemics were treated as prodigies and referred to religious authorities for interpretation. Even in these cases, however, the official response varied significantly from one epidemic to the Cicero, De finibus 5.2). For the demolition of the latter Cornelian reconstruction of the Curia Hostilia in 44 to make way for the Curia Julia, see Cassius Dio 44.5.1. Despite the senatorial order, it does not appear that the Curia Hostilia was ever rebuilt. 91  Cassius Dio, 54.1.2: πονούμενοι οὖν ὑπό τε τῆς νόσου καὶ ὑπὸ τοῦ λιμοῦ ῾ἔν τε γὰρ τῇ Ἰταλίᾳ πάσῃ ὁ λοιμὸς ἐγένετο καὶ τὴν χώραν οὐδεὶς εἰργάσατο: δοκῶ δ᾽ ὅτι καὶ ἐν τοῖς ἔξω χωρίοις τὸ αὐτὸ τοῦτο συνηνέχθἠ νομίσαντες οἱ Ῥωμαῖοι οὐκ ἄλλως σφίσι ταῦτα συμβεβηκέναι, ἀλλ᾽ ὅτι μὴ καὶ τότε ὑπατεύοντα τὸν Αὔγουστον ἔσχον . . . 92  Cassius Dio, 54.1.1–2.5. 93   S HA Gallieni 5.2–5. For a list of epidemics during the empire, see Retief and Cilliers 2000.

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next. In fact, epidemics instigated many of the most important innovations in republican religious history, from the invention of the lectisternium in 399 to the formal recognition of the Greek healing deities Apollo Medicus and Asclepius. Much of the religious experimentation regarding the official response to epidemic disease can be directly tied to unusually long-lasting epidemics. The reason for this willingness to experiment is perhaps best illustrated in the case of the epidemic of 428, when the Senate took action to reign in a popular religious movement. The peregrina atque insolita piacula in themselves were unlikely to have been the Senate’s primary concern, since, only five years earlier, it had constructed a temple for Apollo Medicus in response to another epidemic. Rather, the problem was likely to have been the fact that the new rituals were not officially sanctioned. In subsequent cases of extended epidemics, most notably those of 365–363 and 295–293, the Senate was proactive when their first-line religious prescriptions failed. In 364, the Senate attempted three separate expiations, including the adoption of an Etruscan ritual. In 293, the Senate began the multi-year process of importing the cult of Asclepius from Epidaurus after other expiations had failed. Both the religious experimentation inspired by epidemic disease and the Senate’s attempts to control the popular religious reaction must be read against the backdrop of the various other types of healing available in Rome throughout the republic. Greek medicine may not have been an appropriate response to an epidemic because of its own limitations, but throughout the republican period central Italy was host to a number of sanctuaries and sacred springs that were sites of popular medicine.94 None of the familiar aspects of these sanctuaries, such as sacred water or anatomical votives, ever appeared in conjunction with epidemics. With the exception of the honours paid to Apollo Medicus, Asclepius, and Salus, there is nothing inherently medical or even disease-focused about the expiations themselves, which were generally no different in character from expiations used in other situations. In other words, the public nature of an epidemic and its disruption to state functioning conceptually differentiated epidemic disease from smaller-scale infectious diseases and non-infectious ailments. A fruitful comparison can be made with the practice of individual propitiatory inscriptions in Lydia and Phrygia discussed by Chaniotis, especially the observation that ‘the primary aim of the rites which we find in the propitiatory inscriptions is to relieve a sinner of his sin . . . It was a widespread belief in the ancient world that the individual’s sin 94  Edlund-Berry 2006a and 2006b.

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had ­consequences not only for him, but also for his family and his relatives, sometimes for the whole community.’95 The difference in the Roman Republican case is that the ‘sins’ were all public ones, mostly having to do with incorrectly performed state rituals such as the taking of auspices at the start of the political year. As a rule, the priests who interpreted the cause of an epidemic disease and offered propitiations were the very same priests who performed normal state rituals, and when the people at large took action, they did so usually at the behest of the Senate in the form of individual rituals targeted at state gods. In the rare cases in which the Roman people independently turned to foreign gods and practices (Livy’s ‘superstitiones’), they did so only after a Senatorial expiation had apparently failed, suggesting that public religious action was indeed the popular first-line response to epidemic disease at Rome. 95  Chaniotis 1995, 335–6.

Chapter 6

Metals in Medicine: From Telephus to Galen Julie Laskaris

A Pragmatic Approach to Pharmacology

The author of the Hippocratic Affections states: ‘It is worthwhile to learn from everyone about medicines that are drunk or applied to injuries; for people do not learn of these things by reasoning but by luck, and the skilled not more than laymen.’1 In urging his audience to be receptive to useful remedies from layman and expert alike, this author promotes a practical attitude that was surely also operative throughout the long pre-history of medicine in Greece. The imprimatur of a Dioscorides or a Galen may have secured the place of some remedies in the Greek and Roman elite scholarly medical traditions—and have given some of them a longer life than they deserved—but we also see that those traditions were generally open to the drug lore of herbalists and midwives and even of laymen. Theophrastus, whose Enquiry into Plants IX was highly influential on every still-extant pharmacological text from classical antiquity, with some allusions found even in Dioscorides,2 acknowledges his reliance upon herbalists and drug-sellers and preserves some of their knowledge.3 He names two herbalists, Thrasyas and Alexias, calling attention to their high levels of expertise. Thrasyas, he said, had developed a particularly efficacious drug mixture for a quick and painless death; in fact, he had made numerous deadly compounds and carefully observed the effects of poisons on different ­constitutions.4 Thrasyas had also discovered what we would term drug resistance, and had built up an immunity in himself to the effects of hellebore; in fact, Theophrastus mentions others who have similar knowledge, including shepherds and drug-sellers.5 1  Γὰρ φάρμακα, ὅσα ποτὰ καὶ ὅσα πρὸς τὰ τραύματα προσφέρεται, μανθάνειν ἄξιον παρὰ παντός· οὐ γὰρ ἀπὸ γνώμης ταῦτα εὑρίσκουσιν οἱ ἄνθρωποι, ἀλλὰ μᾶλλον ἀπὸ τύχης, οὐδέ τι οἱ χειροτέχναι μᾶλλον ἢ οἱ ἰδιῶται (45 Potter = VI.254L). 2  Scarborough 1985, 20. 3  Theophrastus, HP 9.1 and 9.8–20. 4  Theophrastus, HP 9.16.8–9.17.2. 5  Theophrastus, HP 9.17.1–9.17.3.

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Theophrastus speaks with obvious approval also of Thrasyas’s student Alexias who, he says, knows the entire medical art and not pharmacology alone.6 At another point, Theophrastus compares herbalists favourably with doctors on the grounds that they know how to compound the deadly drug aconite, which the doctors do not; the drug is useless, he says, to those who do not understand it.7 In a nod to popular lore, Theophrastus adds that aconite has no antidote apart from a mixture developed by country dwellers, though it is not infallible.8 Dioscorides and Galen work many traditional, and even magical, ingredients into their pharmacological writings, each author generally accounting for the therapeutic properties in terms of his own pharmacological system.9 Noteworthy, too, is Galen’s respectful interchange with an experienced midwife concerning the drugs used in treating the patient they have in common.10 As Von Staden notes, Galen intended to prescribe the very drugs the midwife had secretly been giving all along; they had turned out to be ineffective, however, and Galen relies upon the midwife’s testimony in deciding that a different course of treatment was required.11 Theophrastus evokes lay knowledge when he discusses the customs of the Arcadians who, living as they do in a land rich in medicinal plants, drink cows’ milk in the spring rather than take medicines, in the belief that in spring the plants’ medicinal properties are strong enough to be imparted to the milk.12 Perhaps Arcadian herdsmen had recognized the effects of a lactating mother’s food intake on her young, as Soranus was later to do.13 Soranus notes that the nurslings of sows who have eaten darnel and of goats who have eaten scammony will become dizzy or will be purged, though the mothers are not themselves affected, and he concludes from this that, in the tricky business of finding the right dosage for a sick baby, the wet-nurse should eat what the baby requires.14 Pliny also mentions the benefits of milk infused with the qualities of medicinal herbs,15 and he tells us that a certain Democrates cured a patient by giving her the milk of goats to whom he had fed lentisk.16 6  Theophrastus, HP 9.16.8. 7  Theophrastus, HP 9.16.5–9.16.7. 8  Theophrastus, HP 9.16.5. 9  Dioscorides: Scarborough and Nutton 1982, 189–190. Galen: Von Staden 1997; Keyser 1997. 10   De venae sect. adv. Erasistrateos 1 (11.187–188K). 11  Von Staden 1997, 61–63. 12  Theophrastus, HP 9.15.4. 13  These observations are essentially correct: drugs can pass easily from the bloodstream to the milk; see Reece 1991, 326. 14  Soranus, Gyn. 2.56. 15  Pliny, HN 24.28. 16  Pliny, HN 24.43.

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The apparently conscious behaviour of animals could also be a source of knowledge for our authors as it most likely was for the lay population.17 In his discussion of the hellebores, Theophrastus claims that humans first learned of the purgative properties of white hellebore by observing sheep eating it and being purged by it; he adds that horses, oxen, and pigs do not eat black hellebore, however, since it is fatal to them.18 Similarly, he states that sheep and other animals avoid the deadly aconite,19 that some sheep steer clear of wormwood while others eat it and benefit by it,20 and that Attic cattle know not to eat thapsia, whereas imported cattle will ingest it and die from it.21

Metallic Medicines

These passages, while hardly exhaustive of the topic, are sufficient to establish that the pragmatic approach to pharmacology indicated by the author of Affections was fairly standard. Experienced people, whether lay or expert, can be the source of useful pharmacological knowledge. Given that, it is reasonable to argue that the therapeutic use of metallic minerals,22 which is evident already in Mesopotamian and Egyptian texts, probably arose in the earliest days of metallurgy, when miners and metalworkers are likely to have discovered their fast-acting biocidal properties.23 If this is correct, the implications are rather broad, suggesting a foreign and very early origin for Greek and Roman knowledge of those metallic medicines derived from imported metals, the entry into the literate pharmacological tradition of this knowledge, and 17  The observation of animal behaviour has played a role in the development of many systems of traditional medicine and it is influencing modern medical research. The term ‘zoopharmacognosy’ has been coined to describe self-medicative behaviour in animals; see, for instance, Huffman 2001. 18  Theophrastus, HP 9.10.2. 19  Theophrastus, HP 9.16.4. 20  Theophrastus, HP 9.17.4. 21  Theophrastus, HP 9.20.3. 22  The terminology related to minerals and metals can be confusing. A mineral is a homogeneous, usually crystalline, solid that nearly always arises from inorganic processes. Metals are a subclass of minerals that have properties that include high density, malleability, and lustre; ‘metal’ can also refer to an alloy of two minerals. Gold, silver, and copper are among the metallic minerals. Ores are aggregates of minerals found in sufficient quantity to be mined and processed profitably; they are usually embedded in rock. 23  As Craddock 2008, 94 observes: ‘Science owes more to mining than mining owes to science.’ Craddock was referring to the debt of mathematics and mechanics to mining, but I will argue that medicine is in similar debt.

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this tradition’s reliance upon the knowledge and experiences of miners and metalworkers. We know today that several of the metals in common use in Greek and Roman antiquity have powerful biocidal, styptic, and other healing properties that work with sufficient speed to be noticed easily (to be discussed below). The most common of the ancient metallic medicines had such properties: gold, copper, silver, zinc, and antimony. I will centre the present discussion primarily on copper, as it was the first metal to appear in an archaeological context,24 and it appears very frequently in our medical texts. Despite its early use, copper, while abundant in some areas, is not ubiquitous and so is not found in the oldest archaeological sites.25 The archaeological records of the Near East and Iran reflect very early use of such copper minerals as malachite, azurite, and chrysocolla (twelfth and eleventh millennia BCE); native copper first appears in the archaeological record in Anatolia in a late ninth millennium context, and Anatolia is the initial source of the copper that finds its way, on the coattails of the obsidian trade, to Mesopotamia and the Levant.26 To date, there is no evidence that copper was extracted from an ore by smelting before that from Serbia and Iran (c. 5000 BCE), though improved archaeological techniques may lead to the detection of earlier evidence.27 We do not know to what uses the malachite and other copper minerals were initially put. These copper compounds are frequently found close to the earth’s surface and, since exposed copper turns blue or green, people may have been attracted by their beauty and used them for ornamentation and as pigments.28 Iron, at any rate, which is found in usable concentrations far more commonly than copper (indeed, it is virtually ubiquitous) is also far more difficult to smelt; in fact, it was used as a pigment for 300,000 years before it was smelted.29 In short, humans took much longer to find copper than they did iron, but once they did, they were able to process it more readily, eventually making jewellery with it, and then tools and weapons. The latter were not particularly useful items, however, before the knowledge of alloying brought about harder ­metals:

24  Killick and Fenn 2012, 562. 25  Killick and Fenn 562; Craddock 2008, 96. Iron, by contrast, is found nearly everywhere, but the technology for extracting it was not developed until the early second millennium BCE (though see below on its very early use as a pigment); Killick and Fenn, 561. 26  Killick and Fenn 562. 27  Killick and Fenn 563. 28  Killick and Fenn 562. 29  Killick and Fenn 563.

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copper-arsenic alloys appeared by the fifth millennium BCE,30 followed by bronze (an alloy of copper and tin, with lead sometimes added) in the fourth millennium BCE, and then brass (an alloy of copper and zinc) in the first millennium BCE.31 We cannot know with certainty if copper’s therapeutic properties would have been evident to those using it in unprocessed form, but they may well have been: copper requires no special preparation to be an effective biocide. The Egyptians used malachite as both a cosmetic and as a medicine to treat eye infections and burns,32 and the source for most Greek copper was probably malachite. In any event, workers extracting metal from copper ore were almost certain to have noticed its therapeutic benefits since, according to recent studies, copper’s antimicrobial properties are apparent even from its use on touch surfaces, such as door and faucet handles.33 For this reason, the use of copper and copper alloys on hospital touch surfaces is being studied with a view to limiting the incidence of hospital-acquired infections; as one researcher notes: ‘Bacteria, yeasts, and viruses are rapidly killed on metallic copper surfaces, and the term ‘contact killing’ has been coined for this process.’34 Results of such studies point to the effectiveness of copper and its alloys against even Methicillin-resistant staphylococcus aureus (MRSA), Escherichia coli (E. coli), and Clostridium difficile,35 and copper has now been registered with the United States Environmental Protection Agency as an antimicrobial substance.36 By demonstrating the rapidity of copper’s effectiveness against some microbes, this research indicates that copper’s therapeutic benefits for the treatment of wounds, burns, and skin ailments could have been discovered accidentally by early miners and metalworkers, and perhaps even earlier by those making use of malachite and other compounds for pigments and other ornamentation. Pliny, who very likely learned about mining and metallurgy

30  Rapp 1999, 701. 31  Craddock 2008, 110. 32  E.g., Ebers Papyrus 15, 372, 421, 491 (Westendorf 1999, 550, 616, 623, 633); Nunn 1996, 106, 146–7, 198, 199, 201. Nunn 147 accepts the findings of Majno 1975, 111–15, concerning the bactericidal properties of malachite. 33  For example, Grass 2011, 1541–7, which, though primarily concerned with the use of copper on hospital touch surfaces, alludes to copper’s pre-historic and historic medicinal uses; Elguindi et al., 2011, 240–2. 34  Grass 1541. 35  Elguindi et al. 2011, 237. 36  Grass 2011, 1541.

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first-hand as procurator of Hispania Tarraconensis,37 notes that wounds that occur in copper mines heal very quickly38—a remark that tracks with the findings of current research. It would be surprising, therefore, if the earliest miners had not made the same observation themselves, given the occupational hazards they faced. At any rate, medical self-help among early metalworkers is likely in another context: Robert Arnott has proposed that Bronze Age metalworkers concocted the first known compound medicine in Greece, perhaps to treat the arsenical poisoning to which their jobs would have made them ­vulnerable.39 I am not suggesting that early miners and metalworkers developed the complicated metallic medicines described in our texts—some of which involved more complex metallurgic processes than existed in the earliest days of metallurgy—but simply that they are the most likely to have stumbled upon the basic fact that some metals possess fast-acting properties helpful in the treatment of wounds, burns, and skin ailments. In addition, our evidence does not permit us to hold that the regions that first developed metallurgy are necessarily the ones from which the Greeks learned of metallic medicines; they may have been, but the arguments over where and how knowledge of metallurgy developed and spread are in flux, and the timespans involved are great.40 We are safer in maintaining that knowledge of the therapeutic benefits of metals developed in any given place along with metallurgical skills, that that knowledge entered the oral and eventually the written traditions of herbalists and doctors, and that it then followed established avenues of cross-cultural transmission. It is likely then, that knowledge of metallurgy came into Greece from neighbouring regions, and it is quite certain that knowledge of copper metallurgy did, as copper was not present on mainland Greece in enough abundance to be useful; Greece also had to import the other metal needed for producing bronze—namely tin.41 Not surprisingly, therefore, the Greek word for copper, bronze, and other copper alloys, ‘chalkos,’ is not Indo-European: its origin is likely to be eastern and connected with kalxos (purple).42 Certainly regions 37  Healy 1986, 111; Craddock 2008, 100: ‘Pliny . . . wrote what are clearly detailed first-hand descriptions of the gold mining operations, and his comprehensive and technically accurate descriptions of the silver smelting processes show that state officials could be fully conversant with the processes involved.’ 38  Pliny, HN 34.100. 39  Arnott 2004, 163. 40  Killick and Fenn 2012, 564–8, give an overview of the main views. 41  Rapp 1999, 702–3. 42  Beekes 2010, s.v. chalkos.

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to the east and south of Greece, including Cyprus, the Levant, and Egypt, saw early use of copper.43 That the Greek and Roman pharmacopoeias included Mesopotamian, Egyptian, and other exotic items is not controversial. Legitimate questions arise, however, concerning the identities of particular items: were ethnic labels used simply to lend prestige, whether or not they were accurate? Did the common presence of an item represent borrowing, diffusion, or parallel development? And then we should ask whether there is anything worthwhile to be gained even if we establish that a particular exotic drug or a particular recipe entered Greek and Roman pharmacopoeias: can this tell us anything about the impact of one culture on another? Heinrich von Staden points to possible limitations in this regard, stating that ‘original semantic, structural, theoretical, or functional context . . . often is usurped and transformed by new cultural contexts.’44 Likewise, medical anthropologists working on the impact of modern biochemical pharmaceuticals on the traditional medical practices of present-day cultures often note that it is common for persons accustomed to the traditional practices of their own culture to accept wholly foreign prescription drugs—especially if they are seen to be effective—but in understanding how these new drugs function, they will keep to traditional modes of ­explanation.45 In addition, an exotic item may have been imported initially as a food or a perfume or for some other non-medicinal use, and its therapeutic benefits discovered later, as Laurence Totelin has pointed out.46 While these are valid points to bear in mind, I think that we can make our claims more secure when we consider the contact between two or more cultures more broadly, including the patterns of trade and of the transmission of other technologies and bodies of knowledge. For example, the question of whether or not the gynaecological works of the Hippocratic Corpus do indeed record many Egyptian substances should be considered in the context of increased Greek-Egyptian contact via the trading colony of Naucratis, which was established not long before the earliest of our gynaecological texts and continued for many years. Relevant, too, are the five thousand Egyptian and Egyptianizing items (Aigyptiaka) found in Greece in Geometric and Archaic contexts, often in the graves of the very young and in the temples of deities connected with fertility and childbirth.47 The Egyptianizing items are of particular interest because they demonstrate 43  Killick and Fenn 2012, 562. 44  Von Staden 1992b, 588. 45  Reid 1983, 153. 46  Totelin 2009, 143. 47  Skon-Jedele 1994, 1782 n. 16, 1778.

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Greek acquisition of Egyptian techniques. The objects found at the Cretan cave sanctuary of the birth-goddess Eileithyia Inatia, which is the greatest single collection of Aigyptiaka on Crete, include figurines associated with fertility, childbearing, health, and sex.48 As mentioned above, Egyptian medicinal use of copper and copper compounds has been well-documented. Noteworthy, too, is Case 6 of the Edwin Smith papyrus, which mentions copper in an unusual simile: the folds of the brain are likened to the corrugations of molten copper in the crucible.49 The successful use of this simile relies upon doctors having direct contact with metalworkers, perhaps to obtain unadulterated copper for their medicines, as we know Galen travelled to a mine to do centuries later (discussed below). Doctors would also have encountered metalworkers when they bought their instruments, since these were highly-specialized tools that were almost certainly made to order.50 We could make the same case for Greek doctors of the Bronze Age, since a set of finely-made bronze surgical tools—among our earliest pieces of evidence for the existence of medicine as a specialized craft in this period for Greece—has been found in a fifteenth-century burial at Nauplion.51 Telephus In the absence of medical texts for the Bronze Age, we can find an indication of early Greek medicinal use of copper in the myth of the healing of Telephus, the son of Heracles and Auge. There are many variations in the accounts of his birth and marriage, but in all versions Telephus ends up in Asia Minor; indeed, he comes to be known as a king of Mysia and the founder of nearby Pergamon.52 The part of his story relevant to the present discussion is his wounding by 48  Skon-Jedele, 1768–1779; Kanta and Davaras 2011, 168–187. 49  Nunn 1996, 50; Edwin Smith Papyrus 6 (Westendorf 1999, 715). 50  Jackson 1990, 10; Nutton 2013, 79 n. 12. Galen describes how he would design some of his own instruments, creating wax models and giving them to metalworkers (Peri alupias 5). I am grateful to John Scarborough for this reference and to Rebecca Flemming for supplying the Greek text. 51  Protonotariou-Deilaki 1973, 92 with plates. See, too, land tenure tablet from Pylos (PY Eq 146) granting land to a doctor (ijate—the same agent-noun found from Homeric epic on); Chadwick 1958, 116–117 (s.v. i-ja-te); Palmer 1963, 422; Ventris and Chadwick 1973, 547. A distinct word for drug (pamako = pharmakon) has been preserved by Pylos tablet Un 1314; see Janko 1981, 30–34. 52  Gantz 1993, 428–31, 576–80 collects the references to the myth of Telephus apart from the new fragment of Archilochus; for that, see West 2006, 11–17.

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Achilles, which happens when the Greeks get lost on their first attempt to reach Troy. They attack Mysia, mistaking it for Troy; Telephus leads the defence and kills many Greeks, but cannot stand up to Achilles and is wounded by him while fleeing. His wound will not heal and he receives an oracle from Apollo stating that only what caused the wound could heal it. All assume that Achilles must perform the deed, and Telephus promises that he will give directions on how to find Troy, and not aid the Trojans himself, if Achilles will help him, but (in some sources) Achilles refuses on the grounds that he knows nothing about healing. Odysseus steps in to say that the oracle must mean that the spear itself is required for healing the wound. Achilles’ famous Pelian spear is fetched, and Achilles scrapes the encrustation (ios) on the spearhead directly into the wound, healing Telephus. In most translations of the texts referring to Telephus, the spearhead is assumed to be iron, and the encrustation, rust. But I agree with Gantz53 that the folkloric tenor of the story indicates that it arose in a much earlier period. I think it likely that the story arose in the Bronze Age; that the spearhead was conceived of then as bronze and the encrustation, verdigris,54 and that the myth thus reflects knowledge of the healing properties of copper.55 It should be noted that the Greek word for the encrustation, ios, can be used equally well of rust and of verdigris. Dioscorides, in fact, takes care to specify, using ios siderou for rust and ios xustos—scraped ios—for verdigris.56 One might ask that if this knowledge concerning copper were common, why could not any spearhead—or any form of copper—have been used? That is where other more emotional or more psychological aspects of the tale come in: the healing of Telephus will bring about healing among Greek enemies. They must reconcile to find out how to reach Troy, and so they will arrive there stronger and unified. Therefore, this particular spear—with the one who delivered the wound performing the healing—is the only one that will work. Fulfilling the oracle will bring the warring sides to the same spot and put back on track the ordained Greek mission to Troy.57

53  Gantz 579. 54  The patina that forms over time on copper and its alloys. 55  While we cannot be sure, it seems likely that the classical audience for this story would also have conceived of the spearhead as bronze, given that in the epic tradition Trojan War heroes carry bronze weapons. 56  5.93 and 5.91. 57  This interpretation may suffer from too much optimism, as it is equally the case that the reconciliation will result in the eventual death of Telephus’ son at the hands of Achilles’.

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Such a context is required to explain what is otherwise so puzzling: Achilles’ claim to know nothing about medicine. He is, after all, famous in the Iliad for his knowledge of medicine, which he is said to have learned from Cheiron.58 The spear that is to heal Telephus is a reminder to the audience of Achilles’ tutelage, since it was Cheiron’s gift to Peleus. This story, then, in addition to what it contributes to the saga of the Trojan War, arguably marks Achilles’ debut as a fully-fledged healer.59 Achilles, the son of a goddess, instructed in the art of healing by a strange and divine creature,60 is now called upon by the god of medicine to perform his first act as a healer in his own right. For the myth to function in this way, and even for it to be understood in the other ways I have suggested, the act of healing performed in it must have been credible to its audience, just as the account in Hesiod of the division of the meat at Mekone, while conveying much on a deep level about the relationships of men and women and of humans and gods, also gets the essential details of sacrifice right—indeed must get them right for the story to work. For these reasons, the story of the healing of Telephus very likely reflects Bronze Age knowledge of the medicinal properties of copper, even as it conveys a message about the need for Greek unity in the face of the impending war and the rightness of the Greek mission to Troy.

Greek Medicine

Metallic medicines are found in numerous works of the Hippocratic Corpus, including in the gynaecological texts, some of which are among our oldest prose texts and, as discussed earlier, the ones with the greatest number of foreign substances in their pharmacopeia. In general, we find metallic medicines called for in wound treatment, including surgical wounds, and often when a need for cleaning is emphasized. Among the most noteworthy passages is Diseases 2.30 (7.48 L), in which flower of copper is to be applied to the surgical site after a tonsillectomy. At Diseases 2.47 (7.64–72 L), flower of copper is considered a superior treatment as it is to be used to make pus break out if 58  11.828–832. 59  See Mackie 2001, 1–17, for an analysis of the role Cheiron played in the life of Jason who, in Mackie’s view, ended up as a healer in a metaphorical sense. Mackie points to numerous other examples in which the pupils of Cheiron (including Achilles) bring about reconciliation or end political or social strife. 60  Perhaps in Cheiron’s half-bestial nature there is a hint that Greeks believed that animals self-medicate and that humans can learn from them (as discussed above).

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an infusion using ass’s or goat’s milk does not work. Ulcers 12 (6.414 L) deems a styptic containing flower of copper to clean better than the preceding one. Sometimes metal-based remedies are called for to substitute for more drastic measures, which is surely a nod to their perceived effectiveness. This is the case at Haemorrhoids, 7–8 (6.442 L), in which treatments using copper ore, flower of copper, and verdigris are recommended as alternatives to cautery and excision. This is a powerful acknowledgement of the efficacy of these remedies, and it implicitly flies in the face of the well-known final passage of Aphorisms that ranks cautery and surgery above pharmaceutical treatments (7.87 = 4.608 L). On Sight 4.1 (9.156 L) is a significant passage for our purposes. Here ‘one of the moist preparations containing flower of copper’ is to be rubbed onto the scarified eyelid. This wording implies that there are numerous and familiar medications with flower of copper, and that flower of copper is the crucial ingredient. At On Sight 5–6 (9.156–158 L), flower of copper, scale of copper, and a copper vessel are all part of the recommendations for treating eye problems. Ulcers 12–18, 21, and 23 (6.412–422, 424–428 L) call frequently for medicines with copper and other metals in them to treat skin lesions, and one unusual passage specifies that a copper vessel is to be used and that the ingredients are to be stirred in such a way that some of the copper enters the mixture (12 = 6.412 L). In this section, too, we see that copper is frequently used in conjunction with two other foreign ingredients with antimicrobials properties—myrrh and frankincense.61 While early miners and metalworkers were likely to have discovered the medicinal virtues of copper, silver, and some other minerals and metals, by the time of Pliny and Dioscorides, metallic medicines were a fixed feature of the pharmacopeia, and Dioscorides in fact criticizes two of his predecessors on the grounds that they left out of their work sections on metallic medicines.62 The field was not closed to expansion, however, and both authors use their experiences with mining and metalworking to increase their medical and pharmacological knowledge. I have already mentioned Pliny’s observation that wounds heal very quickly in copper mines. Dioscorides notes that the men working with cinnabar, a highly toxic form of mercury, cover their noses and mouths with a bladder in order to limit their inhalation of the vapours.63 This passage shows that Dioscorides considers the actions of these workers to be worth noting; thus, the workers are the source of the knowledge of the toxic 61  Craik 2006, 24, points to the long afterlife of treating the eye disease trachoma with copper-based medicines. 62   Preface 1. 63  5.109.

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effects of cinnabar vapour in Dioscorides. We might go further and speculate that Dioscorides records this information for the sake of readers who might themselves process cinnabar or go to a cinnabar-processing workshop to obtain that item. There are other indications in the text that the workers may have contributed to the textual tradition of pharmacology: when describing chalkanthon, Dioscorides gives several alternate names for it, including that of the workers: stillatition.64 We generally assume that he records alternate names for substances to help his readers acquire them, so perhaps this passage indicates that doctors and herbalists might obtain chalkanthon directly from the workers and need to know how they termed it. Certainly when discussing several methods for making diphryges, Dioscorides indicates that the foundry supervisors are producing the medicine from start to finish: The supervisors put stones known as pyrites into the furnace and they roast it (just as they do chalk) for many days. When it resembles red ochre in colour, they remove it and put it in jars.65 It is worth noting that diphryges is one of the substances Galen obtains when he visits the copper mine at Soli on Cyprus; he considers it to be the most effective remedy against malignant tumours.66 The other drug Galen was especially anxious to obtain on his visit was cadmia, a zinc oxide produced during the smelting of copper.67 Galen ended up being given a large amount of copper slag to take home with him, the gift of the procurator in charge of the mine.68 Dioscorides and Galen display an intimate knowledge of mining and metal production, and they clearly are keen to observe and communicate with miners and metalworkers. While we have Galen’s word for it that he visited the mine at Soli, with Dioscorides, there is no such certain evidence, though his descriptions of the manufacturing processes of metals have the vividness of eyewitness accounts, not of received wisdom. John Riddle says that ‘Dioscorides may have been a better mineralogist than he was a botanist. His detailed m ­ anufacturing instructions are cause to place his work among the pioneer works on minerals.’69 Dioscorides also frequently includes the methods used to substitute or adulterate the metals, so as to warn his readers. In fact, the latter descriptions are 64  5.114. 65  5.120. 66   Simp. Med. 8.2, 12.203K. 67   Simp. Med. 9.3.11; 12.219–20K. 68   Simp. Med. 9.3.21. 69  1985, 149.

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sometimes so detailed that a would-be criminal could very likely have used them for a primer. Dioscorides also sometimes informs his reader of how to test for adulteration of the product, or for its outright substitution, by describing a distinctive taste that the genuine product should have, or by suggesting subjecting the substance to fire to see which colour it produces. In like vein, Pliny laments in his discussion of metallic medicines that doctors no longer produce their own remedies, but rely on drug-sellers who, in Pliny’s view, are all frauds. Pliny sometimes provides instructions on how to perform streak tests to determine the genuineness of a mineral.70 While fraud was a problem also in relation to plant-based medicines, and Dioscorides is careful to provide many details so that plants may be correctly identified, one imagines that preparations containing metals would have been the more tempting to fake or adulterate in proportion to their greater value, which would have been derived from the costliness of the ingredients, the labour required for preparation, and their efficacy. On the other hand, the detection methods offered by Dioscorides and Pliny for metallic medicines were probably more accurate than any they could offer for botanical ones. Dioscorides’ descriptions of the intense labour required to turn an ore into a high-quality medicine shed some light on an additional motivation for the doctors and drug-sellers in Pliny’s ken. Take, for example, the handling of litharge, a mineral form of lead oxide: Make it white as follows. Take up to an Athenian choenix of what is called argyritis . . . break it into bean-sized pieces, and toss it into a new ceramic jar. Add water and two pints of white wheat, then take a handful of barley, wrap it with thin linen cloth that’s clean, suspend it from the jar handle, and boil until the barley is broken down. Pour everything onto a clean broad plate, separate out the wheat and throw it away. Pour water on to wash the residue while rubbing vigorously with your hands. Then take the mixture outside, let it dry, and grind it in a Theban mortar, adding warm water until it has dissolved. Strain the water and pound it again for an entire day [emphasis mine]; in the evening pour hot water over it and let it be. In the morning strain the water, add more water; repeat this three times a day for seven days. After that, mix five teaspoonfuls of m ­ ineral salt to a pound of litharge, add warm water and beat it three times a day, each time straining out the old water and adding in fresh water. Do this

70  In a streak test, one simply has to draw the mineral across another surface (sometimes one made of a specific metal) and see what colour is left behind; these are generally very reliable and easy to perform; see Healy 1986, 121.

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until it has no saltiness, adding warm water even if it turns white. Then throw out the liquid and dry in a very hot sun, and put it in jars.71 The time and energy expended on this preparation is considerable. One can see why doctors would be tempted to take the easy way out and buy such products from drug-sellers—and also understand why the drug-sellers would have a motivation even above and beyond the economic to substitute or adulterate them. All in all, it seems that the market value of ores and metals, the effort expended to produce medicines from them, and the striking therapeutic benefits of some of these preparations would have combined to make them costly items, and so well worth the defrauder’s while. By the same token, the very fact of the lengthy descriptions in Dioscorides implies that at least some doctors were willing to put in strenuous effort to ensure that they had genuine ingredients that had been processed correctly—and perhaps even, like Galen, to travel to a mine—and indicates how highly they esteemed metallic medicines. From the evidence of Pliny and Dioscorides we can see that the manufacturing of metallic medicines generally included several initial steps that were part of the normal processes for turning minerals into metals. In other words, in the normal course of their labours, the workers were part way to having fully processed medicines as described in our texts. Whether or not they themselves developed the remaining steps is beyond the scope of our evidence, but the fact that these medicines were frequently the offshoot of normal manufacturing supports the idea that the workers were the source of the knowledge that such metals were useful pharmacologically. We can conclude, then, that the biocidal properties of the metals used by the Greeks and Romans, and especially those of copper, were such that the miners and metalworkers who handled them constantly were almost certain to have discovered their therapeutic usefulness. Copper in particular is very fast-acting, and Pliny takes note of how very quickly wounds of those in the copper mines heal. For those medical traditions for which we have Bronze Age textual evidence, we see copper and other metals being used for eye infections, burns, and wound treatment, and I believe that the myth of Telephus indicates that the Greeks possessed the same knowledge at roughly the same time. In later sources, we see metallic medicines consistently held in high regard, and from Pliny, Dioscorides, and Galen, we can detect interaction between miners and metalworkers and our medical authors. Thus, it seems likely that a working knowledge of the therapeutic effects of some metals was possessed by the earliest metalworkers and miners. 71  5.102.

Chapter 7

Crossing the Borders Between Egyptian and Greek Medical Practice* Isabella Andorlini This paper offers a survey of the interrelationship between Egyptian and Greek medical practice in Graeco-Roman Egypt, focusing on the papyri. Magic and religion played a significant role in Egyptian medical practices that remained fairly constant from the Old Kingdom (c. 2600 BCE) until the arrival of Greek practitioners during the Hellenistic period (c. 332–30 BCE). Their arrival introduced changes, but there is evidence that medicine in Ptolemaic Egypt was practiced mainly in the Egyptian style.

Greek Experiences in Early Ptolemaic Egypt

In a letter dated around the middle of the third century BCE, perhaps written in Memphis (so C.C. Edgar), a certain Dromon asks Zenon to order one of his people to buy a kotyle (about one-fourth of a litre)1 of Attic honey (the best honey came to Egypt from Attica, and was considered a great luxury— Attic honey could sometimes be bought in Alexandria, but honey was scarce in Egypt), for Dromon has been commanded by the god to use this as a medicament for his eyes—the order of the god is explicitly described as κατὰ πρόϲταγμα τοῦ θεοῦ. ὡϲ δʼ ἂν ἀναπλέηιϲ ὑγιαίνων, ϲύνταξόν τινι τῶν παρὰ ϲοῦ ἀγοράϲαι μέλιτοϲ Ἀττικοῦ κοτύλην· χρείαν γὰρ ἔχω πρὸϲ τοὺϲ ὀφθαλμοὺϲ κατὰ πρόϲταγμα τοῦ θεοῦ (P.Cair.Zen. III 59426, lines 5–8 = Sel. Pap. I 91 = Trismegistos 1066; 260–250 BCE).2 *  Professor Andorlini was not able to revise this paper for publication. I am most grateful to a reviewer who must remain anonymous, and to Roger Bagnall and David Leith, for help in preparing the present version.—WVH. 1  For the liquid measure kotyle in the Hippocratic collection, see Potter 1980, 133. 2  The god was presumably the Memphite Sarapis, who prescribed benefits by means of dreams. The best evidence for ordinary worshipers engaging in incubation at Saqqâra was

© trustees of columbia university in the city of new york, ���6 | doi ��.��63/9789004326040_008

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When you are about to sail up-river in good health, order one of those in your company to purchase a kotyle of Attic honey, since I have need of it for my eyes, according to the god’s command. At this time, Dromon was probably living in Memphis and the temple to which he resorted would have been the great Sarapeion at Saqqâra, where medical advice was communicated to sufferers through dreams. In any case the god must have been Sarapis (identified by the Greeks with Asclepios/Imhotep), a major Memphite cult.3 The sick Dromon went to this shrine, where sometimes the sick were healed through incubation. Temples were among other things health-care centres. But what may be most interesting here is that another letter from the Zenon archive shows an iatros giving a prescription almost identical to the god’s (PSI IV 413 = Trismegistos 2096).4 In other words, men of Greek culture were already making use of Egyptian medicine, which in turn overlapped with Greek medicine. In another petition of the same period,5 a certain Zoilos of Aspendos, otherwise unknown, was apparently instructed by Sarapis to tell Apollonios, the finance minister of Ptolemy Philadelphus, that a Sarapeion should be built for him in the Greek quarter of the town, presumably at Alexandria,6 where the writer lived. Evading the task, Zoilos was overtaken by a dangerous illness from which he escaped only by promising to obey the god’s bidding. So this text too shows us that in the early Ptolemaic period a man of Greek culture could be deeply immersed in Egyptian medical practices. One of the temples most renowned for effective cures was the Memphis Asclepieion, where Imhotep’s healing power was put into practice by specialized priests. Another much later text, a narrative in Greek preserved in P.Oxy. XI 1381, of the second century CE, describes how the writer and his mother regained health thanks to Imhotep, who, during a dream, cured them from a

published relatively recently: a graffito written on the left forepaw of a stone sphinx in the dromos around 275–225 BC states that ‘there are countless mischievous ones in the sleeping chamber’ ([ἐ]ν ἐνκομητηρ̣ί[ωι] �̣ | μύριοι ϲινάμ̣ [ωροι] (SEG XLIX (1999), no. 2292). 3  Thompson 2012, 19, 72, 241–242 (incubation), and 245 n. 310. On medicine in Egyptian healthcare centres, see Clarysse 2010, I, 274–290. 4  P. Lang 2013, 126. 5  P.Cair.Zen. I 59034 (257 BC), lines 9–10 εἰϲ ἀ�̣ρρ̣ ω ̣ ̣ ϲ̣[τ]ί�α̣̣ [ν] μ̣ [ε π]ερ̣ιέ̣ β̣� ̣α̣λεν μεγάλην ὥϲτε καὶ κινδυνεῦϲα̣ί �̣ με (‘I was overtaken by a dangerous illness’). The text has recently been re-edited (Renberg and Bubelis 2011; I follow their text but omit their underdotting). Disease as divine punishment was also of course a Greek idea. 6  At Memphis according to others (cf. Renberg and Bubelis 189).

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violent fever. The writer’s concern is the propagation of the Imhotep-Asclepios cult among the Hellenophone population of Egypt.7 Most medical recipes for everyday health needs relied on a pharmacopeia that drew on an amalgam of Egyptian and Greek medicine. The traffic in drugs seems to have gone in both directions, providing us with very early evidence for an interrelationship. This was in fact very far from new in Ptolemaic times. A recipe in the famous Ebers papyrus of c. 1550 BCE, for example, mentions beans of Cretan origin:8 Ebers 28: Another (remedy) to cause purgation . . . (then comes a section about an unknown herb) . . . which are like beans from the Keftiu land (. . .). Archaeological evidence also suggests that there was traffic of pharmacological drugs between the Aegean world and Egypt.9 A papyrus of the second century BCE that refers to a native doctor specializing in the use of clysters as a cure who employed in his practice a Greek who was learning Egyptian script has given rise to extensive discussion. The letter is apparently from a mother to her son: πυνθανομένη μανθά|νειν ϲε Αἰγύπτια | γράμματα ϲυνεχάρην ϲοι | καὶ ἐμαυτῆι, ὅτι | νῦν γε παραγενόμενοϲ | εἰϲ τὴν πόλιν διδάξειϲ | παρὰ Φαλουῆ[τι] ἰατροκλύϲτηι τὰ | παιδάρια καὶ ἕξειϲ | ἐφόδιον εἰϲ τὸ γῆραϲ. (P.Lond. I 43 = UPZ I 148 = Trismegistos 3540; second century BCE). When I heard that you are learning Egyptian letters, I shared your joy, since now at least on your return to the city you will be teaching the ‘boys’ [probably ‘slaves’] in the house of Phalou[tes] the enema specialist, and you will have a way to support yourself into your old age.10 According to Roger Rémondon the employment of a Greek interpreter by an Egyptian doctor has broader implications for Egyptian society: the existence of a school, or a surgery, specialized in healing by the administration 7  The text is copied on the verso of P.Oxy. XI 1380. See Naether and Thissen 2012, Signoretti 2012. Demotic papyri tell similar tales, see e.g. Ryholt 1998. 8  Arnott 1996 and Totelin 2009, 180–182. 9  Laskaris 1999. 10  On this text see among others Rémondon 1964, Bagnall 1995, 33–35, P. Lang 2013, 205–206. An enema-doctor called an ἰατροκλύϲτηϲ occurs also in P.Hib. II 268 (c. 260 BC), lines 14–15, and fr.

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of enemas—a typically Egyptian medical practice—proves that Greeks were incentivized to learn Egyptian (demotic script, presumably) by a desire to gain access to Egyptian medical knowledge. Predispositions Thus Greek medical experience in Egypt fairly soon became involved with local practices, not surprisingly. There may have been some Greek predisposition in that direction. One should not underestimate the influence of Homer, and according to a well-known passage in Odyssey IV, Egypt was rich in drugs and possessed the most knowledgeable doctors.11 Herodotus’ journey to Egypt around the middle of the fifth century BCE was by no means unique, and it is plain that by his time, that is to say Hippocrates’ time too, some Greeks were greatly impressed by Egyptian medicine. Herodotus provides evidence for this and also for the high degree of specialization among Egyptian doctors: Ἡ δὲ ἰητρικὴ κατὰ τάδε ϲφι δέδαϲται· μιῆϲ νούϲου ἕκαϲτοϲ ἰητρόϲ ἐϲτι καὶ οὐ πλεόνων. Πάντα δ’ ἰητρῶν ἐϲτι πλέα· οἱ μὲν γὰρ ὀφθαλμῶν ἰητροὶ κατεϲτᾶϲι, οἱ δὲ κεφαλῆϲ, οἱ δὲ ὀδόντων, οἱ δὲ τῶν κατὰ νηδύν, οἱ δὲ τῶν ἀφανέων νούϲων (Herodotus, II 84). Medicine there is divided up as follows: each physician applies himself to one disease only, and no more. All places abound in physicians; some physicians are for the eyes, others for the head, others for the teeth, others for the parts about the belly, and others for internal disorders. He singles out Egyptian eye-specialists for particular mention, reporting the story that King Cyrus asked the Pharaoh Amasis to send him the best eye doctor in Egypt.12 This text cannot by itself be more than a hypothetical guide to the attitudes of the Greek immigrants to Ptolemaic Egypt and their descendants. But the Hippocratic corpus too shows that Egyptian medicine had already aroused Greek interest. It has been shown that the treatises of the Hippocratic collection share birth prognoses and gynaecological techniques with earlier Egyptian medical 11   Odyssey IV.229–32: ‘the food-giving field bears most kinds of drugs: many good when mixed, many harmful. And each doctor there is knowledgeable beyond all men’. 12  Herodotus III 1: ὅτε Κῦροϲ πέμψαϲ παρὰ Ἄμαϲιν αἴτεε ἰητρὸν ὀφθαλμῶν, ὃϲ εἴη ἄριϲτοϲ τῶν ἐν Αἰγύπτῳ (‘when Cyrus sent to Amasis asking for the best eye-doctor in Egypt‘).

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writings, such as the Papyrus Carlsberg VIII (c. 1300 BCE) and the Berlin and Kahun Medical Papyri (c. 1820 BCE), on the one hand, and the works Barren Women (Steril. 214), Nature of Women, and Aphorisms (V 59) on the other.13 Furthermore, an influx of Egyptian drugs into pre-Alexandrian Greek pharmacology is solidly attested by the ingredients labelled Egyptian appearing in a number of medicines recorded in the Hippocratic writings of the fifth and fourth centuries BCE. Many of the gynaecological recipes of the Hippocratic works contain Egyptian ingredients from the vegetable kingdom. In addition to ntry or natron, known to the Greeks as nitron, a sodium carbonate, the texts mention Egyptian alum, oil, salt, saffron, acorns, and other substances. Egyptian animal drugs—especially hyena bile and the urine and excrement of various animals (Dreckapotheke)—also made their debut in the Hippocratic collection before appearing later in the Alexandrian pharmacopeia.14 An intriguing case study is provided by a Rylands papyrus of Ptolemaic date, which combines the format of a Hippocratic-style gynaecological collection with ingredients attested here for the first time. The text, of unknown provenance and assigned to the third or second century BCE, preserves a version of a recipe against uterine suffocation parallel to a Hippocratic prescription contained in a passage of Diseases of Women. A small variation in one of the ingredients indicated, however, merits mention here. While the Hippocratic version reads ‘when she is suffocated by the womb, let her drink castoreum and fleabane in wine separately or together’,15 the papyrus version runs as follows: πρὸϲ τοὺϲ ἀπὸ τῶν ὑϲτερῶν πνιγμῶν ἐνυδρίδοϲ τοὺϲ | νεφροὺϲ ξηράναϲ δίδου ὅϲον τοῖϲ τριϲὶν δακτύλοιϲ λαβεῖν ἐν οἴνῳ εὐώδει τοῦτο καὶ πρὸϲ τοὺϲ τῶν διδύμων πό|νου βο{ι}ηθεῖ καὶ κλυϲτήριόν ἐϲτιν ὑϲτερῶν (P.Ryl. III 531, II, lines 12–15).

13  Iversen 1939. Further discussion in Totelin 2009, 179–183. 14  The use of dung is a mark of Egyptian influence, see Nunn 1996, 148–151 (drugs of animal origin). For animal drugs, see, e.g., Hippocrates, Nat. mul. 7.1 (τῷ οὔρῳ τῷ τοῦ ἀνθρώπου), 18.3 (καὶ πίνειν διδόναι τὸν κάϲτορα), 32.89 (χολὴν ταύρου), 32.97 (ὑὸϲ χολήν), 34b1 (οὔρου βοείου); Mul. I 75 (λύκου κόπρον), II 189 (πελιάδων κόπρον); Steril. 245 (ὀνίδα ξηρήν), Superf. 28 (τοὺϲ ϲκώληκαϲ δὲ τοὺϲ κοπρίνουϲ), 32 (κάϲτοροϲ ὄρχιν) (VIII 164.15; 370.4; 458.21; 492.21; 500.21 Littré), and Loc. Hom. 47.8, where cow dung and cow bile are recommended for women’s ailments. Crocodile dung and hyena bile were among the animal products utilized by Herophilus for an ointment in the mid-third century BCE, according to Aëtius VII 48 (CMG VIII 2, 303 = T260 von Staden). 15  Cf. Hippocrates, Mul. II 200–201 (VIII 382–386 Littré, c. 450 BCE; esp. VIII 382.12–13 Littré): Ὅταν πνίγηται ὑπὸ ὑϲτερέων· κάϲτορα καὶ κόνυζαν ἐν οἴνῳ χωρὶϲ καὶ ἐν ταὐτῷ πινέτω.

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In the case of hysterical suffocation, take dried otters’ kidneys, as much as can be held in three fingers, and serve in sweet-smelling wine. This is also helpful in the case of pains in the testicles and is an enema for the womb.16 The author was likely re-contextualizing the existing Hippocratic medications using otter kidneys as a substitute for castoreum (a very common drug in Hippocratic and Roman pharmacology, it is the exudate from the castor sacs of the mature Castor fiber L., the beaver).17 Why does the compiler of this papyrus recipe prescribe not castoreum but the unusual otter kidneys, of which there is no mention in the Hippocratic writings? The compiler may have had access to collections of recipes that circulated anonymously and independently from the Hippocratic works. An equally attractive hypothesis, however, is that the author was a Greek living in Egypt who was familiar with efficacious Egyptian substances of the animal kingdom. The change seems to furnish an example of the adaption of a recipe to an Egyptian milieu. Herodotus mentions the Nile otters (II 72), asserting that they were thought to be sacred, whereas Castor fiber is hard to imagine in such an environment.18 Tebtunis Of the villages in the Arsinoite nome, it is arguably Tebtunis that gives us the best opportunity to analyse Greek-Egyptian medical interactions in the Roman period, and I shall sketch something of the topic as I see it and the kinds of contributions that Tebtunis papyri can make to studying this cultural phenomenon. Tebtunis also offers the potential for putting documents into an archaeological context, a context only partly recoverable from finds at other sites. Moreover, early Roman Tebtunis had a thriving Egyptian temple community, with numerous priests who took an interest in the religious and technical literature pertaining to their status. The House of Life there accommodated a collegium of priests whose prime duty was to use rituals to protect the gods, 16  = MP3 2418; LDAB 1313. Cf. Hippocrates, Mul. II 200–201 (VIII 382 Littré). See further Hanson 1998, esp. 79–81, Andorlini 1999, esp. pl. 3, and Hanson 2009, 73 n. 6. 17  Cf. Celsus, Med. XXIII 1, 5; XXV 8, 12. The yellowish secretion of the castor sacs was, and still is, used as a tincture in perfumes, and, until the eighteenth century, was used to treat many different ailments (including headache, fever and hysteria). 18  Cf. Hero­dotus IV 109 on beavers in Scythia, and the use of beaver testicles there for curing diseases of the womb. Beavers were in fact extinct in the Mediterranean world long before Herodotus or Hippocrates: Devecka 2013, 90.

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and to establish an instruction centre where priest-doctors could pass on their knowledge to practitioners. Most of the documents we have, however, did not belong to a temple library, but to individual priests.19 From Tebtunis too come evidence that the traditional Egyptian use of papyrus for medicinal purposes20 spilled over into the Hellenic or semi-Hellenized community. But the Hippocratics already knew of burnt papyrus as a medical ingredient.21 Papyrus served as an ingredient of recipes, while papyrus paper functioned as a bandage or as an adhesive plaster. Papyrus competed with linen as a means of applying remedies to the affected part of the body. Strips of papyrus served on occasion as bandages, but far more frequent was the use of a chartarion as a sort of band-aid intended to keep the poultice attached to the diseased part of the body. Both these applications are mentioned in papyri of the Roman period excavated in the temple context of Tebtunis. In the recipes surviving in the collection of PSI X 1180,22 ‘burnt papyrus’ wetted in water is the component of a lotion used specifically to treat leprosy, while a piece of medicated paper was applied locally for lichen.23 One notes that the instruction given in the Ebers recipe (Ebers 482), in which ‘burnt papyrus not 19  Tait 1992, Ryholt 2008. The Tebtunis papyri of the Roman period come from several groups of different origin: the papyri excavated by Grenfell and Hunt, now at Berkeley; the Florentine fragments, both Egyptian and Greek, excavated by the Italian Archaeological Mission under C. Anti and G. Bagnani between 1931 and 1933, now at the Vitelli Institute in Florence; and those found clandestinely and now in many collections. Cf. O’Connell 2007. 20  Our information about this practice goes back to the Ebers papyrus (see above). ‘Cooked unwritten papyrus’ mixed with ‘wax, oil, and wah-legume’ appears to be applied on the fourth day of a cure to relieve the pain of a burn (Ebers 482). 21  Hippocrates, Mul. I 105 (c. 450 BCE; VIII 228.20–23 Littré). 22  Full edition in Andorlini 2004a. This text was part of a large number of rolls in both the Greek and Egyptian languages, with the Egyptian ones written in both Hieratic and Demotic scripts. The papyrus was found by the Italian excavators at Tebtunis in two subterranean rooms adjacent to the temple complex of the crocodile-god Sobek, cf. Andorlini 2004b (with earlier bibliography), Hanson 2005. 23  Cf. PSI X 1180, Fr. A, III, lines 5–7: τὸν λιχῆνα προεζμ̣ ηϲά�̣μενον κα|τάχριε καὶ ἔξωθεν γῦριν· ἐπάνω δὲ | το[ῦ] φαρμάκου χαρτάριον ἐπίθεϲ (‘having rubbed the area affected by lichen beforehand, smear it with the finest meal externally, and cover the application with a bandage made from papyrus’), and PSI X 1180, Fr. A, II, lines 11–12: πρὸϲ λέπραϲ̣, ἐὰν ἐ�κ̣ ̣ |δ̣έρ̣� η̣ ̣ ϲ α̣ὐ̣�τά̣ ̣ϲ� ,̣ βάμμα παπύρου κεκαυμ(ένηϲ) (‘against leprosy; when you have scraped off these lesions, prepare an ointment with burnt papyrus’). For this use, cf. Dioscorides, MM I 86.1 Wellm.: ἡ δὲ κεκαυμένη πάπυροϲ ἄχρι τεφρώϲεωϲ δύναται νομὰϲ ἐπέχειν τὰϲ ἐν ϲτόματι καὶ παντὶ μέρει· βέλτιον δὲ ὁ χάρτηϲ καεὶϲ δρᾷ τὸ τοιοῦτον (‘papyrus that is burned to ashes keeps in check sores in the mouth and everywhere else; but papyrus roll that was set on fire does this kind of thing better’).

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previously written on’ is specifically recommended, coincides with the information in the recipe book from Tebtunis. Both Egyptian and Greek traditions confirm that the application of papyrus sheets to wounds (sheets assembled into a roll, i.e. a chartarion) was by far the commonest medical use of papyrus in antiquity.24 Also at Tebtunis, the use of ‘hyena bile’ (in PSI X 1180, Fr. B, col. III, line 15 χολ(ῆϲ) ὑαίν(ηϲ)) and ‘excrement of ibis’ (in Fr. A, col. III, line 21 ἴβ[ιοϲ] κόπρον) reveals the penetration of Egyptian Dreckapotheke into a receptarium composed in Greek.

Egyptian Medicine in the Wider World

Given the Hippocratic writers’ interest in Egyptian recipes and the prestige of Alexandrian doctors such as Herophilus, it is scarcely surprising that Greek doctors in the wider Mediterranean world continued to show interest in Egyptian drugs and medicine. In an anonymous treatise within the Galenic corpus entitled ‘Introduction, or the Doctor’ and roughly datable to the first or second century CE, special attention is paid to Egypt.25 At the very beginning the author raises the question of the invention of the art and provides answers emphasizing the Egyptian advances in medicine, referring to the lines in Odyssey IV on the use of drugs, and citing other stories of the Egyptian medical tradition that were in vogue in his time: dissections of corpses in mummification, treatment of cataract, the invention of the clyster (or enema), and so on. It has been cautiously suggested that the attention devoted to Egypt throughout may indicate the homeland of the author.26 24  Cf. Andorlini 2015. 25  Εἰϲαγωγὴ ἢ ἰατρόϲ alias Introductio seu medicus (XIV 674–797 K.). See now the edition of Petit 2009. I, 1–3: Πῶϲ εὕρηται ἡ ἰατρική; . . . παρὰ δὲ Αἰγυπτίοιϲ ἦν μὲν καὶ ἡ τῶν βοτανῶν χρῆϲιϲ καὶ ἡ ἄλλη φαρμακεία, ὡϲ καὶ Ὅμηροϲ μαρτυρεῖ . . . ἐκ δὲ τῆϲ ἐν ταῖϲ ταριχείαιϲ ἀναϲχίϲεωϲ τῶν νεκρῶν πολλὰ καὶ τῶν ἐν χειρουργίᾳ παρὰ τοῖϲ πρώτοιϲ ἰατροῖϲ εὑρῆϲθαι δοκεῖ. τινὰ δὲ ἐκ περιπτώϲεώϲ φαϲιν ἐπινενοῆϲθαι . . . καὶ τὸ κλύζειν δὲ ἀπὸ τῆϲ ἴβεώϲ φαϲιν εὑρεθῆναι (. . .). ‘How was medicine invented? [A short paragraph about the Greeks follows, mentioning plants and pharmaka]. But among the Egyptians too plants and other pharmaka were used, as Homer also testifies . . . It seems that many surgical practices employed by the first doctors were invented as a result of dissection of corpses for purposes of mummification. Others are said to have been discovered by accident [he describes a cataract procedure]. And clyster evacuation is said to have been modeled on observation of the ibis [on the Nile]’. 26  Issel 1917, Hanson 1985, 25–6; cf. Petit 2009, 109.

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In a further attestation to the enduring reputation of Egyptian practitioners outside the country, we learn from Pliny that Egyptian specialists in skin diseases regarded as native in Egypt, such as leprosy and lichen, were from time to time invited to Rome to treat difficult cases.27 But Galen is naturally our richest source. A passage from Galen’s work On the Composition of Drugs according to Places reports the following: τὸ ἀχάριϲτον ἐπιγραφόμενον, πρὸϲ τὰϲ μεγίϲταϲ ἐπιφοράϲ. μόνῳ τούτῳ ἐν Αἰγύπτῳ οἱ ἰατροὶ χρώμενοι εὐημεροῦϲι καὶ μάλιϲτα ἐπὶ τῶν ἀγροικοτέρων (Galen, Comp. sec. loc. IV 7 = XII 749.13–15 K. ex Asclepiade). An eye salve called achariston, against severe flux from the eyes. By use of this remedy alone, the physicians in Egypt are successful (in treating the disease), especially among the country people. In another passage Galen praises a ‘yellow plaster’ that seems to have been derived from an Egyptian milieu: τὴν ἐνδοξοτάτην τῶν κιρρῶν, ἣν ὀνομάζουϲι διὰ δικτάμνου, τῶν ἱερῶν ὀνομαζομένων καὶ αὐτὴν, ὥϲπερ ἡ ἴϲιϲ, ἐπειδή φαϲιν αὐτὰϲ ἐκ τῶν ἱερῶν τῶν ἐν Αἰγύπτῳ κομιϲθῆναι (Galen, Comp. per gen. II 12 = XIII 518.7–9 K.). the most famous of the ‘yellow plasters’, which they call “made with dittany” and which is named among the ‘holy plasters’, like the ‘Isis’ plaster, because they say that they have been brought from the temples priests in Egypt. Note that there is a recipe entitled ‘yellow plaster’ in our Tebtunis receptarium, namely in PSI X 1180, Fr. A, II, line 32 (κιρρά). In another example Galen records a remedy called ‘Hybris’ (perhaps to be interpreted as ‘very energetic’), apparently devised by someone from Oxyrhynchus and known to him through another Egyptian Greek:

27  Pliny, NH XXVI 4: ‘adveneruntque ex Aegypto, genetrice talium vitiorum, medici hanc solam operam adferentes magna sua praeda’, and NH XXIX 93: ‘Cossinum equitem Romanum amicitia Neronis principis notum, cum is lichene correptus esset, vocatus ex Aegypto medicus ob hanc valetudinem eius a Caesare, cum cantharidum potu praeparare voluisset, interemit.’

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Ἄλλη. Ὕβριϲ τοῦ Ὀξυρυγχίτου, φάρμακον ἐπιτετευγμένον πρὸϲ παντὸϲ ἰοβόλου πληγήν. ἀνεγράφη ὑπὸ Ἀπολλωνίου τοῦ Μεμφίτου. (Galen, Antid. 2 = XIV 188.9–12 K.).28 Another remedy called ‘Hybris’, obtained by a man from the Oxyrhynchite [sc. nome], is very effective against the bite of every venomous animal; it is recorded by a certain Apollonius from Memphis. This antidote, applied against poisonous bites from animals, curiously overlaps the evidence of a Tebtunis papyrus concerned with bites of asps and crocodiles (P.Tebt. II 273 = GMP II 5, VI, line 9), exemplifying the process of derivation and adaptation from an Egyptian environment. Galen learned by experience in Alexandria that amputation of fingers was effective for asp-bites (De loc. aff. III 11 = VIII 197.9–16 K.).29 He also uses dung of crocodiles, possibly imported from Egypt, as a means to cure skin diseases (Simpl. X 29 = XII 308.7–12 K.)30

A Late-Antique Coda

Perhaps the most explicitly medical votives to have survived from Coptic Egypt are those found in the shrine of the local saint Colluthus, commonly referred to as Abu Colta, which are associated with the numerous iatro-magical papyri found during the excavations led by John de Monins Johnson at Antinoöpolis.31 28  The text given by Kühn runs Ὑβριϲτοῦ Ὀξυρρυγχίτου, alluding to a man named Ὑβριϲτήϲ (vel -ίϲταϲ), a personal name not attested in Egypt so far. For Ὑβρίϲταϲ and Ὕβριϲτοϲ documented outside Egypt, see LGPN 2013, V.B, 418. The mention of the nome Oxyrhynchites, however, requires the construction τοῦ Ὀξυρυγχίτου. Thus Ὕβριϲ τοῦ Ὀξυρυγχίτου can be regarded as a plausible correction.—Both Winkler 1980, 73–79 (on p. 53 she prints Hybristes), and Ihm 1997, 237, assume that the chapter by Galen πρὸϲ ἐχιοδήκτουϲ (XIV 183–190 K.) relies on Asclepiades. 29  See Gourevitch, this volume, p. 000. 30  ἡ δέ γε τῶν κροκοδείλων κόπροϲ ὥϲπερ τῶν προϲώπων τὴν ἔφηλιν ἀφαιρεῖν πέφυκεν, οὕτω καὶ ἑλεῖν ἀλφοὺϲ καὶ λειχῆναϲ: ‘The excrement of crocodiles, just as it naturally removes facial spots, so too it gets rid of leprosy and lichen’ (the apparent meaning). 31  I am grateful to Rosario Pintaudi for providing me in advance with the article of Peter Grossmann on the procedure of incubation in the shrine of St. Colluthus (Grossmann 2014). For images of ex votos see Antinoupolis I (Pintaudi 2008), 27, nos. 64 and 65. Cf. Andorlini 1998, 19–22. P.Ant. II 66 includes thirteen magico-medical prescriptions; cf. P.Ant. II 65 and 140.

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The shrine of Saint Colluthus, recovered in the northern necropolis of the Greek city of Antinoöpolis in middle Egypt, developed a traditional Egyptian oracle procedure. At Saint Colluthus’ sanctuary people found familiar rites of divination. In the kiman of the northern necropolis were recovered many Christian ‘ticket’ oracles, still unrolled or thrown away after opening, and some of the most precious ex votos of bronze, which were left behind to acknowledge Colluthus’ most impressive miracula.32 Most of the queries concerned business and travel, but some addressed health issues. The vast majority of the ex votos were in the form of breasts, eyes, and feet.33 Colluthus was a healer renowned for curing eye diseases, supposedly martyred at the beginning of the fourth century CE under Emperor Diocletian. Devotees would present written queries, worded in both positive and negative form, and receive back the portion of the query that the saint’s local priests deemed correct.34 Amulets and other objects associated with Colluthus were certainly believed to work, and the regional cult-centre of Antinoöpolis, with its oeconomus, eclipsed scientific medicine, following scribal formulations and the practice of incubation identical to those used in traditional Egyptian temples. This is not the place to write the history of the medical use of amulets in Egypt. Suffice it to say that they were an old tradition in both Egyptian and Greek milieux. Here are two allusions, the first from an Oxyrhynchus papyrus: τὸ πρὸϲ παρίϲθμια περίαμμα | εἰϲ τὸ χρυϲοῦν πέταλον τῶ Ϲαρμάτῃ | πέμψον γρα⟦  ̣⟧ψαϲ (lege γράψαϲ) εἰϲ πιττάκιον | ὡϲ περιέχει. (P.Oxy. XLII 3068.1–4, 3rd) The amulet against tonsillitis, for the gold plate, send it to Sarmates, having copied it on a slip of papyrus word by word. Here is another from the collection of the Greek Magical Papyri published by Preisendanz: Φυλακτήριον ϲωματοφύλαξ πρὸϲ δαίμοναϲ, πρὸϲ φαντάϲματα, || πρὸϲ πᾶϲαν νόϲον καὶ πάθοϲ. ἐπιγραφόμενον ἐπὶ χρυϲέου | πετάλου ἢ ἀργυρείου ἢ καϲϲιτερίνου ἢ εἰϲ ἱερατικὸν χάρτην φορούμενον ϲτρατιωτικῶϲ ἐϲτιν (PGM VII, col. 16, 580–584 = Preisendanz II, 26). 32  For the miracles of Saint Colluthus, renowned as archiatros, see Till 1951. For therapeutic oracular tickets addressed to Colluthus, cf. Donadoni 1964, Zanetti 2004. 33  See Devos 1981, Del Francia Barocas 1998, 101. 34  Cf. Frankfurter 1998, 3–48, Fournet 2009, 129 and pl. 26, Schenke 2013.

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A phylactery, a guard against daimons, against phantasms, against every sickness and suffering, to be written on a leaf of gold or silver or tin or on hieratic papyrus. When worn it works mightily.35 Conclusions The ancient prestige of Egyptian medicine among the Greeks, based presumably on the general prestige of Egyptian culture and on the high degree of specialization among Egyptian doctors, is likely to have made the Greek immigrants into Egypt more willing to take up local medical practices, as of course they did. But Egyptian influence was felt outside the country too once writers in the Greek language made Egyptian medicine more widely known in other parts of the Mediterranean and international doctors such as Galen came to know more about it. And there was surprisingly little criticism, even of Dreckapotheke. 35  Trans. H.D. Betz 1986, 134.

chapter 8

Representations of the Physician in Jewish Literature from Hellenistic and Roman Times Catherine Hezser Ancient Jews who were afflicted with diseases had a number of options to explain the causes and to find healing. These options were partly overlapping and complementary, even though the underlying ideologies might seem contradictory. Biblical tradition traces illness back to sins; only God himself and the human observance of God’s commandments were believed to change this state.1 Throughout antiquity various types of self-promoting healers offered their wares, ranging from herbal remedies to magical spells and amulets.2 In addition, trained physicians, whose knowledge was based on empirical science and Greek medical traditions, were active at least in the major cities of Roman Palestine.3 If we apply the labels ‘religious’, ‘popular’, and ‘scientific’ to healing, various overlaps between these three phenomena are recognizable: physicians might complement medicinal treatments with remedies based on ‘popular’ beliefs; religious leaders such as priests and rabbis would utilize physicians and their knowledge for their own religious and ritual purposes; and these leaders could also possess medical knowledge themselves and/or engage in ‘spiritual’ healings. 1  On the biblical understanding of illness and its treatment see Allan 2001; Avalos 1995, 284–99. On the ancient belief that illness and disability were punishments inflicted by God/the gods see also the contributions in Avalos et al. 2007. On the rabbinic adaptation of the biblical notion of illness see Kottek 1985. 2  Simon Magus, Jesus, and the wandering charismatics of the early Jesus movement were popular healers whose offers were often linked to certain religious beliefs—they functioned in the sphere of popular religion. Their and their colleagues’ practices involved exorcisms, prayers and spells, and objects that allegedly protected against evil spirits and the evil eye. Kottek 1985, 12–15, calls these forms of healing ‘irrational medicine’. For the focus on healing in early Christianity see Porterfield 2005, 21–47. 3  On Greek physicians and the Roman appropriation of Greek medicine see especially Nutton 2004, 159–86. See also Kudlien 1986; Jackson 1988; King 2009, 32–7. Kottek 1994, 11, stresses that ‘it is obvious that professional physicians practiced in Judea in Josephus’ times’. Josephus mentions physicians especially in connection with Herod’s diseases, see ibid. 21–2 (with references).

© trustees of columbia university in the city of new york, ���6 | doi ��.��63/9789004326040_009

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In this article we shall look at the ways in which physicians are presented in Jewish Hellenistic and rabbinic sources from the authors’ and editors’ religious points of view. Scientific nature-based medicine seems to have had a better reputation among Palestinian rabbis than popular forms of healing, which were often associated with magical rites and idolatry.4 Although physicians may have been religious themselves, in general, their healing practices would not have been based on their mediatorship with the divine. They would therefore not have competed with rabbis on religious grounds. Some Jewish physicians may even have been followers of rabbis. Their expertise in the human body was basically different from the intellectual expertise of rabbis. At the same time, rabbis viewed human beings as a unity of body and soul, and rabbinic halakhah comprised all areas of daily life.5 Issues concerning the physical state of the body were and still are relevant for many areas of rabbinic law, such as (im)purity, family law, and damages. Therefore the expertise of physicians was of major importance for rabbinic halakhah. In reality, late antique Jews are likely to have resorted to any type of remedy that promised healing or at least the ease of pain. Religious charismatics, doctors, practitioners of what we nowadays call ‘alternative’ medicine, and socalled charlatans relying on people’s credulity would have offered their wares in an open marketplace.6 Rumors of healings and the persuasiveness and prestige of individual healers may have been more important than the patient’s and healer’s religious beliefs. The attempts of rabbis to regulate the treatment of their fellow Jews’ bodies were mainly governed by their fear of idolatry. They believed that, ultimately, only the one Jewish God could bring about healing. Everything that contradicted this notion in theory or practice was deemed suspicious.

Hellenistic Jewish Views of Physicians, Medicine, and Healing

Nigel Allan has already argued that ‘acknowledgement of the physician began to develop only with the increasing impact of Hellenism on Judaism’.7 Hellenistic Jewish writers would have been familiar with Greek physicians

4  See also Veltri 2010, 597–8; Veltri 1998–99. 5  On rabbinic views of the unity of body and soul see, e.g., Hirsch 1947, 150–74. 6  On the ‘marketplace’ model of ancient healing practices see Nutton 1992. 7  Allan 2001, 393.

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active in Alexandria and other places of the eastern Mediterranean.8 The members of the higher strata of society, to which the Greek Jewish writers belonged, are likely to have consulted these physicians in case of illness. Some Jews who lived in Hellenized environments may have become physicians themselves by joining ‘schools’, becoming apprentices of Greek doctors, and learning medicine by observation and practice.9 How did this Greek medical tradition relate to more traditional local and religious notions of illness and healing? In general, it seems that traditional notions of the divine infliction of pain and disease continued among Greek Jewish writers. According to the Letter of Aristeas, written to explain the translation of the Hebrew Scriptures into Greek in Ptolemaic times, ‘unexpected evils such as death or disease or pain or anything of this kind’ can only be averted through prayer to God and righteousness (Aristeas 232). The Testament of Job, often dated to the first century BCE, stands in the biblical tradition in presenting pain and suffering as God’s punishment. Especially interesting is the fact that physicians are mentioned but rejected by the author of this text: Then Sophar rejoined and said: ‘. . . What now do you wish that we should do for you? Behold, we have come here and brought the physicians of three kings, and if you wish, you may he cured by them.’ But I answered and said: ‘My cure and my restoration comes from God, the maker of physicians’ (Testament of Job 8:24–26).10 As human beings, physicians are God’s creatures and subordinates—yet even their function as medical experts and intermediaries is rejected here. The Book of Jubilees is unusual in its explicit reference to medicine and herbal remedies in combination with traditional beliefs in evil spirits. The biblical Noah is presented as a paradigmatic physician:11 And one of us [the Watchers] He commanded that we should teach Noah all their medicines; for He knew that they would not walk in uprightness, nor strive in righteousness. And we did according to all His words: all the malignant evil ones we bound in the place of condemnation and 8 According to Nutton 2004, 156, in the Hellenistic period Greek medicine spread ‘to become the dominant medical system of the whole of the Mediterranean.’ 9 On the ‘school’ and household as the contexts of medical training in Hellenistic times see Nutton 147. 10  Translation in accordance with M.R. James at www.earlyjewishwritings.com. 11  On Jubilees chapter 10 see also Werman 2004, 151: Noah appears as a cultural hero here.

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a tenth part of them we left that they might be subject before Satan on the earth. And we explained to Noah all the medicines of their diseases [i.e., diseases inflicted by evil spirits], together with their seductions, how he might heal them with herbs of the earth. And Noah wrote down all things in a book as we instructed him concerning every kind of medicine. Thus the evil spirits were precluded from (hurting) the sons of Noah (Jub. 10:10–14).12 Here the knowledge and practice of medicine are subordinated to God and taught by his (good) spirits—medicine is said to have a spiritual or religious origin and basis. What is especially new is the positive function attributed to this expertise: medical knowledge can be used as a remedy against the sufferings inflicted by demons. It seems, though, that humans are thought to bring these sufferings upon themselves by succumbing to ‘seductions’ and diverting from the path of righteousness. Hellenistic medicine and the traditional belief in spirits and demons are harmonized with each other here. The ‘herbs of the earth’ are potent remedies against the ‘evil spirits’ because both are thought to have been created by God. The medical book allegedly written by Noah and based on spiritual instruction may be envisioned as a parallel to Moses’ divinely inspired writing of the tablets of the Law. The spiritual basis of Noah’s medical knowledge stands in contrast to Greek secular medicine. Werman’s argument that ‘Jubilees employs the idea of the cultural hero as a tool to prohibit the use of . . . medicine’ is not persuasive, though.13 The author does not prohibit but spiritualizes medicine and integrates it into the religious realm of Jewish monotheism.14 In the Assumption or Testament of Moses physicians appear in an altogether different role. They are envisioned as undoing circumcisions by restoring foreskins. As part of the seemingly hellish scenario of total Hellenization, the author imagines ‘their young sons . . . operated on by physicians in order to bring forward their foreskin’, just as their wives are ‘given to the gods among the gentiles’ (Testament of Moses 8).15 Greek doctors or surgeons are probably referred to here. Their work is believed to run counter to the maintenance of Jewish identity—they appear as the agents of radical Hellenization.

12  Translation with R.H. Charles at www.earlyjewishwritings.com. 13  See Werman 2004, 151. 14  See also Lange 1997, 384, who argues that this text can be understood as ‘an etiology of medicine’. 15  Translation with R.H. Charles at www.earlyjewishwritings.com.

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The cultural and political context alluded to here in retrospect may be the persecution of Judaism under Antiochus IV Epiphanes. An ode to the physician appears in Sirach chapter 38. This text is especially interesting, since the proverb at its beginning reappears in later rabbinic literature: Honor the physician with the honor due to him, according to your need of him, for the Lord created him. For healing comes from the Most High. . . . The skill of the physician lifts up his head, and in the presence of great men he is admired. The Lord created medicines from the earth, and a sensible man will not despise them (Sir. 38:1–4).16 As God’s instrument the physician receives a very positive assessment here: he is a skilled expert in his craft to whom honor is due; no sensible person will refuse his help if he or she needs him. This view probably reflects the opinion of educated Hellenized Jews of the upper strata of society who took advantage of the medical science available in the cities in which they lived. By stressing that God is the ultimate healer, the author is able to reconcile Jewish monotheism with Greek science.17 A later verse in the same passage may indicate that the author was familiar with Jewish physicians: There is a time when success lies in the hands of physicians, for they too will pray to the Lord that he should grant them success in diagnosis and in healing, for the sake of preserving life (Sir. 38:13–14). Only Jewish doctors would be expected to pray to the Jewish God, unless Sirach identifies the highest god of Hellenism with the Jewish God. The physician’s prayer to God is said to increase the success of his treatments. One may assume that religious Jews would have been more likely to seek healing from religious

16  Translation with the Revised Standard Version. See also Sir. 38:12–15. 17  According to Avalos 1995, 294, Sirach indicates that physicians were accepted ‘within normative Judaism’ by the second century BCE. There is no indication, however, that Sirach represented ‘normative Judaism’, whatever that may mean with regard to Hellenistic times. Avalos himself qualifies his statement by pointing to the ‘promotional color’ of Sirach’s ‘ode to the physician’.

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Jewish doctors who combined their expertise with prayer, even or especially if they lived in Hellenistic contexts.18 Philo of Alexandria is the Greek Jewish author who stands out among others with regard to his frequent references to diseases, medicine, and physicians in both the literal and metaphorical sense. As a philosopher open to Greek philosophy, he seems to have also been appreciative of the secular scientific knowledge of his time. In the late Hellenistic and early Roman period, Alexandria was a center of Greek science and medicine. Herophilus and his followers were the foremost Alexandrian representatives of scientific medicine between the third century BCE and the first century CE.19 At the same time, Alexandria was populated by various types of healing cults, and religious and scientific healing practices overlapped to some extent.20 In contrast to many other Jewish writers before him, Philo was aware of the inevitability of the human body’s deterioration and development of diseases as ‘arising from the distemperature of the powers within us’, rather than as things inflicted from above.21 He knew that the lasting seriousness of a disease reveals itself on the seventh day, when more harmless illnesses recede while serious ones persist.22 A ‘life free from disease’ is seen as an ideal state that was realized in paradise only.23 Diseases are therefore seen as the necessary outcome of human imperfection and the fall from paradise. Until an ideal state is restored by God humans can trust ‘skillful physicians’, who ‘have knowledge of the means of healing the diseases and evil affections of the soul.’24 Physicians are believed to procure remedies for both physical and mental disorders here. They ‘do not obtain their employment by lot, but because their experience is approved of’25—that is, not chance or magic but empirical criteria constitute the basis of the medical profession. Rather than presenting physicians as subordinate to God, Philo uses the image of the physician and his medicine as an allegorical representation of God himself: 18  Wainwright 2008, 266–9, supports the argument that the most likely context is Alexandria in Egypt rather than Jerusalem. 19  On Herophilus and his school see von Staden 1989. 20  On the healing cults and their archaeological remains see Haas 2002, 156–7. On the overlap between religious and scientific medicine see Nutton 2004, 114, who remarks in connection with the all pervasive Asclepius cult that ‘religious and secular healing reinforced rather than opposed each other.’ 21  See Philo, On Creation 41.124. 22  Ibid. 23  See Philo, On Creation 56.153. 24  Philo, That the Worse is Wont to Attack the Better 13.44. 25  Philo, The Special Laws 4. 29.153.

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‘I imagine God the savior extending his all-healing medicine . . . to his suppliants and worshipers, bids them employ it for the salvation of those who are sick; spreading it like a salve over the wounds of the soul, which folly, and injustice, and all the other multitude of vices, being sharpened up, have grievously inflicted upon it.’26 Despite his general appreciation of the advances of Greek medicine, Philo knew that doctors differed in their individual proficiency: ‘. . . some sick persons, owing to the unskillfulness of their medical attendants, have been severely afflicted with disease; while others, through the skill of their doctors, have escaped from dangerous sicknesses.’27 These examples show that, unlike the author of Jubilees, Philo did not simply harmonize between Greek medicine and more traditional beliefs in spirits and demons.28 He was much more knowledgeable about medicine and sophisticated in his approach.29 His distinction between the physician’s expertise in the body and the philosopher’s expertise in matters of the soul draws a clear line between science and religion by, at the same time, presenting them as complementary.

Palestinian Rabbinic Representations of the Physician

Palestinian rabbinic representations of the physician (‫ רופא‬or ‫ )אסיא‬need to be understood on the background of the already-mentioned developments in Judaism in Hellenistic times. Palestinian rabbis lived in a thoroughly Hellenized and Romanized environment and would have been familiar with both Greek and Jewish medical practitioners of the eastern Mediterranean, especially from the third century CE onwards when more rabbis seem to have lived in cities.30 At the same time, rabbis stood in the tradition of the Hebrew Bible with its emphasis on monotheism and divine power over individual fates. How did they manage to tackle these seemingly contradictory traditions of scientific medicine and divinely determined disease and healing? 26  Philo, On the Migration of Abraham 22.124. 27  Philo, On Flight and Finding 4.27. 28  That Philo did not believe in evil spirits or demons as the cause of illnesses is also stressed by Hogan 1992, 168–207. 29  On Philo’s knowledge of medicine see also Niehoff 1991, 19 n. 6, and Sly 1992, 154–66. 30  On the spreading of Greek medicine in the Roman empire see Nutton 2004, 159–86. The adoption of Greek medicine was part of ‘the Hellenization of Italian culture generally and urbanization’ (163). Contact with Greek physicians took place especially in the Greek East: ‘. . . doctors . . . seem to have come to Italy as a result of campaigns in the East’ (164).

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Two contradictory views of physicians may reflect rabbinic ambiguities over this profession. According to Mishnah Qiddushin 4:11, a tradition which is repeated several times in the Talmud Yerushalmi (see Yerushalmi Qiddushin 4:11, 66c), ‘even the best among physicians is going to Gehenna’. The reason for this negative view remains unclear. According to Albeck, physicians are considered prone to making errors which may lead to the death of the patient.31 Other possible reasons are that physicians were thought to charge too much money for their services, that they refused to attend to poor patients, or that they were considered haughty before God.32 Some rabbis may have been wary of the natural explanations and treatments of diseases by physicians. On the other hand, at the end of the same tractate, the Talmud Yerushalmi includes a statement attributed to ‘R. Hezekiah, R. Cohen, in the name of Rav: It is forbidden to live in a city in which there is no physician, no bath, and no court [which administers] lashes and imprisonments’ (Yerushalmi Gittin 4:11, 66d). Like law, health and hygiene were considered essential parts of civic life and the professionals and institutions administering them are deemed indispensable. They also had religious significance: physicians performed circumcisions, ritual baths were essential for purity observance, and the courts may have ruled on the basis of religious law. Rabbis could incorporate and utilize the services and knowledge of health professionals to make them subservient to their own construction of society. Perhaps the increased urbanization of rabbis in the third and fourth centuries influenced their generally positive attitude towards physicians as part of Greco-Roman city life. In addition, the number of Jewish physicians who operated in Roman Palestine may have grown at that time. The phrase, ‘Honor your physician before you have need of him’, the Aramaic version of which appears in Yerushalmi Taanit 3:6, 66d, seems to have been an ancient proverb with a variant in Sir. 38:1 (see above).33 The literary context of the Yerushalmi deals with various kinds of diseases and natural afflictions for which the shofar is blown, presumably to enable people to say a prayer to prevent them. In this context the proverb assumes a metaphorical meaning: it is meant to encourage prayer in praise of God even at a time when one is healthy. The overlap between the physician and God (see also the parables below) seems to be indicative of the overlap between medicine and religion—healing

31  See Albeck 1988, 330 ad loc. 32  See Rosner 1977, 152. Rosner notes that ‘Greeks and Romans and other cultures also had pronouncements critical of physicians.’ 33  See also Exodus Rabbah 26:7.

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through medical remedies and prayers—which is characteristic of rabbinic references to illness and healing.

Mishnah and Tosefta: Physicians as Medical Experts in Ritual Contexts

Although physicians are not mentioned often in the Mishnah and Tosefta, tannaitic rabbis seem to have been thoroughly familiar with them and acknowledged their expertise. Since diseases and defects were ritually significant in connection with purity issues, physicians are said to have been consulted by religious authorities. The few references to physicians in tannaitic sources almost always associate them with religious rituals, especially in connection with the Jerusalem Temple before 70 CE. The Mishnah already mentions two physicians by name. One of them, a certain Todos (‫)תודוס הרופא‬, is presented as an expert in the anatomy of cows in a case story concerning Yavnean sages in Mishnah Bekhorot 4:4. In a rabbinic controversy about the ritual purity of a cow without a womb, Todos is quoted as saying that ‘no cow or sow leaves Alexandria in Egypt without its womb being cut out so that it will not give birth [outside of Egypt]’, probably to maintain an Egyptian monopoly on the breeding of these domestic animals.34 Nutton has noted that animal wombs were often studied by medical experts in antiquity: ‘ancient descriptions of the human womb closely resemble what could be far more easily seen in animals’.35 Also interesting is the rabbinic association of Todos with Alexandria, the Mediterranean medical capital, which specialized in anatomy.36 The fact that Todos is quoted as an authority in ritual matters by Yavnean rabbis seems to indicate that he was considered to be a Jewish doctor whose opinion was important enough to decide rules of the bet din—the rabbinic court.37 In the Talmud Yerushalmi a physician with the variant name Todros is mentioned together with a plurality of anonymous doctors in a story about 34  That pigs were a specialty of Alexandria is also indicated in b. Sanh. 93a, a text which alludes to the tannaitic tradition about Todos. 35  Nutton 2004, 78. See also ibid. 122: ‘Diocles was the first to write a specific treatise on (animal) anatomy, and he used the evidence of his dissection of mules to make inferences about the human womb’. 36  See Nutton 127. 37  It is unclear whether the bet din, mentioned in connection with R. Tarfon, serves as the setting of the dispute or merely underlines R. Tarfon’s authority.

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a synagogue in Lydda (Yerushalmi Berakhot 1:1, 3a). People from the village of Tebi had allegedly deposited a basket with human bones in the courtyard of the synagogue. The physicians were asked to examine the bones more closely so that rabbis could determine whether they rendered the courtyard ritually unclean. Although they could not identify the bones of a skull or spinal column, sages remained ambivalent about the purity of the space. Todros is presented as an expert in human rather than animal anatomy here. The other physician mentioned by name in the Mishnah is called Tobiah (‫טוביה הרופא‬, Mishnah Rosh Hashanah 1:7). He is said to have served as a witness to the New Moon in Jerusalem, together with his son and his freed slave. Again, a physician is associated with a religious ritual here (witnessing the New Moon was important for setting the dates of religious festivals), yet it is not his medical knowledge that is relevant but his reliability. Interestingly, a freed slave is associated with him—that is, he was believed to be rather welloff to be able to afford a slave, who might have continued to serve as his assistant after his emancipation. But this is merely hypothetical: the story is not a reliable historical source, but a halakhic example employed by the Mishnah’s editors to discuss who could be accepted as a witness to the New Moon. Like Todos, Tobiah would have been imagined as a Jewish doctor. His Jewish identity is indicated by his Hebrew name (derived from ‫טוב‬, ‘good’), his ritual function, and his alleged sojourn in Jerusalem before the destruction of the Temple in 70 CE. Other tannaitic texts also associate anonymous Jewish doctors in Second Temple Jerusalem with Temple-related rituals. Mishnah Kritot 3:8 deals with the question of how persons afflicted with boils (who were considered ritually unclean) could participate in the Passover ritual. A reminiscence of practices in Jerusalem is offered as a solution: such individuals would go to a physician on Passover eve and undergo a surgical procedure which detached the afflicted limb from the body so that both the patient and the physician could avoid contact with the boil and participate in the Passover offering. An interesting aspect of this discussion is the assumption that a physician could contract ritual uncleanness through contact with a patient and had to guard himself against such a possibility. A physician is also associated with a religious ritual and rabbinic court in the Tosefta. In Tosefta Gittin 3:13 (4:8 in the Erfurt ms.) a ‘physician who is an expert craftsman [‫ ]אומן‬in burning [sacrifices] under the authority of the court’ is mentioned. He was probably considered knowledgeable about animal anatomy and the identification of defects in sacrificial animals brought to the Temple, as already observed in connection with Todos (M. Bekh. 4:4). The use of the term ‫אומן‬, ‘craftsman’, is interesting since it fits the general

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ancient view of physicians. As Nutton has pointed out, ‘doctors in Antiquity ranked as craftsmen’, both with regard to their expertise in a particular field and with regard to their social status among the ‘middling sort’, to which most rabbis would have belonged as well.38 Besides Temple- and purity-related rituals, physicians are associated with circumcision.39 From Hellenistic times onwards some Jewish doctors may have specialized in circumcisions and circumcision-related injuries. Papyrus evidence seems to indicate that ‘in Egypt the “circumcision doctor” became an official post after the 120s’.40 The Testament of Moses’ reference to doctors who helped Hellenized Jews to undo circumcision (Test. Mos. 8) suggests that a variety of circumcision-related medical procedures were requested by Jews and other ethnic groups which practiced circumcision in antiquity. Jewish doctors involved in ritual circumcisions had to be knowledgeable not only about the medical aspects of the procedure, but also of the religious context in which it took place. A more or less close cooperation between physicians and religious functionaries is imaginable. At least from early Roman times onwards circumcision was also part of the male conversion ritual prescribed by rabbis. The amoraic Midrash Genesis Rabbah transmits a story about two brothers from Adiabene who had themselves circumcised in secret to fulfill a biblical commandment.41 When their mother learned about it she allegedly told her husband that the physician had recommended circumcision for medical reasons (Genesis Rabbah 46:10, Theodor-Albeck ed. pp. 467–8). Circumcisions performed by Jewish doctors were tolerated by Romans only as long as they were limited to other Jews. In the second century CE Antoninus Pius allowed Jews to have their sons circumcised but prohibited the circumcision of non-Jews. Those who acted

38  Nutton 69. See also ibid. 152: ‘Both papyri and inscriptions place the doctor on the same level as village craftsmen’. On doctors as being “of the ‘middling sort’ ” see Nutton 153. 39  See also Preuss 1911, 11, who notes, though, that physicians did not have a monopoly on circumcision. 40  Nutton 2004, 252; for references see ibid. 401 n. 25. Jouanna 2012, 15, refers to a tractate in the Galenic corpus, probably not written by Galen but by an Egyptian doctor, which ‘alludes to the practice of circumcision in Egypt’, including recommendations to also circumcise young girls. On male and female circumcision in Egypt see also Montserrat 1996, 41. 41  According to Josephus, Ant. 20.46, Izates was circumcised by the court physician of the royal House of Adiabene. Kottek 1994, 26, notes that in biblical times circumcision was probably ‘performed by the Patriarchs themselves’, or matriarchs such as Moses’ wife Zipporah who, according to Exodus 4:25, ‘took a flint and cut off her son’s foreskin.’

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against this law would ‘suffer the punishment of a castrator (castrantis poena)’.42 Later Christian Byzantine emperors continued to outlaw the practice if it was performed for conversion purposes.43 The issue of circumcision highlights the role of physicians within a religious context, performing procedures for primarily religious and cultic rather than medical purposes. The already-observed overlap between secular medical expertise and its religious use is particularly evident here.

Talmud Yerushalmi: The Halakhic Relevance of Physicians’ Expertise

Physicians dealt with issues of life and death, and their treatment of patients affected various aspects of daily life which rabbis tried to regulate, such as, for example, purity issues, Sabbath and holiday observance, damages, and matters concerning the family. Therefore it is not particularly striking that amoraic rabbis discussed issues concerning physicians and their patients in halakhic contexts. The fact that rabbis discussed these issues indicates that they wanted to regulate certain aspects of the practice of physicians—that is, they tried to interfere with the management of diseases. Since they believed that the human body was created by God, all aspects concerning it were religiously relevant. Rabbinic halakhah concerning medical issues constitutes the basis of Jewish medical ethics as it developed in medieval and modern times.44 Since Yom Kippur is a fast day, the question arises whether sick people may eat on that day. According to Mishnah Yoma 8:4, “a sick person is fed on the instruction of experts [‫ ;]בקיאין‬and if there are no experts available, he is fed on his own instructions, until he says: ‘Enough!’ ” In the Talmud Yerushalmi (Yerushalmi Yoma 8:4, 45a–b) the ‘expert’ of the Mishnah is substituted by the physician, and the additional issue of a disagreement between the sick person and the physician concerning the issue of fasting is discussed:

42  Feldman and Reinhold 1996, 133, with reference to Modestinus, The Rules, book 6, quoted in Justinian, Digest 48.8.11. 43  See Glick 2005, 42. 44  Fonrobert 2013, 51–2, already notes that we do not find a ‘systematic or comprehensive exposition of any ethical theory in rabbinic literature . . .’; rather, ethical questions are ‘interwoven in complicated ways’ in halakhic discourse. On rabbinic ethics see also Schofer 2007, 313–36.

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If a sick person says: I can [fast on Yom Kippur] and the physician says: He cannot—they listen to the physician. [If] the physician says: He can, and the sick person says: I cannot, they listen to the sick person. There is need [for an opinion] when the sick person says: I can, and the physician says: I don’t know. R. Abbahu in the name of R. Yochanan: This is dealt with as a case of life and death [‫]ספק נפשׁו‬, and in any case of life and death [the needs of the sick person] override the Sabbath [and holiday]. In the statement attributed to R. Abbahu in the name of R. Yochanan, the general principle is stated that concern for a person’s health overrides the observance of a Sabbath or holiday. Preserving a human life was sacrosanct to rabbis and more important than all other religious commandments. Therefore the inclination of the sick person prevails, even if the physician might consider him or her capable of fasting. Damages were another context in which the knowledge of physicians became relevant. The Bible already rules that an assailant who strikes another person so that he becomes injured ‘must pay for his idleness and his cure’ (Ex. 21:19)—that is, he must provide compensation for his lost salary and pay for a doctor, if necessary. Palestinian rabbis build upon this rule and expand it as follows: if someone injured another person and had to pay damages for the injury, but the injured person did not listen to the physician’s advice and the wound broke open again instead of healing, would the assailant have to continue paying (Yerushalmi Bava Qama 8:2, 6b)? Obviously not. The biblical verse, ‘he . . . shall cause him to be thoroughly healed’ (Ex. 21:19), would be overruled in such a case. It applies only as long as the injured person follows the physician’s instructions to expedite his healing.45 According to another opinion, if so-called gargutani (‫ )גרגותני‬break open, the assailant is obliged to continue to pay for the healing. The term refers to a medical condition whose exact meaning remains unclear. According to the context, the purulent wound has not properly healed and breaks open by itself, without the patient’s wrongdoing. In such a case the one who inflicted the injury must continue paying damages. According to the parallel in the Babylonian Talmud, however, the wound may have broken open and become 45  A variant reading appears in the Escorial manuscript of the Talmud Yerushalmi: even if the injured person acts against his physician’s advice, the one who inflicted the injury is obliged to continue paying damages. See also Mekhilta Neziqin 6, ed. Lauterbach p. 269, quoted and commented upon by Yadin 2004, 127. According to Bavli Bava Qama 85a, the offender also has to pay the medical expenses if ulcers developed and prevented the wound from healing, see Rosner 1977, 104.

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gargutani because the patient ate honey and other types of sweets, which were considered to prevent a wound from healing (b. B.Q. 85a). In such a case he would not be entitled to receive further payment for his medical treatment. The rabbis of the Bavli not only suggest possible connections between certain diets and illnesses, they also seem to have been knowledgeable about medical treatments. A wound that has become gargutani can allegedly be cured by applying ‘aloes, wax, and resin’ (ibid.). Yet another context in which a physician could become halakhically relevant was betrothal and marriage. According to Mishnah Ketuvot 7:8–9, the betrothal of a woman who has taken certain vows, or who has certain physical blemishes without the prospective husband’s knowledge, is invalidated. The Talmud Yerushalmi (Yerushalmi Ketuvot 7:8–9, 31c) quotes the following tannaitic tradition: ‘If she went to an elder and he released her [vow], behold, she is betrothed. If she went to a physician and he healed her, behold, she is not betrothed’ (cf. Tosefta Ketuvot 7:7).46 In order to explain these different outcomes, the Yerushalmi editors ask about the difference between an elder and a physician and provide the following (anonymous) answer: ‘An elder uproots the vow from its roots. A physician heals her only for a certain time’. As a religious intermediary, an elder is able to annul the vow as if it never existed. The physician, on the other hand, can bring about temporary healing only; the blemish (or disease) itself could persist and flare up again at a later time. Nevertheless, not all rabbis were convinced of the elder’s abilities. The Yerushalmi therefore notes that ‘There are tannaim who teach: Even if she went to an elder and he released her [from the vow], she is not betrothed’ (ibid.).

The Involvement of Rabbinic Physicians and Sages and Their Students in Healings

In the Talmud Yerushalmi a rabbi can bear the cognomen ‘physician’ and a physician is introduced as an ‘associate’ (chaver) of rabbis. Rabbis ask physicians for halakhic advice, and rabbis and their students are presented as involved in healings. These phenomena indicate a certain amount of overlap in the literary representation of rabbis and (Jewish) physicians. Although rabbis and physicians generally assumed different roles and functions, there were instances in which they were thought to merge. This phenomenon is another outcome of

46  The Tosefta version is more detailed and slightly different: it features a ‘sage’ rather than an ‘elder’; as a consequence of the physician’s healing, she is betrothed.

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the rabbinic tendency to integrate and utilize physicians and their knowledge, to make them subservient to their own halakhic endeavors. In Yerushalmi Berakhot 2:3, 4c a halakhic solution is attributed to R. Ammi ‘the physician’ (‫ )אסיא‬in a context which is not related to ill health but to impurity: can one wear tefillin and pray at a beach on which excrement is found? R. Ammi allegedly mentioned another rabbi’s suggestion that one should cover the excrement with a cloth; nevertheless, this cover-up was not considered sufficient. The cognomen ‘the physician’ seems to be used here to distinguish this R. Ammi from other rabbis by that name who were known to the editors. R. Ammi might have worked as a physician just as other rabbis followed other types of professions besides giving halakhic advice. In the context of Sabbath observance R. Yose is said to have asked his colleague R. Yaaqov b. Acha’s physician about the latter’s toothache. Whereas the physician’s answer is not transmitted, R. Yose allegedly decided that it is permitted to treat painful teeth on a Sabbath (Yerushalmi Shabbat 6:6, 8c). R. Yaaqov b. Acha is called ‘our associate’ in this tradition as is a physician in Yerushalmi Demai 3:1, 23b, in a case involving the feeding of a patient who is an am haaretz—one who does not abide by the strict rules of tithing produce. According to rabbis, the physician may put the untithed food into the patient’s hand, but not into his mouth. While physicians can be identified as rabbis or associates, rabbis are also said to have made their own decisions with regard to medical treatments that could interfere with religious observances, and advised each other in this regard. In Yerushalmi tractate Shabbat many such instances are discussed. For example, according to Mishnah Shabbat 6:5, a woman may not leave the house with wool in her ear on the Sabbath, and if it fell out, she may not put it back in. The Yerushalmi (y. Shab. 6:5, 8b–c) transmits a story about R. Zeira, who wanted to put wool back into his ear because he had an ear ache. His colleagues are said to have rebuked him. According to R. Yannai, ‘it is the oil on the wool that does the healing’, whereas other sages maintained that it is the wool that does the healing (ibid. 8c). Rabbinic literature presents rabbis as very knowledgeable about epidemiology and folk medicine.47 For example, according to Mishnah Taanit 3:4, one can speak of ‘pestilence’ in a town where three out of five hundred people die 47  Amar 1996, 58–61, points out that rabbinic texts mention hundreds of plants that were used for medicinal purposes. In addition, medical instructions and practices are referred to in a number of contexts including Sabbath observance. Rabbis were also very aware of the connection between diet and health, as already mentioned above. See also Rosner 1977, 154–5.

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within three consecutive days—that is, where a mortality rate of 0.6 per cent occurs within three days of the outbreak. Once the disease had become contagious, the death toll would have increased. Pestilence and other epidemic diseases were a constant fear of the ancients, and supplications—prayers asking God to deliver humans from pestilence and other afflictions—also became a part of Christian liturgy in late antiquity.48 In contrast to the image of Jesus as a healer, rabbis and their students are rarely presented as supernatural healers in rabbinic sources. As Lindbeck has already pointed out, ‘the Talmud has a number of stories of Sages praying for help in times of drought or other community disasters, but it very seldom tells of rabbis miraculously helping or healing individuals’.49 The very fact that Christians stressed miracle healing may have averted rabbis from presenting themselves in a similar way. In general, rabbis did not claim charismatic powers; their authority was based on Torah knowledge. Only a few individuals who probably stood outside of the rabbinic movement but were later ‘rabbinized’, such as Chanina b. Dosa, are associated with healings. According to a possibly tannaitic tradition transmitted in Yerushalmi Berakhot 5:5, 9d, R. Gamliel sent for ‘Rabbi’ Chanina b. Dosa to heal his son. The way in which the healing was accomplished is not specified. The story merely relates that when Chanina came down from the upper room, he said that the son had recovered.50 The miraculous element was probably intentionally left out by the rabbinic tradents and/or editors of the narrative. It is also missing in a story about a disciple of the patriarch R. Yehudah ha-Nasi, who allegedly healed a slave of a Roman emperor by the name Antoninus: ‘He said to him: Why is it that you are lying down while your master [Antoninus] is standing on his feet? Immediately the man shook violently and rose’ (Leviticus Rabbah 10:4). In line with the focus of rabbis on words, miraculous actions are replaced by a speech act here. Similarly, rabbinic predictions that someone would die as a punishment of his actions are generally presented as efficacious.

48  On this issue see Stathakopoulos 2004, 23–34 (quantitative overview from the fourth century onwards). 49  Lindbeck 2010, 139. 50  On Hanina b. Dosa and his ‘rabbinization’ see Bokser 1985, 42–92. See also Freyne 1980, 227–47.

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Rabbis as Patients

Numerous rabbinic texts present rabbis as afflicted with diseases, on deathbeds, and as patients. Interestingly, they are presented as having sought healing from diverse sources, ranging from gentile healers to rabbinic impersonations of biblical prophets. Two texts shall serve as examples here. Yerushalmi Avodah Zarah 2:2, 40d relates the following Aramaic example story following a halakhic rule: R. Abbahu in the name of R. Yochanan: Scurvy is a danger to life [and therefore may be healed on the Sabbath]. R. Yochanan had it and he received treatment from [the daughter of?] Domitian in Tiberias. On [Sabbath] eve he went down to her. He said to her: Shall I need anything for tomorrow? She said to him: No. But if you need something, take stones of dates, and some say: of Nicolaos dates, split [into pieces] and burned, a chaff of barley and the excrement of a minor, and grind and apply it. But do not tell anyone.51 Various aspects of the story are extraordinary: a rabbi seeks healing from a gentile woman on the eve of the Sabbath; the female healer suggests a secret concoction containing excrement, reminiscent of magical recipes. One of the conclusions derived from the story is the general rule, attributed to R. Yaqov b. Acha in the name of R. Yochanan: ‘If he or she [i.e., a gentile] was an expert physician [or: craftsman physician] it is permitted [to seek and accept healing from him/her]’. At the other end of healing stories is a story transmitted in Yerushalmi Ketuvot 12:3, 35a about the patriarch Rabbi who allegedly ‘spent thirteen years suffering from a toothache’, whereupon ‘Elijah came to him in the guise of R. Chiyya the Elder’. When he showed him his painful tooth, ‘he (Elijah) put his finger on the tooth and healed it’.52 Healing by a rabbinic colleague is associated with prophetic and divine healing here. The rabbinic healer was believed to be temporarily ‘possessed’ by Elijah’s power, which enabled him to carry out the healing. This identification allowed the tradents of the story to ultimately trace the healing back to God. The focus of the narrative is on the rivalry

51  The story has a parallel in y. Shab. 14:4, 14d. 52  On this text see also Dvorjetski 2007, 265, suggesting that ‘Rabbi Judah suffered from dental disease, possibly associated with the Tzafdina’.

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between Rabbi and R. Chiyya the Elder: ‘Elijah brings peace between the Sages by performing the cure in the form of R. Chiyya’.53

Amoraic Midrashim: Parables and Proverbs about Physicians and their Practice

Amoraic Midrashim contain a number of parables about physicians in which the physician is referred to metaphorically to explain theological and halakhic matters. The parables are interesting with regard to the practices they associate with physicians—practices which must have seemed realistic to the audience for the narratives to work as similes. The narratives are not historical records but generic tales which allude to well-known aspects of the work of physicians. The halakhic or theological contexts elevate the tales to another, higher level on which alternative, spiritual meanings reveal themselves. An important aspect of a physician’s reputation was his capacity to heal, which would have been most evident with regard to his own body. The physician’s own health could serve as an advertisement for his medical skills whereas his own ill-health could raise suspicions. The Gospel of Luke transmits the proverb: ‘Physician, heal yourself!’ (Luke 4:23).54 Luke may have heard such proverbs in the Hellenistic context in which he wrote.55 The proverb is meant as a challenge—to the physician in its literal meaning and to Jesus in the literary context of the gospel. According to popular assumption, someone who claims to be an expert in healing must be able to apply his expertise to his own body (physician) and to the local community (Jesus), respectively. A parallel to the proverb appears in Genesis Rabbah 23:4 (Theodor-Albeck ed. p. 225): ‘Physician, physician, heal your own limping!’ (‫)אסיה אסיה אסי חוגרתך‬. In the midrashic context the proverb is directed at Adam to remind him of his marital duties of begetting children with Eve. A variant also appears in Leviticus Rabbah 5:6 (Margulies ed. p. 118): ‘R. Levi said: Shame on the province whose physician has gout [‫ ]פטגריטוס‬. . .’.56 Here, the focus is not the self-healing capacities of the physician but his ability to heal others if he is 53  Lindbeck 2010, 33. 54  On this proverb see also Pilch 2000, 94, according to whom the proverb was ‘common in antiquity’, its meaning depending on the context. 55  Mittelstadt 2004, 55 n. 126, refers to a similar proverb by Euripides: ‘A physician for others, but himself teeming with sores’ (Fragments 1086). 56  Jastrow 1886–1890, II, 1139, derives the loan word from Greek ποδάγρα, ‘gout in the feet’, ‘sore foot’. On gout in the Bible and (Babylonian) Talmud see Rosner, 1977, 59–60.

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incapacitated. In the midrashic context the proverb is applied to a sinful priest: like the lame doctor, he would be unable to function as an intermediary in other people’s atonement. Another religiously relevant issue that is explained in rabbinic midrash through a physician parable is kashrut. Midrash Leviticus Rabbah 13:2 (Margulies ed. p. 276) relates: R. Tanhum b. Chanilai said: [The matter may be compared] to [the case of] a physician, who went to visit two sick persons, one who was considered to [continue] living and one who was not considered to [continue] living. He said to the one who was considered to [continue] living: This and this thing you may not eat. But concerning the one who was not considered to [continue] living he said to them [i.e., his relatives]: Give him whatever he requests. In the following nimshal (application), the first patient is compared to Israel and the second to the nations. Like the physician who recommended a special diet, God prohibited Israel to eat certain things, whereas the nations, like the doomed patient, are at liberty to spoil themselves with whatever food they desire. The parable works because its ancient listeners and readers were familiar with the special diets which doctors imposed on sick people, recommending them to eat certain foodstuffs and to avoid others to expedite their healing. Dietetics was an important aspect of ancient medicine from the time of Hippocrates and the Hippocratic corpus onwards, and doctors recommended specific diets ‘as part of the therapeutic process’.57 Obviously, the nutritional recommendations would have varied from one doctor to the next, and also depended on the type of illness. Besides dietetics and pharmaceutics, surgery was a specialized discipline within ancient medicine. Rabbinic midrash refers to surgical practices in another parable transmitted in Lev. R. 18:5 (Margulies ed. p. 412): R. Berekhiah said in the name of R. Levi: [A physician] of flesh and blood wounds with a knife and heals with a plaster, but the Holy One Blessed Be He, with what He wounds He heals, as [it is written]: ‘For I shall restore health to you, and from your wounds I shall heal you’ (Jeremiah 30:17).

57  See Nutton 2004, 97. On Galen’s expanded view of diet to include one’s lifestyle see Nutton 246.

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It remains unclear whether different procedures by one and the same physician or a division of tasks between different physicians are envisioned here. In the context of the midrash the parable is used to show that, unlike humans, God is able to inflict punishment (‘wounds with a knife’) and healing (‘heals with a plaster’) in one and the same way.

(Later) Midrashim and the Babylonian Talmud: Physicians’ Use of Amulets, Magic, and Astrology

Texts which associate physicians with practices or beliefs that could be considered magical are relatively rare in Palestinian rabbinic sources.58 Yet a few such traditions appear in amoraic and especially in later Midrashim and in the Babylonian Talmud, in narratives that deal with Palestinian protagonists. It seems that the line between medicine, religious ritual, and magic was blurred in late antiquity because certain afflictions could be explained in both religious and medical terms. For that reason doctors may have combined various forms of treatments, depending on their assessment of the possible causes. The following parable, also attributed to R. Berekhiah in the name of R. Levi, appears in Lev. R. 26:5 (Margulies ed. pp. 596–7): R. Berekhiah in the name of R. Levi: A parable concerning an [ordinary] Israelite and a priest who were afflicted [with epilepsy, which was seen as being possessed by a demon].59 And they were put into the care of a physician who was an expert in amulets, [or: who made use of amulets made by experts] [‫]רופא קמיע מומחה‬.60 And he gave orders to the Israelite and left the priest alone. The priest said to him: Sir, doctor, you did not treat us in the same way. Why did you give orders to the Israelite and leave me alone? He said to him: This one is an [ordinary] Israelite and he is used to walk among the graves [where he could become possessed by demons]. But you are a priest and you do not normally walk among the graves 58  As Nutton 1992, 55–6, has already pointed out, ‘Magical medicine was always around’, especially in Egypt, but ‘our literary texts play down magical and folk healing.’ At the same time, ‘the definition of what is medical and what is magical is very fluid’ in ancient times (56 n. 165). 59  The Hebrew verb ‫ נכפו‬can mean that they were ‘epileptic’ or ‘overtaken by a demon’, see Jastrow 1886–1890, I, 658. See also Tosefta Bava Batra 4:5. 60  The term amulet, ‫קמיע‬, does not appear in the printed edition, probably because the notion of a physician who was also a magician was unacceptable at that time.

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[in order not to contract ritual uncleanness]. Therefore I gave orders to the Israelite and left you alone. The parable is interesting in a number of regards. Firstly, the physician is associated with expertly made or approved amulets. He may not have made these amulets himself, but was considered able to distinguish between effective and ineffective amulets, prescribing those which he considered effective. Rabbis approved of amulets that were made by experts (see M. Shab. 6:2). An amulet was considered to have been made by an expert if it had brought about healing a second and a third time (Tosefta Shabbat 4:9). According to a tradition attributed to R. Abbahu in the name of R. Yochanan in the Talmud Yerushalmi, a physician is considered reliable when saying: ‘This is an amulet made by an expert: I healed with it and [did so also] a second and a third time’ (Yerushalmi Shabbat 6:2, 8b). The following statement attributed to R. Shmuel in the name of R. Zeira specifies that the repeated healings must have been carried out for different patients: ‘If it cured one person, it is reliable for one person; two persons, it is reliable for two; three persons, it is reliable for everyone’ (ibid.). Such amulets could have consisted of various materials (e.g., wood, leaves, herbs, stones, metals) and only the most expensive ones would have contained writing.61 They would have been used in a variety of ways—for example, worn around one’s neck as a protective charm.62 The underlying assumption of the story is that the shared illness must have had different causes due to the patients’ different religious statuses and lifestyles. The ordinary Israelite is believed to be possessed by demons which took hold of his body when he walked over graves. Therefore the physician considers an expert amulet, known to have brought about exorcisms, the most effective remedy for him. The priest, on the other hand, would have avoided cemeteries. Therefore his affliction must have another cause. Perhaps no alternative medicine is suggested here because the mentioned physician was an expert in amulet healings only. Or the priest as a cultic official was assumed to be healed by God directly. In late antique and early medieval times rabbis seem to have continued to acknowledge the expertise of physicians, but they also increasingly stressed the ultimately divine origin of their treatments and capacity of healing. Genesis 61  On the materials, see T. Shab. 4:9. 62  According to Naveh 1996, 24, ‘healing of illness was usually accomplished by the expulsion of evil spirits, demons, and the evil eye. Most amulets were written for the purpose of curing health problems.’ Sometimes specific illnesses are mentioned on the amulets, but illness can also be combined with other issues.

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Rabbah 10:6 (ed. Theodor Albeck pp. 78–9) is based on the already-mentioned praise of the physician in Sirach chapter 38: The son of Sirach said: God brought up drugs [i.e. medical herbs] from the earth with which the physician heals the wound and the pharmacist [prepares] the remedies. R. Simon said: There is not a single herb which does not have a constellation of the stars [‫ ]מזל‬in heaven which strikes it and says to it: Grow! The rabbinic text alludes to Sirach’s statement that ‘The Lord created medicines from the earth’ (Sir. 38:4), linking the physician’s means of healing to God’s creation and God himself. Both the physician and the pharmacist are represented as God’s healing instruments and intermediaries here. The midrash adds an astrological aspect to the growing of medical herbs by positing a direct relationship between the stars of the zodiac and the thriving—and probably also the potency—of the plants. The relationship between medical science and astrology was blurry in antiquity. Even Galen saw ‘an honorable use of astrology . . . in medicine’ by, at the same time, rejecting charlatans.63 From her study of Galen, Barton concludes that ‘astrology can be seen as a rational adjunct to medicine.’64 Nutton even states that ‘it was precisely the acceptance by Galen of the factual basis of some of the theories of the astrologers which allowed medical astrology to become the stock trade of the educated Galenist physician in Late Antiquity . . .’.65 Nevertheless, Galen rejected ‘magical pharmacy’, a phenomenon the midrash may be alluding to. Others such as Thessalus, who had studied philosophy and medicine in Alexandria, wrote treatises on ‘medico-astrological herbal medicine’.66 The midrashic tradents were probably aware of such theories from hearsay. That they ascribe particular powers to the constellations of the stars is rather peculiar, though. Another tradition that might fall into this category appears in the (probably) late Midrash Qohelet Rabbah: a physician in Sepphoris is said to have ‘possessed the secret of the Ineffable Name’—the secret name of God that was believed to possess special potency, able to kill if used by the wrong person.67 The physician allegedly refused to reveal the name to a rabbi, because he feared that he might misuse it. The midrash explains that in Temple times 63  Galen, On Critical Days K 9.901ff, referred to by Barton 1994a, 53. 64  Barton 54. 65  Nutton 2004, 275. 66  See Nutton 276. 67  Qoh. R. 92:3.

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only certain old and trusted priests were considered worthy of receiving the name. Spells were frowned upon by ‘serious’ Greek physicians such as Galen, but they were widespread in antiquity and used at least by some Egyptian physicians to accompany their treatments and to raise their reputation among the populace.68 Similarly, some Jewish physicians may have tried to enhance their treatments through religious and magical practices. The Babylonian Talmud transmits a story about the Palestinian patriarch R. Yehudah ha-Nasi’s physician (‫)אסייה‬, who was called Shmuel Yarchina’ah (‫—)ירחינאה‬that is, the ‘lunar expert’ or astronomer, since the name is derived from ‫ירח‬, ‘moon’ (Bavli Bava Metzia 85b–86a). When Rabbi, who suffered from an eye disease, rejected more traditional medical treatments such as cleaning the eye with a medicinal lotion and applying an ointment, the physician is said to have placed a pouch with spices69 underneath his pillow—an alternative method resembling aromatherapy, which allegedly led to his healing. In the continuation of the story, the physician tells Rabbi that he has seen the ‘Book of the First Adam’ or human being (‫)סיפרא דאדם הראשׁון‬, in which his healing of Rabbi was already predicted.70 This book, a ‘compendium of esoteric lore’,71 is also said to have contained information about rabbinic succession—that is, it was believed to be relevant to rabbis. The story is written in Aramaic and transmitted in the Babylonian Talmud. Despite featuring a Palestinian patriarch, its envisioned setting was probably Sasanian Babylonia rather than Roman Palestine, since Shmuel Yarchina’ah was a Babylonian doctor and sage.72 Louis Ginzberg has suggested that the Book of Adam represented ‘the Jewish form of a view, prevalent among 68  On the wide use of spells, amulets, and other ‘magical’ remedies see Nutton 2004, 276. On physicians in Egypt using spells and other magical devices see Allen 2005, 14. 69  Aramaic: ‫בגובתא דסמני‬, which Jastrow 1890–1896, II, 1002, translates as ‘the tube containing the medicine’. It is unclear, though, whether the same medicine which the doctor offered to directly apply to his eye is meant here or an alternative treatment through a kind of aromatherapy. Since ‫ סמן‬was an ‘ingredient of frankincense’ (see ibid.), the term probably refers to spices. Rosner 1977, 110–11, suggests that the physician was ‘placing a vial of chemicals under the rabbi’s pillow so that the powerful vapors would penetrate the eye.’ 70  The Book of Adam is already mentioned in Ex. 31:2 as a book of ‘all the generations destined to appear from the creation until the resurrection of the dead’—that is, all generations of humankind. In the Babylonian Talmud the idea is expanded to include individual fates. 71  See Rubenstein 2003, 5. 72  Schiffman 2003, 357, identifies Shmuel Yarchina’ah with Shmuel b. Abba, a first-generation Babylonian amora believed to have lived in the first half of the third century CE.

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the Babylonians, that the totality of divine knowledge and of destiny is written on tablets . . .’.73 The Babylonian creation epic Enuma Elish mentions ‘tablets of fate’ or destinies, sealed by the god Marduk.74 In the context of predestination the physician merely functions as an executor in a divinely determined scheme. His knowledge and treatment can bring about healing only if it is part of the divine plan. In contrast to late antique Palestinian rabbinic literature, the Babylonian Talmud explicitly mentions various forms of magic and links them to healings. As Kottek has already pointed out, ‘in Babylonia . . . medicine and magic were closely intertwined, at least in popular lore’.75 Babylonian Talmudic references to magical healings have to be examined within the Sasanian and Zoroastrian cultural context in which the Bavli developed, a task which will hopefully be undertaken by scholars in the future. Conclusions Whereas the Hebrew Bible emphasized that only God was able to heal illnesses because he had full control over the life and death of human beings, in Hellenistic times at least wealthy and educated Jews from the upper strata of society seem to have increasingly accepted Greek medicine and physicians. Some Jews who lived in the major cities of the Near East would have trained and worked as physicians themselves. Their services would have also been requested for religious and ritual purposes by prominent Jewish families and by the institution of the Temple: for example, to circumcise their sons and to examine sacrificial animals for damages. The books of Ben Sirach and Philo of Alexandria provide evidence of the acceptance of Greek medicine and physicians in Hellenized upper-class Jewish circles in late Hellenistic and early Roman times. In Palestinian rabbinic literature of the first to fifth centuries CE, physicians and their knowledge are utilized and made subservient to religious rituals and rabbinic halakhah. At the same time physicians as experts of the human body are clearly distinguished from rabbis as religious authorities, notwithstanding some overlap: a few rabbis may have made a living by working as physicians; The Palestinian patriarch of his time would have been R. Yehudah Nasia (II) then. Ricci 1949, 41, also considers him Babylonian, but earlier and contemporaneous with Rabbi. 73  This view (expressed in Ginzberg 1954) is mentioned by Wineman 1998, 39. 74  Wiseman 39. 75  Kottek 1996, 33.

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rabbinic literature presents rabbis as very knowledgeable of folk medicine. In his study of the relationship between religion and medicine Amundsen points to a model in which ‘medicine is subordinated under religion’, a phenomenon prevalent in societies whose members adhere to one religion. In such societies, ‘religion’s all-inclusive concern with humanity’s well-being provides the exclusive context for medicine’s much more limited concern with the well-being of the body.’76 The biblical tradition on which rabbinic Judaism was based saw human beings as a unity of body and soul created by God and subject to his protection or destruction. Rabbinic halakhah created guidelines for all areas of daily life, encompassing the physical aspects of human embodiment in which the body was exposed to a variety of dangers, from illness to injuries and accidents. Dealing with physical inflictions could overlap and interfere with the carrying out of religious precepts and rituals such as Sabbath observance and family purity. Therefore rabbis used medical knowledge for their own purposes and made (Jewish) physicians subservient to their type of religiosity, believing that, ultimately, they served as instruments of God. Interestingly, Palestinian rabbinic literature generally refrains from presenting rabbis as religious healers in the same way in which the miraculous healings of Jesus and early Christian charismatics were propagated by the early Church. This may have been due to a concerted effort of rabbinic tradents and editors to distinguish the rabbinic movement from emerging Christianity. On the other hand, rabbis did not hesitate to brag about their knowledge of the human body and natural remedies. This knowledge was required to make proper decisions in halakhic matters. It seems that ancient rabbinic discussions about medical issues constitute the basis for the development of a more systematic and comprehensive Jewish medical ethics in medieval and modern times. In the Babylonian Talmud and early medieval midrashic collections the magical element is much more prevalent than in the late antique Palestinian texts. Magic and medicine not only supplement each other but overlap. Amulets, spells, and cosmological speculations are associated with both doctors and rabbis. The proper context for understanding this development would be Persian culture of the third to sixth centuries CE.

76  Amundsen 1996, 2.

chapter 9

Fear, Hope and the Definition of Hippocratic Medicine* Chiara Thumiger

Popular Medicine?

The category ‘popular’, suggestive as it is of an evaluation in terms of epistemological rigorousness or of an indication about the social standing of the individuals or contexts it qualifies, has a multifarious and elusive nature in historical studies. This is even more the case in the field of history of medicine, with its bearing on the construction of scientific discourses and on the transmission of knowledge, on the one hand; and its interlacement with socio-cultural variables on the other. Do we speak of popular in opposition to elite medicine, emphasizing the social standing of its practitioners in one given society? Or do we emphasise methodology and theoretical sophistication in opposition to irrational and magic beliefs, by the standards of one particular scientific tradition? Is it rather a matter of the media (treatises in opposition to votive inscriptions, or papyri containing magic formulas, for instance) underlying the distinction? In the light of all these possible interpretations it is key to apply the label ‘popular’ in specific ways for each historical setting, and avoid, with reference to the ancient world, easy connotations of inferiority by comparison with high, ‘scientific’ discourses.

*  I would like to thank various colleagues in Berlin who listened to an early version of this paper, and commented on it: Giulia Ecca, Oliver Overwien, Wei Cheng, Francesca Corazza, Christina Savino, Irene Calà, Orly Lewis, Anna Maria Kanthak; Giulia Ecca who proofread the Greek; Piero Tassinari for letting me read his unpublished paper on ancient prognosis ‘From Kos to Pergamon: Hippocrates and Galen on the signs of disease’. I am very grateful to Lorenzo Perilli for important advice during my research for this paper and on the final version; he has helped correct many imprecisions and avoid simplifications (although I am of course responsible for all remaining shortcomings), and to D. Konstan for insights about the problems posed by ‘hope’ as emotion in historical studies; to the audience at the conference for their illuminating questions, and to William Harris who organised this important event. Last but not least, I should like to thank the Alexander von Humboldt Foundation which finances my research, and Philip van der Eijk for his continuous help and support.

© trustees of columbia university in the city of new york, ���6 | doi ��.��63/9789004326040_010

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The particular historical setting I propose to explore is that of classical medicine, i.e. the fifth- and fourth-century medical texts that are preserved as part of the Hippocratic Corpus. These testify to a key moment in the self-definition of ancient medicine as science (as such, committed to methodological principles) and techne (as such, teachable and practical) and of the professional figure of the doctor in ancient Greece separately from—as well as in competition, and necessarily in dialogue with—other traditional, non-scientific forms of healing for which we use here the label ‘popular’. In which ways did these ‘scientific’ doctors, committed to the empirical observation of patients and/ or to the elaboration of theoretical and explanatory models in their attempts to cure diseases, strive to distance themselves from operators associated with superstitious belief systems or irrational practices aimed, above all, at gratifying the patients’ desires and meeting their psychological needs? In which way do these strategies help us understand ‘popular medicine’ as alternative, and complementary to ‘high medicine’? One of the areas in which this self-definition visibly took place, I propose, is the management of emotions, in particular of the intense, negative patient feelings that accompany illness. To illustrate this I wish to explore the way in which the Hippocratic doctors handled a key experience: the attempt to foresee and control one’s own (or someone else’s) future, with the optimism and hope, as well as pessimism and fear this necessarily involves. These two emotional spheres, that I label here comprehensively as ‘hope’ and ‘fear’, are the irreducible background to any medical culture—we may even say that they are at the origin of any human attempt to make one’s health and survival an objective.1 1  Although emotions studies have not yet focused extensively on the topic with reference to the ancient world, it has been noticed that an equivalent for our ‘hope’ rarely features in ancient lists of emotions. Based on this, one might be inclined to exclude the existence of an emotion indicating irrational and blind positive openness towards the future in these sources; one may object (as D. Konstan pointed out to me in conversation) that ‘hope’ intended as the opposite of ‘fear’—fear is pain at anticipated future events, and hope is pleasure at the prospect of such events—is hard to trace in ancient evidence, which suggests an entirely different emotional make up for these expectations about the future from our own. As Konstan notices, for Aristotle the opposite of φόβος is θάρρος: confidence, rather than hope. This point deserves detailed discussion, which could not find space here; to the purpose of our exploration, however, I take the patients’ wishful and anxious tension towards a positive outcome to be a universally shared experience, on which we should resist the temptation to follow too radically a constructionist view. Such self-soothing, optimistic expectation of favourable outcomes, driven by pure desire rather than by rational reckoning is the emotion felt by Hector a moment away from his death, at Il. 22, 279–88, as he manages to avoid Achilles’ first blow and for a moment convinces himself that perhaps not all is lost, and the (well-known) prediction

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They are prominent in popular medical expressions such as votive offerings and ritual procedures;2 at the same time, however, they are also aspects our professional physicians could not ignore. In a world where little reliable scientific prognosis or seriously effective therapy for severe diseases could be available, and in which almost no palliative or anesthetic proper were at hand to alleviate pain, the Hippocratic doctor must necessarily face the strong irrational forces that human physical suffering gives rise to. Moreover, unlike in our own (Western, urban) medical cultures, where for a cancer patient, say, to submit to public health care protocols or to follow a branch of alternative medicine would be two entirely discrete, indeed irreconcilable healing venues, the possibilities offered by different kinds of practitioners were far less segregated at the time of Hippocrates. As a consequence, while the modern patient would not expect his oncologist to note, give hearing to or address his fears and hopes as part of the therapy, and he would switch to other healing or spiritual authorities for emotional coaching, we cannot envisage any such sharp dichotomy for the ancient world. Of course spiritual comfort could be looked for elsewhere, away from the professional medical operator; at the same time, in the absence of any ‘official’, ‘certified’ medical care system the expectations patients had about the kind of help and support they were receiving from one or the other authority could not possibly have been as sharply kept apart as they are nowadays. In such a mixed framework of patient expectations and healing discourses, the way the Hippocratic physician chose to handle the irrational aspects and the strong emotions that accompany disease is a key passage in the establishment, and individuation of scientific (elite, professional) medicine vs. popular medicine.

Traditional Views about Health and Foresight

Which traditional ideas about human attempts to foresee the future—and the emotional tensions thereby involved—were widespread in Greece by the time of our period of analysis? Inspection and scrutiny of outcomes present, past and future, considered in a wider cultural frame, are contemplated and about his imminent death might, after all, be false: ‘It seems you missed, godlike Achilles! | so you did not really know that Zeus has doomed me. And still you said it! It was mere glibness of speech, mere verbal cunning | trying to unnerve me with fright, to make me lose strength and courage’ (transl. by A.S. Kline, with adjustments, 2009). 2  See Martzavou 2013 on the rhetoric of hope and anxiety displayed by the iamata inscriptions of Epidaurus; Pearcy 2013.

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complicated by subtle distinctions from a very early stage in Greek culture. The very word ἐλπίς (a well-known key term in Hippocratic epistemology as well, as we shall see) displays an oscillation between rational and irrational: not only in its double meaning of ‘reckoning’ and ‘positive/optimistic expectation’, partly overlapping with our ‘hope’3—a first dichotomy between rational and irrational ἐλπίς (i.e. a neutral and an evaluative meaning); but also in a second distinction between beneficial and harmful ‘positive expectation’ (two different kinds of irrational ἐλπίς: when Hesiod speaks of a bad ἐλπίς in Erga 498–501, the idle delusion that leads to ruin, he is opposing it to a good, protreptic optimism, we may think).4 Democritus DK 58 offers a similar distinction, if possibly more anchored to a rational dimension: ‘the expectations of right-thinking men are easy to reach, but those of men without understanding are impossible’ (ἐλπίδες αἱ τῶν ὀρθὰ φρονεόντων ἐφικταί, αἱ δὲ τῶν ἀξυνέτων ἀδύνατοι), and again, at 292, ἀλόγοι τῶν ἀξυνέτων αἱ ἐλπίδες, ‘the expectations of unwise men are senseless’; finally, the controversial destiny of ἐλπίς in the Erga adds to the duplicity of the concept.5 We cannot devote space to the interpretation of these various 3  On which Myres 1949; Perilli 1994, 67–78, for a rich discussion of a variety of texts identifying aspects of ‘irrational hope’ in some ancient sources, concluding, however, that ‘an acceptation akin to “conjecture” ’, a [form of] rationality’ seems to be recognisable across the whole range of Greek literature (73, my translation); see nn. 19 and 20 for further bibliography. 4  Erga 498–501: πολλὰ δ‘ ἀεργὸς ἀνήρ, κενεὴν ἐπὶ ἐλπίδα μίμνων, χρηίζων βιότοιο, κακὰ προσελέξατο θυμῷ. ἐλπὶς δ’ οὐκ ἀγαθὴ κεχρημένον ἄνδρα κομίζει, ἥμενον ἐν λέσχῃ, τῷ μὴ βίος ἄρκιος εἴη. The idle man who waits on empty expectations, lacking a livelihood, turns his mind to wrongdoings; it is not a good elpis that accompanies a needy man who gossips in idleness while he has no sure livelihood. 5  At Erga 96–8 ἐλπίς is categorised as an evil, as it is placed within the mythological jar of evils containing negative entities, such as poverty and disease; according to the story, however, it is left in the jar, whereas the other ills are left to wander the earth; she remains, or so it seems, unattainable (see West ad loc. for a discussion): μούνη δ’ αὐτόθι Ἐλπὶς ἐν ἀρρήκτοισι δόμοισιν ἔνδον ἔμεινε πίθου ὑπὸ χείλεσιν οὐδὲ θύραζε ἐξέπτη· πρόσθεν γὰρ ἐπέμβαλε πῶμα πίθοιο Only Hope remained there in an unbreakable home within under the rim of the great jar, and did not fly out at the door; for there the lid of the jar stopped her.

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(and controversial) passages; they appear to be however clear on one point: the existence of a discussion about the value of human scrutiny and knowledge of the future as problematic and ambivalent intellectual activities, as reflected by the feelings they give rise to.6 There is a third complication of particular interest for us (and paradoxical from the point of view of scientific thought): the pleasures and benefits, often reflected upon, of not knowing about one’s destiny. This last point is also firmly present in Greek awareness, indeed a classic feature of Greek popular existentialism. The ambivalence towards what is worth knowing and what is precisely worth ignoring is best illustrated through tragic examples: at the height of his misfortune Ajax says to his child, Aj. 552–5: ‘life is sweetest, as long as we are aware of nothing, before having learnt what it means to feel pain or joy’ (ἐν τῷ φρονεῖν γὰρ μηδὲν ἥδιστος βίος |ἕως τὸ χαίρειν καὶ τὸ λυπεῖσθαι μάθῃς); at OT 1068, the wish bestowed onto the unlucky Oedipus is to preserve ignorance, ‘may you never be aware of who you are!’ (ὦ δύσποτμ᾿, εἴθε μήποτε γνοίης ὃς εἶ); and so on. Among these traditional and literary views there is one text which serves the purposes of our enquiry especially well, a text in which the reckoning of the future and its emotions are explicitly associated to medicine, and precisely to medicine as techne: the tragedy Prometheus Bound. Indeed, this is one of the first occurrences of the term techne with reference to medical activity, perhaps even the first in surviving Greek literature; we cannot establish this with certainty, given the dating and paternity question surrounding this play.7 To the purposes of our discussion, it suffices to say that this text belongs to the period between the years 60s and 20s of the fifth century, and as such it is precious to shed light on how medicine (both as techne and as experience) was understood by a general public in the heart of fifth-century Greek culture. If in the play medicine is not presented concretely as the practice of therapeutical procedures– no actual healing act is performed—it is more than a conventional piece of imagery.8 The dramatic context is in fact the very spe6  See also Martinazzoli 1946; Fränkel 1969, 329–34; Arrighetti 1970–1. 7  The play is generally dated to the 60–50s or the 30–20s of the fifth century: i.e. it is taken either to be a late Aeschylean play, even later than the Oresteia (458) (on the basis of stylistic analysis—Sophoclean influences, dialogue structure, use of the antilabe) or ascribed to the years 440–430, i.e., it is thought to be a non-Aeschylean, sophistic work openly challenging Aeschylean theology. Griffith 1983 and Zuntz 1993 leave the question open, regarding the case against authenticity as not sufficiently strong; Marzullo 1993 is one of the few scholars to firmly reject the Aeschylean paternity. The play was first or second of a trilogy, with Prometheus Unbound and perhaps Fire-bearer (Purophoros). 8  This play and the work of Aeschylus more generally have received attention for their engagement with medical technical languages, practices and themes; Zuntz 1993, Marzullo

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cial punishment inflicted to the titan Prometheus by Zeus. Prometheus has been chained to a mountain rock, and is exposed to the daily torture of being visited by an eagle which comes to devour his liver; after each visit the organ grows again allowing the ordeal endless repetition. The titan’s suffering, represented as an excruciating illness, is mirrored by that of the cow-maiden Io, who encounters Prometheus in the course of her frenzied wanderings and receives from him a prophecy which finally alleviates her pain. In a literal sense, first of all, medicine is formally introduced as one of the technai (477, οἵας τέχνας τε καὶ πόρους ἐμησάμην, ‘which arts and resources I devised’), one of the gifts (listed at 436–506) Prometheus has given to humanity: τὸ μὲν μέγιστον, εἴ τις ἐς νόσον πέσοι, οὐκ ἦν ἀλέξημ’ οὐδέν, οὔτε βρώσιμον, οὐ χριστόν, οὐδὲ πιστόν, ἀλλὰ φαρμάκων χρείᾳ κατεσκέλλοντο, πρίν γ’ ἐγώ σφισιν ἔδειξα κράσεις ἠπίων ἀκεσμάτων, αἷς τὰς ἁπάσας ἐξαμύνονται νόσους. the greatest benefit [was this], if one fell into a disease, [previously] there was no remedy, no curative food, ointment, or drink, but for want of drugs they would perish, until I showed them the mixture of beneficial remedies, with which they might keep away all illnesses (478–83). First and foremost, medicine is presented not as a generic healing activity of a divinely inspired kind, but as a technical skill proper, taught by Prometheus to be learnt by man (ἔδειξα), and comprising different procedures and medicaments (ointments or drugs to mix to the right proportion, dietetic prescriptions of food and drinks). Secondly, medicine participates in the play in a complex metaphorical design. This is in itself not unique in tragic poetry, as well as literary

1993, Bain 1995, Podlecki 2005, Griffith 1977, 1983, Ruffell 2012. On medicine in the play, see Guardasole 2000a, 40–58, for an introduction to Aeschylus in this respect, and 49–50 on Prometheus Bound; Hughes Fowler 1957. One of the most cogent pieces of evidence for a reference to medicine as a professional skill in the play is the use of technical language: the distinction between the term νόσημα and νόσος (at 225, 978); the use of ἀλέξημα, κρᾶσις for drugs preparation, unique to this play in Aeschylus: see Guardasole 2000a, 49 n. 59.

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representations more generally and political imagery.9 Disease and malaise in particular, νόσος, are well known to be part of Aeschylean poetic idiom; so, whether the play is genuinely Aeschylean or manieristically composed in an Aeschylean fashion, the use of medical imagery is still not exceptional. The extent of the allusion in this play, however, in its combination with the reference to medicine as taught art and with real bodily suffering make it uniquely instructive for an inquiry about popular perceptions on healing activities. References to disease and healing are here a fundamental metaphor for the expiation of transgression and the redressing of misfortune that are the core of the plot.10 Thirdly, there is the portrayal of Prometheus. In this play the imagery of disease and cure is associated to concrete physical pain, most of all the mutilation of Prometheus’s liver and its pointless healing, effectively a caricature of the health-disease-recovery, or health-disease-death curve human patients must go through. Moreover, the sufferer is at the same time his own self-healer, and possibly the healer of others (the fellow-sufferer Io, as well as mankind as a whole), and a teacher of medical techne, as we have seen: the scope and aim of the activity of the medical practitioner, not only the suffering state of the patient are brought into the picture. In this way, we are deep into a set of medical allusions when we get to the topic of knowledge of the future and medical prognosis we have proposed to analyse. At 698, the chorus celebrates the importance of knowing the end of one’s suffering, imploring Prometheus to speak: λέγ’, ἐκδίδασκε· τοῖς νοσοῦσί τοι γλυκὺ τὸ λοιπὸν ἄλγος προυξεπίστασθαι τορῶς: ‘speak, show/teach us: for the ill it is sweet to know in advance the end of one’s remaining suffering’: sweet is to be able to anticipate the end of pain, and cultivate ‘hope’. These verses build 9   For the dialogue between tragedy and medicine see Pigeaud on mental disturbance (1976, 1981), the monograph by Guardasole 2000a, and earlier Jouanna (1987 and 1988) for an exposition of data and methodological issues; Holmes (2008 and 2010, 228–74) on Euripides and Hippocratic medicine; Kosak 2004; on medical imagery and the political, see Brock 2000, 2006, 2013, 69–82; Cagnetta (2001). 10  Prometheus’ need to appease Zeus is described as an attempt to ‘heal ill drives with words’, as the chorus suggest that ὀργῆς νοσούσης εἰσὶν ἰατροὶ λόγοι, as early as vv. 377–8 (Jouanna 2012, 69, mentions scholiastic commentaries attributing Hippocratic influence to this passage); at 479–80, in his status as victim and holder of special powers and knowledge, Prometheus is compared to a ‘bad doctor who fell ill (in turn)’, κακὸς δ’ ἰατρὸς ὥς τις ἐς νόσον πεσών; at 596, the suffering of the other victimised character in the play, the maiden-cow Io, is a θεόσυτόν . . . νόσον, a divine disease against which she longs for a remedy (τί μῆχαρ, ἢ τί φάρμακον νόσου, 506); the chorus wishes to interrogate her disease, almost in a scientific manner (they state: πρῶτον ἱστορήσωμεν νόσον, 632).

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on an earlier gnomic statement (536–9), ἡδύ τι θαρσαλέαις | τὸν μακρὸν τείνειν βίον ἐλπίσι, φαναῖς | θυμὸν ἀλδαίνουσαν ἐν εὐφροσύναις | φρίσσω δέ σε δερκομένα | μυρίοις μόχθοις διακναιόμενον . . ., ‘it is sweet to stretch one’s life forward with the sweetness of hope, corroborating it with joy; but I shudder to look upon you, grated by ten thousand sufferings . . .’. The prognostic tension comes from a deeply empathic party, the chorus, and derives from the disturbing contemplation of the physical pain of another, gaining value from its relationship with hope, which makes it γλυκύ, ‘sweet’. On the other hand, the play complicates the emotions that accompany the foresight and enjoyment of good health, problematising the equivalence of knowing the future with ‘good’ and not knowing it with ‘bad’ (the scientific equivalence we would be drawn to make, given the early explicit reference to medicine as a techne one can teach and learn, progressive in nature). The play, instead, insists that there is a gain, sometimes, in not knowing. Earlier in the play, among the gifts offered by the Titan as benefactor of humanity, at the beginning of the list (and most surprisingly) we find ἐλπίς, here intended as the irrational projection of a better future—and specifically an empty, even ill-placed kind of expectation, here indeed approaching our concept of ‘hope’. Once again, the occasion is the compassionate contemplation of the suffering of others (248–50): {Χο.} σιδηρόφρων τοι κἀκ πέτρας εἰργασμένος ὅστις, Προμηθεῦ, σοῖσιν οὐ συνασχαλᾷ μόχθοις· ἐγὼ γὰρ οὔτ’ ἂν εἰσιδεῖν τάδε ἔχρῃζον εἰσιδοῦσά τ’ ἠλγύνθην κέαρ. {Πρ.} καὶ μὴν φίλοις ἐλεινὸς εἰσορᾶν ἐγώ. {Χο.} μή πού τι προύβης τῶνδε καὶ περαιτέρω; Πρ. θνητούς γ’ ἔπαυσα μὴ προδέρκεσθαι μόρον. Χο. τὸ ποῖον εὑρὼν τῆσδε φάρμακον νόσου;   Πρ. τυφλὰς ἐν αὐτοῖς ἐλπίδας κατῴκισα. Χο. μέγ’ ὠφέλημα τοῦτ’ ἐδωρήσω βροτοῖς. ‘One must have a heart of iron, and be made of stone, Prometheus, not to feel compassion at your suffering. For I wish I had not seen this suffering of yours And just by looking at you, my heart is in pain’. ‘Surely my friends feel pity for me as they see me’ ‘But did you not reach even further than that?’ ‘I ceased mortals from foreseeing their own death’ ‘and which medicine did you find for this disease?’

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‘I planted in them blind expectations’ ‘It is a great benefit that you have gifted to the mortals’. The gift, the μέγ’ ὠφέλημα that comes from the acknowledgement of human pain, the φάρμακον for the νόσος of foreseeing death is a μὴ προδέρκεσθαι, the not-seeing allowed by τυφλὰς . . . ἐλπίδας. Both the ‘blind expectations’ and the ability to save oneself through healing and effective medical care are gifts of Prometheus, sides of the same medal. That much Prometheus is in a fit position to appreciate: he has in himself the source of rational foresight, of truthful prognosis (prophecy); the medical knowledge; and the experience of the irrational hopes (and fears) of a sufferer. In fact, precisely because he is a sufferer, a patient of sort, Prometheus himself remains unaided by the techne he taught mortals, as well as by the gift of prophecy he gave to mankind (485), and is left prey to despair and hopelessness, in the chorus’ words (472–5): πέπονθας αἰκὲς πῆμ’ ἀποσφαλεὶς φρενῶν πλάνῃ, κακὸς δ’ ἰατρὸς ὥς τις ἐς νόσον πεσὼν ἀθυμεῖς καὶ σεαυτὸν οὐκ ἔχεις εὑρεῖν ὁποίοις φαρμάκοις ἰάσιμος. Unbearable is the pain you suffer, you are out of yourself and wander off; and as a bad doctor you have fallen into illness, and you are at a loss, and you cannot find with which cure you can heal yourself. In conclusion, not only do we find in Greek literature, as early as the archaic age, mature reflections on the eudaimonistic concerns involved in prognosis, but the first (or at least a very early) mention of medicine as techne in surviving Greek literature is closely associated, in this respect, with elements that seem to characterize Hippocratic medicine by their absence: identification with the pain of others; suffering that is experienced in first person; a highly charged emotionality upon admitting to the limitations of the powers of medicine to control human future.

Knowledge of the Future and Health Prognosis in the Hippocratic Sources

Against a cultural background which has produced the complex representation of Prometheus Bound, in fact, it is at first sight surprising that not only the word ἐλπίς but, most to the point, the human response to the future of one’s

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bodily health in general appears to be applied in such sober manner to matters of efficiency in the Hippocratic texts. With all their differences and variations of genre, the disregard for the subjectivity of emotional experiences these texts display remain constant. The horizon of activity is defined in terms of scientific reckoning and pragmatic feasibility, through a posture of objectivity which does not address patient individual psychology in any explicit way: as Holmes has recently explored, an authority that is disjointed from the experience of its patients is constructed.11 The content of the emotions of hope and fear is the same as that of prognosis, a key part of Hippocratic medicine. Prognosis in the Hippocratic texts has been much discussed, and I should only survey a few key-points briefly.12 As it is well-known, Hippocratic prognosis is declined in the medical sources as knowledge of the future, but also control over what is hidden in the present and past: ‘the present, and what happened before, and what will foreseeably happen’, τά τε παρεόντα καὶ τὰ προγεγονότα καὶ τὰ μέλλοντα ἔσεσθαι, as famously in Progn. 1 (Jouanna 1,3–4 = L. 2.110,3–4).13 The formula is traditional and ­evocative—mantic and poetic skills are often described as displaying similar powers to those of medicine.14 Despite these culturally familiar formulations, in the Hippocratic texts prognosis appears to be restricted in three fundamental ways by comparison with poetic versions of ἐλπίς, as well as accounts and of the experience of foreseeing one’s future. First, it is presented as an act of which the physician is subject and source: in this sense, it resembles closely prognosis in contemporary medical practices. Secondly, it is made to correspond to precise actions, such as cures and diets to be prescribed, and the deliberation on 11  Holmes’ 2013 speaks of ‘disembodiment’, a disruption between the speaking/writing physician’s body and that of the observed patient as two subjectivities which are not allowed to meet (Prometheus, in this sense, offers a wonderful alternative to such model). 12  The classic discussions are Edelstein 1975, Robert 1975, 262–265, Marzullo 1986–87; von Staden 1987; see also Nutton 2004, Lloyd 2005, 56–8. In a broader prospective, on the prognostic sign see Manetti 1987 and 2013, and Sansone 1975, chapter 3, for a discussion of ‘prescience’ in Aeschylean poetry. 13  See Jouanna 2013 ad loc., 82–83. 14  Compare Epid. 1, 5 (L. 2.634.6–7 = Kühlewein 189, 24–190,2), λέγειν τὰ προγενόμενα· γιγνώσκειν τὰ παρεόντα· προλέγειν τὰ ἐσόμενα·, ‘declare the past, recognise the present, pre­ dict the future’. Cf. Plato, Laches 198d, οἷον περὶ τὸ ὑγιεινὸν εἰς ἅπαντας τοὺς χρόνους οὐκ ἄλλη τις ἢ ἰατρική, μία οὖσα, ἐφορᾷ καὶ γιγνόμενα καὶ γεγονότα καὶ γενησόμενα ὅπῃ γενήσεται (quoted by Jouanna 2013 ad loc.), ‘for example, in the case of health, it is medicine always and alone that surveys present, past, and future processes alike’. The tricolon openly recalls the Hesiodic and Homeric epithets for prophets and poets respectively (Il. 1, 69–70; Theog. 32).

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whether or not to attempt a cure on the patient. Thirdly, prognosis emerges as having precise aims and effects: it functions as a ‘PR’ device aimed at gaining the trust of the patient or his/her family, or at least repel criticism. Prognostic accuracy, especially in the most dangerous occurrence of acute diseases (which constitute the bulk of Hippocratic pathology) can secure or severely endanger the reputation of a physician, in particular when an attempt to cure is carried out on a patient who appears to be condemned to die.15 In summary, the prognosis advertised in the treatises of the Hippocratic Corpus seems to convey a fundamentally intellectual and pragmatic dimension that is entirely at odds with popular expectations and views in times of illness. This picure can be filled out further.16 First, the view of the future as a pragmatic form of reckoning. In the Hippocratic sources the term ἐλπίς is used by and large as part of an ‘intellectual vocabulary’, to use Perilli’s expression;17 to indicate rational reckoning of chances of improvement or survival. Thus at Progn. 7.7, L. 2.126.6, Jouanna 18, 3, for example, μανῆναι ἐλπίς, or Prorrh. 1.38, L. 5.520.5 = Polack 79, 12, ἐλπίς ἐκστῆναι, or at Progn. 9, (L. 2.134.1 = Jouanna 25, 10), τὸ νόσημα ἐς ἀπόστασιν τραπῆναι ἐλπίς; the term can indicate chance, as in Epid. 6.8.32 (Manetti-Roselli 194,11 = L. 5.356,12–13) μία ἐλπὶς εἶναι τοῦ γυναι­ κωθῆναι, εἰ τὰ κατὰ φύσιν ἔλθοι, ‘there was only one chance to feminize her: if her period would come’. Such use of ἐλπίς is present in various Hippocratic texts, either with a neutral meaning of ‘prognosis of xy’ or, antonomastically, for ‘chance of survival’. ἐλπίς is thus in these texts a key professional practice indicating the reckoning of the outcome of an illness; as such, it plays an important role in the key decision on the opportunity of treating certain severe cases or not. This crucial point is clearly spelt out in De Arte 3, 6 (Jouanna 226,12–227,1 = L.6.4.17–6.18), where it is said that doctors should ‘not treat those who have been overmastered by the disease’ (i.e., hopeless cases): καὶ πρῶτόν γε διοριεῦμαι ὃ νομίζω ἰητρικὴν εἶναι· τὸ δὴ πάμπαν ἀπαλλάσσειν τῶν νοσεόντων τοὺς καμάτους καὶ τῶν νοσημάτων τὰς σφοδρότητας ἀμβλύνειν, καὶ τὸ μὴ ἐγχειρεῖν τοῖσι κεκρατημένοισιν ὑπὸ τῶν νοσημάτων, εἰδότας ὅτι πάντα ταῦτα δύναται ἰητρική.

15  See Edelstein 1975, 76; Von Staden 1987, 102–3. 16  Other scholarly narratives converge on this point: apart from the discussion of ‘disembodied authority’ in Holmes 2013, already mentioned, see the traditional idea of a figure of medicus amicus only emerging late in Greek tradition (initially proposed by Mudry 1980; see the survey in Stok, 2009). 17  Perilli 1994.

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First I will define what I conceive medicine to be. In general terms, it is to do away with the sufferings of the sick, to lessen the violence of their diseases, and to refuse to treat those who are overmastered by their diseases, realising that those are all the powers of medicine.18 The importance of recognising incurability is a point repeatedly made by the Hippocratic doctor, and found also at Progn. 1 (L. 2.112.10–11 = Jouanna 9–11), τοὺς ἀποθανουμένους τε καὶ σωθησομένους προγιγνώσκων καὶ προαγορεύων ἀναίτιος ἂν εἴη, ‘you will be blameless if you learn and declare in advance19 those who will die and those who will get better’. Several readers have nuanced the received impression that one should never intervene in incurable cases;20 at any rate, the point at stake in this evaluation of the future belongs to professional protocol, and is entirely unconcerned with the emotions of the sufferer.

Managing the Patients’ Hopes and Fears

While in these discussions the point of view of the physician prevails, what happens to the hope and fear felt by the patients who are made the object of medical conjectures, anxiously waiting for a response from their doctor, or wearing themselves out through bodily pain in total uncertainty of the future? In the Hippocratic writings these emotions undergo, I suggest, a process of transmutation, a kind of ‘alchemic’ change.21 These transmutations have the

18  On the question raised by such statement, see Wittern 1979; Rosen and Horstmanshoff 2003, 99–104, on hopelessness in a general discussion of the ἀνδρεῖα that must sustain the physician in his battle against disease (on this agon, see also von Staden 1987, 97–99). 19  For an alternative interpretation of προ-αγορεύω as ‘to give a pronouncement in public’, before many people, rather than ‘saying in advance’ as in Jouanna, 2013 ad loc. see Marzullo 1986–7, 203. 20  See Edelstein 1967b, Wittern 1979, Von Staden 1987, Rosen and Horsmanshoff 2003. Von Staden 1987 has illustrated better than anyone else how these borders between curability and incurability were more shaded and conditional than it might appear at first sight, with a more composite range of attitudes about hopelessness, that left much more room for maneuver. In such a looser epistemological frame, the emotions of the patients become more important than if a certain prognosis of death is established and communicated—it is more open than one would think. 21  I am adopting here a concept taken from Elster’s theory of emotions: the idea that certain emotions, unfitting to a context of communication, or to one’s objectives, or to a convenient agenda or set of values are manipulated through voluntary misrepresentation—cf.

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purpose of validating the professional and technical agenda under construction, and protect it from irrational derailments.22 Let us see some examples. Hopelessness and fear can be reframed as ignorance, ill judgment, and misconduct over which the competence and power of the doctors are made to shine. Consider De arte 7 (Jouanna 231,15–232,3 = L. 6.10,26–12,6): οἱ δ’ οὔτε ἃ κάμνουσιν οὔτε δι’ ἃ κάμνουσιν, οὐδ’ ὅ τι ἐκ τῶν παρεόντων ἔσται οὐδ’ ὅ τι ἐκ τῶν τούτοισιν ὁμοίων γίνεται εἰδότες ἐπιτάσσονται, ἀλγέοντες μὲν ἐν τῷ παρεόντι, φοβεύμενοι δὲ τὸ μέλλον καὶ πλήρεις μὲν τῆς νούσου, κενεοὶ δὲ σιτίων, ἐθέλοντες δὲ τὰ πρὸς τὴν νοῦσον ἤδη μᾶλλον ἢ τὰ πρὸς τὴν ὑγιείην προσδέχεσθαι, οὐκ ἀποθανεῖν ἐρῶντες ἀλλὰ καρτερεῖν ἀδυνατέοντες. the patients know neither what they are suffering from, not the cause thereof; neither what will be the outcome of his present state, nor the usual results of like conditions. In this state he receives orders, suffering in the present and fearful of what is foreseen to come; full of the disease, and empty of food; wishful of treatment rather to enjoy immediate alleviation of his sickness than to recover his health; not in love with death, but powerless to endure. This passage, in line with a posture that is characteristic in De Arte,23 emphasizes the position of the patients as helplessly ignorant, οὐ εἰδότες, pressed between present pain and fear of the future (an emotional caricature of the mantic, and of the professional knowledge of present, past and future claimed by the physician). Emotional intensity is very perceptible in this passage: the expression οὐκ ἀποθανεῖν ἐρῶντες, ‘not because they passionately desire to die’ is a baffling specification which suggests engagement with, or response to a general opinion, the topos that patients, or sufferers ‘would’, at times, ‘rather political discourse- or unconscious transmutation—into new, more fitting formulations: Elster 1999, 332–358. 22  The Hippocratic authors show extreme modesty when it comes to the feelings raised by disease and by the pain of others (Kosak 2005 also acknowledges the ‘lack of pity’ generally displayed by the Hippocratic texts): a unique testimony in this sense is offered by Flat. 1 (Jouanna 102,5–103,2 = L. 6.90,5–7) ὁ μὲν γὰρ ἰητρὸς ὁρεῖ τε δεινά, θιγγάνει τε ἀηδέων, ἐπ’ ἀλλοτρίῃσί τε συμφορῇσιν ἰδίας καρποῦται λύπας, ‘[The physician] sees terrible sights, touches unpleasant things, and the misfortunes of others bring a harvest of sorrows that are peculiarly his’. The austerity of the Hippocratic physician when it comes to human emotions more generally, which are discussed succinctly, and fundamentally in physiological terms, can be read in the same spirit. 23  See Jori 1997, 191.

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die’ than endure the ordeal of illness and cure.24 The possibility of desperation and self-defeat is rejected by this writer—the doctor knows better what these emotions are supposed to be, and how they can be resolved into sound action. The expression ‘love of death’ for suicidal drives is found also at Verg. 3 (L. 8.468.16–7=Lami 24, 7), where the disturbed maiden ἐρᾷ τοῦ θανάτου ὥσπέρ τινος ἀγαθοῦ, ‘longs for death as if it was something good’, and at Mul 177, L. 8.360.5, where the ill woman θανεῖν ἐρᾶται, ‘desires to die’. In these gynecological examples, the symptom De Arte dismisses becomes part of a picture of mental suffering, a form of desperation not further motivated, a sign of distress many others. We can however compare, again, a fragment from the Aeschylean Prometheus Unbound (fr. 193 Radt, 22–4=Cic., Tusc. Disp. 2.22–4) where the physical suffering of Prometheus is directly staged: here the desire to die is clearly part of the pathological experience, even iatrogenic in nature, we may think, as the sufferer is ‘kept away from dying’ (aspellor) by a superior agent. Prometheus’ own words as patient: sic me ipse viduus pestes excipio anxias, amore mortis terminum anquirens mali. sed longe a leto numine aspellor Iovis . . . and so, bereaved of my own self, I endure a succession of anguishing torments, ever seeking an end to my sufferings, longing for death. But the power of Zeus keeps death far away from me. . . . Longing for death and despair seem to be well-known facts in the psychology of the ill; the Hippocratic doctor openly rejects this emotion, reducing it to a case of diminished capacities, so to say, physiologically explained (De Arte) or to a mental disturbance (in the gynecological cases). The feeling of despair that accompanies illness and bodily suffering is explicitly reframed as mental disorder also at Prorrh. 1,8 (Polack 75,14–76,1 = L. 5.512,4–6), which mentions the ‘derangements in those who are letting themselves go/giving up on themselves’, αἱ προ-απαυδησάντων παραφροσύναι, which are κάκισται, ‘most harmful’.25 I interpret the hapax προ-απαυδάω as ‘to be fainting/languishing in advance/in anticipation’, comprising the fear of a nearing crisis or death. On this reading, there would be a ‘derangement 24  The expression is a common hyperbole in tragedy to characterize desperation and intense grief (cf. Soph. Ant. 220, Eur. Hec. 358, Hel. 1639). 25  Potter 1995, 267 ad loc.; see Manetti-Roselli 1982, 174–175 ad loc.

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of hopelessness’, recognized as dangerous. προ-απαυδάω is a difficult term; in support of my reading one may quote the cognate verb used in a much later text, Praeceptiones 9 (Heiberg 33, 19–23 = L. 9.264,19–23). This passage gives explanatory details addressing clearly, this time, the pathogenic power of desperation: ‘the reality of the art’ (οὐσίη τῆς τέχνης), we read, becomes evident if the physician ‘does not refrain from exhortations, urging the patients not to worry in mind, through eagerness to reach the point of recovery . . . for left to themselves patients give up on themselves (ἀπαυδέοντες) through their painful conditions and depart life’, προσαγορεύσιος τοιαύτης μὴ ἀποσταίη.26 This later medical author recognizes the ‘letting oneself go’ as typical of the patient, part and parcel of the experience of disease, whereby the Hippocratic passage reduces the emotion to a pathology—a plain παραφροσύνη.27 Fear transmuted into a mental disturbance is also a frequent move.28 A good example is the Epidemics case of Mnesianax (Epid. 7, 45) (Jouanna 79,24–80,3 = L. 5.414,2–4). His is defined from the start as a case of ὀφθαλμίη, and it is accompanied by mental disturbances throughout. Among them there is one particular obsession, where we may recognize what we call hypochondria:29 ἐπεὶ δ’ ἐντὸς ἑωυτοῦ ἦν καὶ ἐξανίστατο, οὐκ ἐξιέναι ἤθελεν ἀλλὰ δεδιέναι ἔφη· εἰ τέ τις περὶ νουσημάτων χαλεπῶν διαλέγοιτο, ὑπεξῄει φόβῳ, ‘when he regained control over himself and stood up he did not want to go out, but said that he was afraid; and if someone mentioned to him about serious illnesses, he was taken by fear’. In the case of this patient fear of illness (or about his own health, perhaps his vision disturbances) is framed as pathological behavior. The psychology or cognition at work behind these fears are not acknowledged, let alone therapeutically addressed.30 26  κελεύων τοῖσι νοσέουσι μηδὲν ὀχλεῖσθαι κατὰ διάνοιαν ἐν τῷ σπεύδειν ἀφικέσθαι ἐς καιρὸν σωτηρίης . . . αὐτοὶ μὲν γὰρ οἱ νοσέοντες διὰ τὴν ἀλγεινὴν διάθεσιν ἀπαυδέοντες ἑωυτούς [τε] μεταλλάσσουσι τῆς ζωῆς. I thank Giulia Ecca for signaling this reference to me. 27  The references to patients variously described as ἀνέλπιστος are similar: the desperate state is a mere marker of critical state, as at the end of Epid. 3.1, case 6 (L. 3.52.7–8= Kühlewein 221.1–2), ἀνελπίστως ἑωυτῆς εἶχεν, ‘she felt hopeless about herself’. 28  See Di Benedetto 1986, 35–43, on the emotion of fear. 29  On the disease itself as source of fear, and on fear, even possibly, as part of the etiology of the disease see Di Benedetto 1986, 39–40. Fear is clearly recognized as emotional response divergent from actual risk at Epid. 3.4 (L. 3.74.5 = Kühlewein 225, 24–5), where we read that certain ailments were ‘more frightening than [actually] ‘severe’, ἦν δὲ ταῦτα φοβερώτερα ἢ κακίω. 30  The above mentioned recommendations, in Praeceptiones, about the importance of psychological soothing in dealing with the ill come from a much later context (ca. 1–2 AD) than the classical texts we are considering; likewise, we have to wait for the possibly

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The best example of the Hippocratic handling of emotions is how fear is transfigured into shame in a passage from the Sacred Disease (Morb.Sacr. 12.1 (Jouanna 22,13–23, 5 = L. 6.382,19–384,3): ὅσοι δὲ ἤδη ἐθάδες εἰσὶ τῇ νούσῳ, προγινώσκουσιν ὅταν μέλλωσι λήφθήσεσθαι, καὶ φεύγουσιν ἐκ τῶν ἀνθρώπων· ἢν μὲν ἐγγὺς ᾖ αὐτῷ τὰ οἰκία, οἴκαδε, εἰ δὲ μή, ἐς τὸ ἐρημότατον, ὅπῃ μέλλουσιν αὐτὸν ἐλάχιστοι ὄψεσθαι πεσόντα, εὐθύς τε ἐγκαλύπτεται. τοῦτο δὲ ποιεῖ ὑπ’ αἰσχύνης τοῦ πάθεος, καὶ οὐχ ὑπὸ φόβου, ὡς οἱ πολλοὶ νομίζουσι, τοῦ δαιμονίου. τὰ δὲ παιδάρια τὸ μὲν πρῶτον πίπτουσιν ὅπῃ ἂν τύχωσιν ὑπὸ ἀηθίης, ὅταν δὲ πλεονάκις κατάληπτοι γένωνται, ἐπειδὰν προαίσθωνται, φεύγουσι παρὰ τὰς μητέρας ἢ παρὰ ἄλλον ὅντινα μάλιστα γινώσκουσιν, ὑπὸ δέους καὶ φόβου τῆς πάθης· τὸ γὰρ αἰσχύνεσθαι οὔπω γινώσκουσιν. those however who are used to the disease know beforehand when they are about to be seized and flee from men; if their own house be at hand, they run home, but if not, to a deserted place, where as few people as possible will see them falling, and they immediately cover themselves up. This they do from shame of the affection, and not from fear of the divinity, as most people (οἱ πολλοί) suppose. And little children at first fall down wherever they may happen to be, from inexperience. But when they have been often seized, and feel its approach beforehand, they flee to their mothers, or to any other person they are acquainted with, from terror and dread of the affection, for being still infants they do not know yet what it is to be ashamed.31 This author takes some effort, in this rather unique digression, to describe and interpret a specific behavioural aspect, the patients’ desire to flee when an attack is imminent, differentiating between the mature and the childish emotional response to the disease. There are signs of a somehow forced train of thought here, which suggests a second aim: how would a child old enough coeval or however imperial age Decent. 16 (Heiberg 29,17–19 = L. 9.242,5–8) to find mention of the issue of letting patient know about a death prognosis or not: ‘. . . without ever revealing anything of the patient’s future or present condition. For many patients through this cause have taken a turn for the worse, I mean by the declaration I have mentioned of what is present, or by a forecast of what is to come’ (μηδὲν ἐπιδεικνύντα τῶν ἐπεσομένων ἢ ἐνεστώτων αὐτέοισι· πολλοὶ γὰρ δι’ αἰτίην ταύτην ἐφ’ ἕτερα ἀπεώσθησαν διὰ τὴν πρόρρησιν τὴν προειρημένην τῶν ἐνεστώτων ἢ ἐπεσομένων). 31  Transl. by C.D. Adams, with adjustments.

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to feel the attack coming, and seek shelter, be prey to fear of the πάθος (not of the gods or of an unknown force, n.b.) but specifically lack a sense of shame? At any rate, whether this particular point is anthropologically and psychologically true or not, is not important for the present discussion (and impossible to find out, for us as much as for the doctor who wrote that account); what is remarkable, for our discussion, is that in the rational, humanistic spirit of the treatise it is important for the author to exclude fear from the range of patient ailments—as there is nothing to be feared—and dismiss it as the reading of ‘the (ignorant) majority’, ὡς οἱ πολλοὶ νομίζουσι: an optimistic representation of how knowledge of an illness should automatically snatch it away from the realm of fear and (vain) hopes and bring it under rational control. To an external reader, however, this passage speaks equally of the fear that comes with the patient’s personal ‘prognosis’, his or her projection of the attack, and the limitations to what reason can do to master it. Conclusions In conclusion, a portrayal of prognosis in Hippocratic medicine as purely scientific, rational reckoning devoid of any emotional involvement, in opposition to the level strongly tinged with hope and fear on which popular forms of healing operate, tells only a part of the story. What is conspicuous, as I hope to have shown, is the attempt to neutralize these feelings on the part of doctors who constantly had to deal with irrational and emotional appeals in the course of their practice, through strategies of transmutation: into intellectual and scientific shortcomings, into features of mental weakness, or into pathological factors. In this way, the treatment of the fears and hopes involved by diseased experiences in the Hippocratic authors illustrate one of the means through which elite medicine originally endeavored to define itself as profession and art, in opposition to popular practices: via the subjugation of the patients’ emotions to the intellectual authority of the doctor, and through the elision of empathy from the rhetoric of the profession.

chapter 10

Medical Care in the Roman Army during the High Empire Ido Israelowich A range of evidential sources indicate that medical care was habitually provided in the various units of the Roman imperial army.* However, while there is no doubt that medical care was on offer within the Roman army, that it was provided by physicians who were also soldiers, and that it was supervised and managed by military commanders, its extent, raison d’être, formation, and impact on civic medicine are not beyond dispute.1 This chapter will evaluate the scope of medical care available to Roman soldiers during the High Empire and assess its impact on Roman healthcare in general, and upon popular medicine in particular. The essay’s starting point will be an evaluation of the evidence in support of the existence of a ‘medical corps’, and its reach within the military setting. I will then move on to consider its responsibilities, and reconsider the influence of the Roman medical corps on wider society. Finally, to conclude, I will ask whether a ‘grand design’ lay behind the medical corps’ foundation by the Roman imperial government.

Evidence for Medical Care in the Roman Army

There is a wealth of evidence to support the assertion that medical care was available throughout the Roman army. To begin, official titles of military personnel, together with material remains, confirm that soldiers received the services of doctors. Inscriptions commemorated army doctors bearing the titles

* I would like to thank Professor W.V. Harris for inviting me to the Popular Medicine conference in 2014. I am also grateful to the Israeli Science Foundation for generously funding the research leading to this article. 1  Jackson 1988, ch. 4, and Nutton 2013, ch. 12, discuss the impact of the Roman conquest and its army on the evolution of surgery. Wilmanns 1995 is an excellent study on the personnel of the Roman army, as are Davies 1969, 1970, 1972, 1989. Baker 2002 and 2004 provides a fascinating exploration of the archaeological aspects of the military’s valetudinaria.

© trustees of columbia university in the city of new york, ���6 | doi ��.��63/9789004326040_011

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of medicus alae,2 medicus castrensis/castrorum,3 medicus chirurgus,4 medicus clinicus,5 medicus cohortis, medicus duplicarius, medicus legionis, medicus ordinarius, and other variants.6 These inscriptions originate from Britain in the west to Syria in the east, from Germany in the north, to Egypt and North Africa in the south— hence they reveal the presence of army doctors throughout the Empire. They refer to physicians who served in the army and took the soldiers’ oath.7 They indicate a relatively high level of specification amongst army doctors in terms of the medical profession itself (e.g. medicus chirurgus and medicus clinicus); also in terms of jurisdiction (e.g. medicus alae, medicus cohortis, and medicus legionis) and in terms of military status (e.g. medicus duplicarius, medicus ordinarius).8 In addition, inscriptions allude to the officers who were in charge of the administration of medical care within the army units, such as the optio convalescentium and the optio valetudinarii.9 Remains of military hospitals have been recorded in Isca Silurum, Hod Hill, Valekenburg, Vetera, Haltern, Novaesium, Aequae Mattiacorum, Vindonissa, Ehngen- Risstissen, Oberstimm, Quintana, Locica, Carnuntum, Ulcisia Castra, Stojnik am KosmajGebirge, Novae, and Beroea. Inscriptions referring to medical personnel were found in many other military sites, and Juliane Wilmanns has traced evidence for medical personnel in sixty-seven Roman army sites.10 In addition to titular indication of medical personnel, archaeologists have found medical instruments in many of the legionary and auxiliary camps, such as surgical tools and boxes of materia medica.11 These instruments resemble each other throughout the Roman Empire. Moreover, medical authors such as Celsus and Galen, and pharmacological treatises such as those of Scribonius 2  Ephemeris Epigraphica VII no. 979 = RIB 1028 = Wilmanns no. 33; CIL XI 3007 = ILS 2542. 3 C IL VI 31172 = ILS 2193a; CIL VI 19 = ILS 2194. 4 A E 1945 no. 62. 5 C IL VI 2532 = ILS 2093. 6 Cf. Davies 1969, 1970, 1972; Nutton 1970; Wilmanns 1987, 1995. 7 A physician took the military oath, thus becoming a miles, even miles principalis or miles immunis (Dig. 50.6.7). Their service counted as stipendia and was bound to military law, cf. Nutton 1971, 262. The second-century jurist Tarruntenus Paternus includes physicians and other specialists with the immunes, which means that they were exempt from certain soldierly duties in return for other services, CJ 12.35.6; Dig. 4.6.33. 8 For the question of rank amongst medics in the Roman Army see Gilliam 1940, Sander 1959, Davies 1969, Wilmanns 1995, 75. 9 C IL VI 1057; CIL X 3478 = ILS 2858; CIL VI 175; CIL VI 31145; CIL IX 1617 = ILS 2117; CIL XIII 8011; AE 1937 no. 181; CIL VIII 2563 = ILS 2437. 10  Wilmanns 1995, 306–307. 11  Jackson 1988, ch. 4.

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Largus and Pedanius Dioscorides, describe many of the items that have been found in military sites. This material evidence confirms that medical care in the Roman army was not provided on an ad hoc basis and that it did not rely on local knowledge and supply. Moreover, it shows that medical care was offered in all units of the army and that this form of medical care was standardised and regulated by the Roman state itself. The titles of the medical staff, the appellations of the officers in charge, and the similar architectural form of the military hospitals all suggest a central guiding hand.12 However, material evidence per se does not reveal the extent of the medical care on offer, the responsibilities of its officers, and its raison d’être. It reveals little on the interrelations between army doctors and civic society. It does not inform us whether medical services within the imperial army evolved naturally, or due to a conscious resolution of the imperial government. Literary testimony sheds further light on the nature of medical care offered to the soldiers and on the motives for providing it. Here, the experience of Velleius Paterculus is of particular interest, not necessarily due to its reliability but due to his perspective. He writes: And now for a detail which in the telling may lack grandeur, but is most important by reason of the true and substantial personal qualities it reveals and also of its practical service—a thing most pleasant as an experience and remarkable for the kindness it displayed. Throughout the whole period of the German and Pannonian war there was not one of us, or of those either above or below our rank, who fell ill without having his health and welfare looked after by Caesar with as much solicitude indeed as though this were the chief occupation of his mind, preoccupied though he was by his heavy responsibilities. There was a horsed vehicle ready for those who needed it, his own litter was at the disposal of all, and I, among others, have enjoyed its use. Now his physicians, now his kitchen, and now his bathing equipment, brought for this one purpose for himself alone, ministered to the comfort of all who were sick.13

12  For the existence of military hospitals in army camps see Webster 1985, 200. The objections raised by Baker 2002 and 2004, revolve around the common shape of the military hospitals, not their actual existence. 13  Velleius Paterculus 2.114. For similar exempla cf. Valerius Maximus 1.7.1 (Caesar); Scriptores Historiae Augustae, Alex. Sev. 47.2 (Alexander Severus); Ammianus Marcellinus 30.6.4 (Valentinian); Orosius 6.18.15 (Caesar).

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According to Velleius, medical care included treatment on the battlefield itself, safe evacuation of the wounded, a healthy diet, and sanitary facilities.14 It reflected a more holistic approach to military medicine than the mere treatment of battle injuries; the inclusion of a healthy diet and hygiene alongside first-aid treatment, as integral parts of medical care, indicates a comprehensive notion of healthcare, and one in which lifestyle is central.15 This testimony of Velleius should be read as reflecting the voice of the principate.16 The Roman civil wars resulted in the abolition of the Republic and the foundation of a new form of regime known as the ‘principate’. Augustus and future principes gained their political power not by elections and client support, but by the support of a professional army.17 The emperors were therefore keen to show their care and affection for the armed forces by large donations of money and close attention to their needs.18 In turn, the soldiers, who owed their livelihood to the emperor, guaranteed his reign and, when possible, a smooth succession of power. Velleius himself was born in the aftermath of the Battle of Actium and joined the army as a young man, serving as a military tribune in Thrace, Macedonia, Greece, and the East. He then became prefect of cavalry and legatus before serving for eight years in Germany and Pannonia under Tiberius. His voice is that of a professional soldier who was able to climb the social ladder on the basis of his military career. The effort made to offer medical care to the troops, reinforcing the position of their benefactor, was significant. However, the picture depicted by Velleius is still one of ad hoc medical care. The efforts of the imperial house are portrayed as beneficia—they relied on the goodwill and the resources of a magnate, rather than on members of a professional medical corps. The description of Velleius is, therefore, not of a professional medical corps, whose tasks are clearly defined and whose service is an act of duty rather than one of grace. 14  This view is corroborated by various other pieces of evidence, cf. Davies 1989. 15  Galen himself argued that a good doctor can achieve the same results by means of diet that a lesser physician could only achieve by drugs and surgery: Galen, On Examining the Physician 10.1 (CMG Suppl. Or. 4.116–117). 16  Cowan 2010. 17  It is meaningful to talk about a Roman professional army at least since Marius’ ‘proletarii’ reform in 107 BCE and, as Gabba has convincingly demonstrated, this reform was only a final stage of an on going process of increasing enrolment of proletarii into the Roman citizen militia. However, throughout the Republican era recruitment to the army was inseparable, at least in theory, from public duties and required a Roman citizenship. The Augustan revolution changed that. Now military service was a career choice, which, when completed successfully would have merited a citizenship. Gabba 1976, 1–70. 18  Campbell 1984, 32–58.

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A later monument from the early second century CE reveals a different reality, however. A scene from the Column of Trajan in Rome portrays a wounded soldier attended to on the battlefield by a fellow soldier. The image shows the bruised soldier’s leg resting on a box, which suggests that the carer was either a miles medicus or a capsarius.19 The miles medicus, known from inscriptions, was a soldier with basic medical training whose duties must have included first aid during battle.20 The image on the Column of Trajan most likely captures a capsarius, as the box of medicine (i.e. capsa) is also depicted. The capsarius was part of the valetudinarium’s staff, but, as his title suggests, he did not have the level of expertise of his senior colleague, the medicus.21 The affiliation of the capsarii to the hospital’s staff is recorded in inscriptions.22 Hence, a century after the Germanic wars in which Velleius took part, medical care in the Roman army was no longer arranged on an ad hoc basis, and was not perceived as an act of grace of the imperial house or of a military commander. Rather, the existence of a large number of hospitals in army camps, the prevalence of medical personnel within the army, and the involvement of senior officers in administering the medical services within the army unit all indicate that medical care had become more standardised, and would be best described as a medical corps. Though the term itself was never used, the titles of its members and the clear marking of professional jurisdiction suggest a general policy in the formation and administration of healthcare within the army.

The Responsibilities of the Medical Corps

This discussion of the existence of this corps leads to the question of its responsibilities. While it is clear that the medical staff offered clinical and surgical aid, it is also highly plausible that their skills and knowledge were required and used during the recruitment of new soldiers and when preventive medical measures were needed. Since the Roman imperial army was the single most costly burden on the imperial purse, and since it was the support of the armed forces that secured the imperial government, it is only reasonable that the emperors wanted the troops to be safe and sound. Poorly recruited soldiers and unnecessary deaths and injuries were costly and detrimental to morale. It 19  Jackson 1988, 133. 20  C IL XIII 7943; CIL III 14347, 5. 21  Wilmanns 1995, 120–122. 22  C IL XIII 5623; CIL XIII 11979 = ILS 9182; ILS 9095; AE 1986 no. 594; CIL III 133386 = RIU 875; CIL VIII 2563 = ILS 2437.

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is therefore not surprising that the clinical duties of the medics were likely to have had considerable administrative implications. Evidence from Vindolanda shows that lists of the sick and the injured were habitually compiled. A duty roster for 18 May 90 CE shows that thirty-one out of 752 men were unfit for duty: fifteen were ill, six were injured (uolnerati), and another ten suffered from eye problems.23 Vindolanda was not exceptional. Similar lists were also found in the Roman fort of Bu Njem in Libya, and in Judaea.24 A papyrus from Dura dated 222–224 CE records that one man was sick (aeger), a dozen or so had been ill and were not fit for service (n(on) s(anus)), another had not returned, presumably due to illness, and one had died.25 An entry in the pridianum of cohors I Hispanorum in 105 CE in respect to the men who were unsuited for combat included the sick (aegri).26 Since these lists were official, and must have been a valuable tool in the hand of the military commander who planned how best to meet his duties with the actual resources available to him, the decision to define a soldier as unfit for duty needed to be authoritative and final. While there is no evidence that the medical staff was in charge of preparing these lists, it is highly plausible, as physicians acted as figures of authority in the Roman courts in civic society during the High Empire.27 Formal questions, which were likely to have rested on medical consultations, also included the status of soldiers who were forced to retire from service before completing their full length of duty due to an injury or an illness (missio causaria). Roman soldiers served a period of twenty or twenty-five years before gaining the right to retire and enjoy the benefits granted to veterans. The large number of official bronze diplomas, listing the names of the soldiers who were honourably discharged and received the Roman citizenship that their service merited, indicate the importance of the successful completion of military service. An early retirement without proper cause would have impaired the veteran’s retirement rewards.28 Therefore, the ability to retire before completing a full length of service, while maintaining the rights of a veteran in case of debilitating injury or ailment, was an important facet of the Emperor’s reassurance of the troops in return for their support. Thus, a diploma of Vespasian dated 23  Bowman and Thomas 1991. 24  Cf. The sick list of 253–259 CE on an ostracon from Bu Njem published by Marichal 1992, 130, and on Judaea P. Yadin 723. 25   P. Dura 102 = Fink 1971 no. 8. 26   P. Lond. 2851 = CLA 219, col.2.44. 27  Israelowich 2014. 28  For the nature of these diplomas and their contributions to modern research see Eck and Wolff 1986.

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70 CE mentions the ‘causarii, who have served in legio II Adiutrix pia fidelis, who have become ineffective for war’.29 This diploma meant that soldiers who were injured in war did not lose their rights if they were no longer fit for service. Their future was secured by the emperor like that of any other soldier who successfully completed his allotted period of duty. Similarly, Modestinus reveals that a soldier who became an invalid and was forced out of the army was entitled to the praemium.30 This piece of legislation is even more inclusive than the diploma of Vespasian, as it poses no restrictions to the causes of debilitation. Dig. 49.16.13.3 (Macer) defines a missio causaria as ‘when anyone, because of a weakness of mind or body, is declared not at all suited for military service’. Hence, even the mentally ill (PTSD sufferers?!) could have been acknowledged as causarii. As is often the case with the Digest, the Roman lawyers did not discuss procedure—that is, how the causarii were diagnosed and by whom. However, the magnitude of the decision to label a soldier as causarius was great. It entailed substantial financial repercussions. It is to be assumed that such a decision should have been authoritative and, once taken, indisputable. Here too, since physicians were seen as figures of authority in the Roman civic courts during the High Empire, and since it is the same administration that found physicians most suitable to provide healthcare in the army, it is reasonable that army doctors were consulted before a soldier was designated a causarius. Similarly, recruitment to the Roman Army was conditioned by a physical examination. P.Oxy. 1. 39 records the discharge of a probandus on account of his visual impairment. The papyrus itself is signed by three different hands in confirmation of the resolution. Here too, while there is no definite proof that medical personnel conducted the examination, it is a safe assumption. Alexandria was a renowned medical centre during the High Empire where expert doctors were always at hand, and the Egyptian courts habitually requested forensic reports from public physicians.31 Furthermore, a later item in the Justinian Code attributed to the emperors Theodosius and Valentinianus states that physicians were consulted in cases in which soldiers who were formally released on medical grounds (causarii) later requested to return to active duty.32 Though this item refers neither to recruitment nor to missio causaria, it does attribute an important role to the opinion of physicians in the administration of the army. The hypothesis that medics had an active role in 29  C IL XVI 10. 30   Digest 49.16.13.2. 31  Israelowich 2014, 454–459. On public physicians see Nutton 1977. 32  C J 12.36.6.

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recruitment is reinforced by a rescript of Trajan, which reversed a previous ruling that prohibited recruits with only one testicle from enlisting.33 This rescript would have been redundant if there were no actual physical examination of all recruits. The role of a rescript in the Roman legal system was to provide an authoritative answer to a concrete query that needed resolution and could not be resolved by existing legislation.34 Once written and dispatched, rescripts had the force of law. Thus, the very existence of such a document indicates both that recruits actually underwent detailed physical examinations, and that there were general guidelines that directed the examiners. General physical standards and regulated examinations of all recruits throughout the Roman world during the process of recruitment indicate the existence of a medical corps. An examination of potential recruits offers an opportunity to inquire into the possibility of a much more extensive role played by physicians (guided by Greek medical notions) in shaping the form of the Roman army.35 In his manual on military matters, which was compiled in late antiquity but probably reflected more genuinely the reality of the first two centuries CE, Vegetius offered his readers a set of criteria for selecting the most appropriate recruits for military service.36 He thought it worthwhile to examine whether the recruits came from the country or from a city;37 next, he argued that the age of the recruits should be considered, as well as their height.38 Interestingly, Vegetius thought that the better recruits could be recognised at selection by their faces and physical posture.39 Finally, he argued that their trade was relevant.40 Setting height, age, and employment aside, this attention to people’s provenance, posture, and facial expression as being indicative of their physical and mental attributes calls to mind the Hippocratic tradition of On Airs, Waters, and Places. In this treatise, which addressed the itinerant physician, the Hippocratic author meant to teach how to produce an accurate prognosis. 33  ‘Menenius libro primo de re militari pr. Qui cum uno testiculo natus est quive amisit, iure militabit secundum divi Traiani rescriptum: nam et duces Sulla et Cotta memorantur eo habitu fuisse naturae’: Dig. 49.16.4. 34  On the rescript system see Honoré 1994, and, more generally, Millar 1977, 328–341. 35  For recruitment to the Roman army see Davies 1989. 36  Vegetius’ silence regarding the medical corps should be seen first and foremost as an oversight, probably due to lack of knowledge, as inscriptions show that medical personnel was already widespread in the army during the first two imperial centuries. 37  Vegetius 1.3. 38  Vegetius 1.4–5. 39  Vegetius 1.6. 40  Vegetius 1.7.

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The premise of this treatise is that topography and climate have a crucial effect on the human constitution. A physician who knows how to analyse the nature of the waters taken, the air breathed, and the sort of place resided in will know what sort of ailments to expect. Equipped with this knowledge and technique, the itinerant physician would be in a position to quickly gain credence among prospective clients in a medical marketplace that had no licensing system.41 While the first half of the Hippocratic author’s treatise examined the various types of waters, airs, and places, and their prospective effect on the bodies of those residing there, the second part analysed the impact of the environment on the inhabitants’ personalities. Following this Hippocratic paradigm, Vegetius argued that all people who dwelt near the sun, being parched by great heat, were more intelligent but had less blood and were therefore less capable of fighting at close quarters because every wound could be mortal. The people from the north, on the other hand, who were remote from the sun, were less intelligent but had more blood. According to Vegetius, it is best to recruit from the more temperate regions because the plenteousness of the blood of those who came from these mild provinces meant they would have a ‘contempt for wounds and death, and intelligence cannot be lacking either which prevents ill-discipline in camp and is of no little assistance with counsel in battle’. This climate-based ethnography, as Vegetius himself explained, won the approval of the most learned men.42 A standing army, manned by professional soldiers who serve for a long duration in permanent camps in the outskirts of the empire, was of course prone to a wide spectrum of health-related hazards. Infectious diseases, food poisoning, and poor hygiene could have easily incapacitated an entire military unit. Thus, M. Antonius the triumvir, Marcus Aurelius and his colleague Lucius Verus, and Septimius Severus all suffered severe casualties due to the spread of epidemics amongst the troops.43 According to the Historia Augusta biography of Lucius Verus ‘it was his fate to bring the plague with him to those provinces through which he made his return journey, right up to Rome’.44 The devastating nature of the plague was not unnoticed by civic physicians. It is assumed that the decision of Galen to leave the city of Rome in 166 CE and return to his native

41  For the artisan nature of the Hippocratic physician see Edelstein 1937. 42  Vegetius 1.2.2: ‘ea quae a doctissimis hominibus comprobata sunt non omittamus’. 43  Plutarch Ant. 50; cf. Septimius Severus’s siege at Hatra in 198 CE (Herodian, 3.9.6). For the devastating impact of the Antonine Plague see the papers gathered in Lo Cascio 2012. 44  S HA Verus 8.1.

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Pergamum was motivated by his fear of that plague.45 The later testimonies of Ammianus Marcellinus and Orosius reveal that the horrendous sights were still remembered centuries later.46 Likewise, food poisoning was a potential danger. The letter of a soldier of the Egyptian fleet addressing his father reveals how simple food poisoning caused by bad fish could incapacitate a whole unit.47 In principle, a healthy diet was routinely provided to the Roman soldier.48 It is noteworthy that a healthy diet was seen by most Graeco-Roman physicians as essential for health. Treatises about regimen in general and about the positive influence of various types of nutriments for specific illnesses in particular were composed by physicians as early as the Hippocratics throughout classical antiquity to Galen and beyond. Hence, it is only logical that army doctors were consulted in matters of a healthy diet for the troops and that they warned against the hazards of food poisoning. Dangers that could be avoided by preventive medicine were noted and discussed by military authors. Vegetius dedicated an entire chapter to the subject. The common denominator shared by all of these instructions is their Hippocratic origin. For example, Vegetius instructed that military camps must be built in a safe place with a sufficient supply of firewood, fodder, and water, and, if a long stay was planned, particular attention should be paid to choosing a salubrious site.49 According to Vegetius, a suitable location should not be pestilential or near unhealthy marshes, nor in barren plains and hills. In addition, tree cover is crucial.50 Vegetius was not breaking new ground here— similar comments were made by Celsus, whom Vegetius read,51 and Vitruvius, in the context of city planning.52 Like Celsus and Onasander, Vegetius paid particular attention to the hazardous effect unhealthy marshes could have on soldiers camping nearby. Indeed Onasander warned Roman generals not 45  Galen XIX.15 K = Scripta Minora II, p. 96. Religious explanations were common and added to an overall air of anxiety: for example, the plague was the result of opening a golden casket containing the dread vapour in the temple of Apollo at Seleucia; SHA Ver. 8.1–2. Avidius Cassius, the Roman general and future usurper who wrongfully sacked Seleucia, was also to blame, for breaking a treaty. Lucian has the false prophet Alexander selling magic charms, exploiting the general anxiety: Lucian, Alex. 36. 46  Ammianus Marcellinus 23.6.24; Orosius 7.15.5–6; 7.27.7. 47   P. Mich. 8. 478. 1–18. 48  Knörzer 1963; Davies 1970; Fink 1971, no. 51, ii/2; Davies 1989, 68. 49  Vegetius 1.22. 50  Vegetius 3.2. 51  Celsus 1.2.3. 52  Vitruvius 1.4.

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to camp in marshy sites because the smell in such places caused illness and­ infection.53 The water supply itself, according to Vegetius, should not be neglected by the military commander. More generally, Vegetius reminded the generals to be attentive to the seasons, medicine, and exercise, which are all important for controlling the health of the army.54 All of these recommendations were in tune with the works of Greek physicians and could have been traced by a doctor or even by an educated layperson back to the Hippocratic corpus. Moreover, nearly all medical personnel had Greek names, which offers another indication of how entrenched Greek medicine was within the Roman army. In consequence the army enabled Greek medicine to be spread to the far corners of the Roman world.

The Effects of the Medical Corps on Wider Society

It is now time to evaluate the effect this medical corps had on society at large. To begin with, such a medical corps was a large employer. The size of the Roman army has led Wilmanns to estimate the number of doctors on active duty to be between 600 and 800 at any given moment. In addition, knowledge and expertise regularly flowed between civilian and army healthcare providers. Such interrelations between popular medicine and medical care in the Roman army occurred in various ways and covered many facets of healthcare, such as the development of surgery, the importance of hygiene, and the transmission of knowledge and techniques to the outskirts of the empire and back. Of the three, the development of surgical knowledge and practices is the easiest to detect. Warfare yields specific injuries that need immediate attention because of the risk of blood loss and infection. The repetitive nature of these injuries, which resulted from similar lacerations caused by similar weapons, forced army doctors to attempt surgical procedures that were uncommon in civic society, and to perfect their skills and instruments. The knowledge gathered spread to civilian society through army doctors and treatises.55 A detailed description of such procedures is provided by Celsus, who dedicated a few chapters of his treatise on medicine to the treatment of injuries caused by projectiles. Celsus explained how to remove missiles, arrows, lead balls, pebbles, and other types of weaponry, and what to do if the missile was 53  Onasander 8.2. 54  Vegetius 3.2. 55  For the practice of battlefield-injury treatment in the Graeco-Roman world see Salazar 2000.

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also poisoned. In addition, Celsus addressed the sort of surgical tools required for these tasks.56 According to Salazar, the same instruments Celsus described were still in use by Paul of Aegina (625?–690?), Abukasim (936–1013), Paré (1520–1590), and the Italian Renaissance doctors.57 The fact that these instruments were actually used by army doctors is confirmed by archaeological evidence. An instrument called ‘the forks of Diocles’ that Celsus described as useful for extracting projectiles was found in Ephesus.58 Likewise, a wall painting from first-century CE Pompeii depicts the wounded Aeneas having an arrowhead removed from his thigh with a cross-legged forceps.59 Though army doctors did not work in Ephesus and Pompeii, the procedure depicted, the skills which were required, and equipmentwhich was used must have found its origin in battlefield surgery. Such an instrument has been found at various sites throughout the Roman world.60 This image captured medical practice that was common at the time it was painted. Furthermore, the protocol of circular amputation that Celsus described was still in use as late as World War I for stumps fitted after emergency amputations.61 This technique allowed primary closure and is still considered reliable. All of these surgical procedures emerged from the requirements of the Roman army. The acquisition of new knowledge and techniques was also made possible by the arrival of the Roman army, and the Roman medical corps with it, into new regions. Pliny the Elder recounted that when Germanicus Caesar moved his camp forward across the Rhine into a maritime district of Germany, only one source of fresh water existed. Drinking it caused the teeth to fall out and the use of the knee joint to fail within two years. Physicians (who, Pliny implied, were consulted) used to call these maladies ‘stomacace’ and ‘scelotyrbe.’ A remedy was found in the plant called britannica.62 This episode demonstrates how the progress of the Roman army and the Roman imperial medical corps, together with a supporting network that collected and dispersed medical knowledge, improved the quality of healthcare not merely within the ranks, but in the Roman Empire in general. New terrains meant new illnesses. New illnesses encouraged the discovery of new cures, either by army doctors 56  Celsus 7.5.1–5. 57  Salazar 2000, 46–50. 58  Celsus 7.5.3; Künzl 1982, fig. 18.10; Majno 1975, fig. 9.15. 59  House of Siricus, Scene with Wounded Aeneas, often illustrated, e.g. in PPM VI, 245, and in Bragantini and Sampaolo 2010, 347. 60  Cf. Jackson 1990, McCallum 2008, 120. 61  Celsus 7.33.1–2; Davies 1989, 217; McCallum 2008, 64. 62  Pliny HN 25.20–21.

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themselves or through the use of local knowledge and experience, and such knowledge found its way into pharmacological literature. As Pliny noted, this herbal medicine was made known to the Romans by the Frisians, who at that time were a loyal tribe in whose territory the Romans’ camp lay. It is an example of how the interrelations between a local population and the Roman army were beneficial to the health of both: the Roman doctors learned the nature of this ailment and how to treat it from the Frisians, and the presence of a Roman military force in the region meant that a constant supply of this drug was made available. Therefore, in order to understand the medical system of the army, it is necessary to be aware of the history of the development of each frontier and the differences between them.63 The infiltration of Roman-army style medical care into new regions also occurred when military doctors attended to the civilian population. Doctors on active duty could have attended civilians for a fee, army doctors could have treated Roman veterans, or retired army doctors could have attended the civilian population in the same fashion they did while on active duty. Thus, a retired army doctor, one M. Ulpius Telesporus (?) was a medicus of the first ala Indiana in Upper Germany, then of ala III Asturum in Mauritania Tingitana. Telesporus was also commemorated as the medical officer of health at the city of Ferentium in Italy.64 Though the inscription does not reveal whether he was an army doctor and a civilian doctor simultaneously, the option seems unlikely. Soldiers were prohibited from taking civilian positions, and were even exempt from civic munera.65 In addition, the city of Ferentium was not in close proximity to a military camp that would have facilitated such a dual appointment. Similarly, an army doctor by the name of M. Valerius Longinus was awarded honorary membership of the town council of Drobeta in Upper Moesia.66 Here too, it is unclear whether Longinus was on active duty while being honoured. His young age suggests he could not have already retired after a full term of service. Since Longinus could not have been employed by the town council 63  Baker 2004, 34. 64  ‘D(is) M(anibus) / M(arco) Ulpio / [Tele]sporo, / medico alar(um) / Indianae et / Tertiae Astorum / et salariario / civitatis splendidissimae / Ferentiensium, Ulpius Protog[e]nes / lib(ertus) pat(rono) b(ene) m(erenti) f(idei)’, CIL XI 3007 = ILS 2542. 65  Exemption from civic munera: CJ 10.53(52).1 (Caracalla); prohibition of civic employment: Dig. 49.16.12.1 (Macer). 66  ‘D(is) M(anibus) / M(arcus) Val(erius) M(arci) f(ilius) / Longinu[s] / med(icus) leg(ionis) / VII Cl(audiae) / ornat(us) orna/ment(is) decu[r(ionalibus)] / a splendid(issimo) / ordin(e) m(unicipii) H(adriani) D(robetensium) / vix(it) an(nos) XXIII / M(arcus) Victorius / [—]anio et Victoria / [Ge]mina fil(io) pien[t(issimo)] / pos(uerunt)’, CIL III 14216, 9 = ILS 7150a.

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of Drobeta and since his service to it could not have been a munus, it is to be assumed that this inscription captures an occurrence in which a member of the Roman medical corps and a soldier on active duty provided professional assistance to civic society. One may suppose that a medicus legionis such as the Aufidius Clemens who made a dedication to Hermes at Pselchis in the Sudan would have been willing to give medical advice to persons of suitable social rank that he encountered on his travels.67 All of these examples demonstrate how inseparable the Roman medical corps was from popular medicine. The numerous veterans who were accustomed to a particular type of healthcare provision and a certain type of carer must have created a considerable demand for such services when they retired. Thus an inscription on a statue base from Heraclea Pontica is a dedication of one Marcius Xenocrates, a physician of the evocati, on a statue of Hygeia to Asclepius from some time during the second century CE.68 The evocati were soldiers who had served out their time and obtained a discharge but chose to re-enlist at the invitation of an officer. As soldiers, they were likely to have enjoyed the medical services provided within the legion. The same Marcius Xenocrates was also honoured by a civilian association of actors in Heraclea Pontica for his profession (κατὰ τὸ ἔργον).69 Since Marcius Xenocrates was a physician of the evocati (ἰατρὸς ἰβοκατίων) as the inscription suggests, he was either an army physician who was not supposed to have treated civilians or a civilian doctor who attended soldiers.70 Either way, Xenocrates granted medical services to both soldiers and civilians. His Greek name and his link with the evocati suggest that he was a retired military physician. After their long years of military service, the evocati were probably accustomed to the type of healthcare on offer in the Roman army and to the sort of professional authority that offered it, namely Greek medicine and Greek-trained physicians. In consequence, Xenocrates was likely an army physician at some stage and then had retired at Heraclea Pontica, giving medical services to both soldiers and civilians who resided there. These two inscriptions therefore demonstrate that army doctors also attended to the local population, thereby spreading the type of medicine offered within the army and dictated by the Roman government’s criteria for recruiting healthcare providers. The spread of Greek medicine throughout the Roman world was a discernible consequence of the policy of the Roman impe67  Αὐφίδιος Κλήμης, / ἰατρὸς λεγεῶ(νος) βκʹ, τὸ�̣ / προσκύνημ̣ [α] ἐπό- / ησα παρὰ τῷ κυρίῳ Ἑ̣ ρ-̣ / μῇ Πωλλί�τ̣̣ της κ̣ αὶ / τῶν ἰδίων πάντων: IGRR I 1361 = CIG 5088 = SEG VIII 860 = SB V 7932. 68  θεῷ Ἀσκληπιῷ καὶ τῇ ἑαυτοῦ πατρίδι τὴν / Ὑγείαν Μάρκιος Ξενοκράτης ἰατρὸς / ἰβοκατίων Σεβαστοῦ Ἀντωνίνου: Inscriptions from Heraclea Pontica no. 7. 69   Inscriptions from Heraclea Pontica no. 2. 70  Cf. Mason 1974, s.v; Samama 2003, no. 318 ad loc.

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rial government to offer healthcare within the army, with the army serving as its agent. The army’s habit of being attentive to local knowledge relevant to health-care, to which Pliny’s description of the discovery and use of the herb britannica for local ailments provides a vivid example and the inclination of the Roman administrative system to spread the medical knowledge it had acquired, which can be inferred from the similarity of the medical instruments found in military camps throughout the Roman world meant the medical care practiced within the army and that used by the communities it came into contact with were not mutually exclusive. Rather, they were mutually supportive. Conclusion The final matter to be addressed here is whether a ‘grand design’ lay behind the Roman imperial government’s development of its medical corps. Was its establishment a deliberate measure or was it a result of natural evolution? Since there is no definitive evidence, all hypotheses are circumstantial. Professional physicians first appeared in Rome in the last decades of the third century BCE in the form of Greek doctors.71 From the time of their initial arrival, the city of Rome attracted Greek physicians who found the upper tiers of the Roman society of the late Republic favourably disposed towards Greek culture and its agents. It was in this context that Greek physicians initially established themselves in Rome. However, until the decline of the Republic the Roman state was indifferent to their practice and vocation. The turning point was legislation aimed to attract physicians to Rome by offering them citizenship and immunity from civic duties,72 which began with Julius Caesar and continued with Augustus and the following emperors.73 Later, physicians, alongside grammarians, sophists, and philosophers, benefited from the exemption from liturgies. The motives behind this legislation were various and do not all concern the Roman imperial army or its medical corps. However, the near exclusiveness of Greeks amongst professional physicians during the High Empire,74 the fact that grants for physicians were initially made when Augustus conducted far reaching military reforms, as well as the importance of the army to the imperial

71  Archagathus: Pliny HN 29. 12–13. 72  Suetonius, Caes. 42.1; Suetonius, Aug. 42.3; Dio Cassius, 53.30.3. 73  For Caesar and Augustus see n. 75. For evidence and analysis concerning the legal status of physicians in general see Below 1953; André 1987; Nutton 2004, ch. 11. 74   Cf. the comments of Pliny the Elder that it is impossible for a physician to win a public contest without being able to read Greek. HN 29.17.

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government and the genuine need for in-house medical care within the army all suggest that the prime goal of the legislation of Caesar and Augustus was to ensure enough suitable candidates for the position of army doctors even if the actual formation of this corps was, by the early principate, far from complete. Either way, the existence of medical services in the army had a considerable effect on popular healthcare. The army provided posts for numerous doctors, and army life offered learning opportunities that were unavailable in civilian society. More importantly, the reach of the Roman army, the homogenous nature of its medical personnel, and its interaction with civic society were crucial in spreading one type of healthcare, namely Greek, throughout the Roman world.

chapter 11

How Popular Were the Medical Sects? David Leith This paper will explore the extent to which the ancient medical haireseis, or ‘sects’ as they are conventionally called, might be considered popular.1 I shall not be concerned with the popularity of sect medicine in the sense that it may have been developed among or practised by ordinary members of the general population. The members of medical sects were uncontroversially seen, and advertised themselves, as representing a specialised class of dedicated healer, as iatroi or medici. There are well known problems of definition in speaking of a medical profession as such in Graeco-Roman antiquity, but if we may speak of one, then it will have been populated pre-eminently by sectarian doctors.2 Nor shall I be interested directly in the popularity of sectarian doctors in terms of their fame or celebrity status, though, as we shall see below, certain physicians such as Thessalus of Tralles could be compared with actors or chariot-drivers with regard to their popular following. I shall be concerned instead with the question of how accessible sect medicine may have been to different sections of the population. I aim to explore in particular how widely diffused sect medicine was in the ancient world, and whether it was perceived as being generally available to patients from a variety of levels in society. From a modern perspective, the healthcare provided by the medical sects often seems to be viewed in opposition to general notions of ‘popular medicine’, sometimes in connection with contrasts between ‘high’ and ‘low’ medicine. While such contrasts are certainly useful, particularly in regard to the approach of the healers concerned, I want to suggest here that in terms of the social status of their patients, sectarian doctors may have treated a less restricted range of the population

1  For the general character of an ancient medical sect, I refer to the remarks of von Staden 1982, 79–80: ‘the evidence suggests that a group with fairly coherent and distinctive theories, with an acknowledged founder (hairesi-archēs), and with publicly identifiable leaders who articulate (a) their rejection of rival theories through theoretically founded polemics, as well as (b) their own systematic alternatives, would qualify as a hairesis’. 2  On the difficulties in defining and distinguishing types of healer in the ancient world, see recently Nutton 2013, 177, 254–278. Cf. Lang 2013, 243–266, on the exclusivity of sect medicine in Ptolemaic Alexandria in comparison with other healing traditions.

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than is often supposed, potentially overlapping to a considerable degree with the recipients of more familiar forms of popular healing. Of course, the ancient medical sects undoubtedly represented a highly theoretical, philosophically informed approach to medicine. The prominent members of the Herophilean sect, or the Empiricist, Methodist, Pneumatist, and so on, were well educated and cultured individuals.3 Those we hear of, that is, the individuals named in our sources, were certainly among the most successful physicians in antiquity, and included not only the founders of the various medical sects, but also their followers who made some kind of impact on medicine or on history in general.4 These individuals tended to cluster around the major centres of medicine, such as Alexandria, Rome, and the various cities of Asia Minor, and they often had direct links with the ruling classes, notably the Hellenistic monarchs or the Imperial family. The sophistication of their medical theories, and the markedly elite status of those with whom they are found associating, have combined to create the strong impression among modern scholars that sect medicine was essentially the preserve of the privileged. We hear about the members of medical sects for two principal reasons: firstly, as authors of medical books which had some lasting influence; and secondly, because of their connections with famous individuals, for example as personal doctors to important historical figures (such as the Herophilean Andreas, who was doctor to Ptolemy IV Philopator, or the Asclepiadeans Marcus Artorius and Antonius Musa, both of whom allegedly saved the life of Augustus).5 Hence, in many cases, we hear about these physicians only because they associated with the elite. Similarly, it is not surprising that the 3  By the Roman period, it had become conventional in writing about the history of medicine to arrange the sects into three major groups, the Rationalists/Dogmatists, the Empiricists, and the Methodists. The Rationalist ‘sect’, however, was in fact a category invented by the Empiricists, comprising a variety of competing sects, united only by their general commitment to the need to discover the hidden causes of disease. The most successful Rationalist sects were the Herophileans, Erasistrateans, Asclepiadeans, and Pneumatists, though as we shall see below there were many less well known individuals who established their own sects as well. On these issues, and on the early application of the term ‘hairesis’ to these groupings of doctors, see von Staden 1982. 4  The evidence for the ancient medical sects has been gathered in a number of fragment collections: for Herophilus and the Herophilean sect, see von Staden 1989; for the Empiricists, Deichgräber 1965; and for the Methodists, Tecusan 2004. Garofalo 1988 focuses on Erasistratus himself, and less on the later fortunes of his sect. The Pneumatist sect is the subject of the still fundamental study by Wellmann 1895. 5  For Andreas and Ptolemy IV Philopator, see Polybius 5.81.1–7. For Marcus Artorius and Antonius Musa, see below.

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most successful doctors should associate with and attract the wealthiest and most influential patients. But this need not mean that the medical sects exclusively ministered to the upper levels of society, or were viewed in antiquity as a class of healer accessible solely to the elite. As I want to argue here, there is scope for thinking about very different levels of sectarian doctors. Our evidence also offers occasional glimpses of their activities far away from the ruling classes in the major capitals, and even though these glimpses are only occasional, they appear to suggest a more widespread phenomenon. To begin with, it will be helpful to be clearer about what it was to be a member of a medical sect.6 Firstly, I take it, one would have to be trained by an already established sectarian doctor, through apprenticeship. This would involve, secondly, absorbing, and accepting, the particular brand of medicine that that sect promoted, including a basic set of doctrines (or at least, in the case of the Empiricists, certain epistemological commitments). This acceptance did not have to be absolute, and presumably one did not have to know and learn every detail, or be completely immersed, in all the writings and scholarly wrangles of one’s sect.7 There was plenty of room for disagreement and revisionism among a sect’s followers, but a basic commitment to its general approach to medicine seems to have been a given. It was of course also necessary to be a practising physician, rather than just a philiatros or interested amateur. Finally, and perhaps most importantly, a member of a medical sect was someone who would have identified himself as such, at least in certain contexts, as a means of advertising the kind of medicine he practised.8 I would also like to distinguish three broad classes of doctors within a given sect. First of all, and obviously most familiar, are the founders of sects, the ‘heresiarchs’ as they are sometimes called: doctors such as Herophilus and Erasistratus, Asclepiades, Themison, Athenaeus, and so on. The second group 6  For membership of the Hellenistic sects, in particular the Herophileans, see von Staden 1982. For the situation in the first century BC, see Flemming 2012. Further studies on particular aspects of sectarian medicine in Rome may be found in Mudry and Pigeaud 1991. 7  The freedom of successive Herophileans to dissent, in certain areas at least, from their predecessors and from Herophilus, or to adjust the focus of the sect’s interests, is discussed in von Staden 1982 and 1989, 445–458. Van der Eijk 1999 emphasises the markedly critical attitude shown by Methodist doctors towards precursors within their own sect. 8  I am grateful to Danielle Gourevitch for raising at the conference the interesting possibility that in some cases doctors might have fabricated an identity as a member of a sect, as a means of creating a specious air of authority. This possibility should be borne in mind in the discussion below, though ‘fake’ sectarian doctors should be as relevant to my overall argument as the genuine ones.

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consists of the most famous and successful sectatores: the doctors who continued to develop their founders’ doctrines, or who made major contributions to the art; those especially who either wrote influential books, or who were attached to major historical figures. I am thinking of figures such as Bacchius the Herophilean, Heraclides of Tarentum the Empiricist, or Antonius Musa the Asclepiadean. Within this second group might also be distinguished a subgroup of local sect leaders, who were a sect’s principal representatives in a particular place. One might usefully compare here the philosophical sects, with their successions of scholarchs, for example the Stoics Chrysippus and Diogenes of Babylon, or especially Posidonius, who set up his own school on Rhodes.9 We shall see comparable examples of Herophilean and Erasistratean local heads below.10 The third group comprises all those sectarian doctors who do not fit into the first two groups. These are the ordinary, largely anonymous pupils and followers that we hear about indirectly in a range of sources, the people who learned medicine from the more famous members of their sect, but who wrote nothing or made no lasting impact, yet nevertheless presumably went on to set up a practice somewhere, and to teach others in the tradition in which they were trained. In terms of relative numbers, these three groups together may be thought to form a pyramid, with a small proportion of individuals at the top making the highest impact, but with potentially large numbers lower down remaining more or less invisible in the record. I shall be interested in this paper in the lowest rung, the sectarian doctors who tended to get overlooked because they did not happen to write anything, or failed to develop relationships with kings or emperors, in short those who were not outstandingly successful. I shall try to make a case, firstly, that these doctors were more geographically widespread than is often assumed, and secondly, that they may also have been much more numerous as well. Although some of these doctors would have been able to

9 This is not to suggest any more systematic parallels with the internal organisation and spread of the philosophical sects, though that is an important subject for further study: Flemming 2012 explores similarities and differences in the development of philosophical and medical sects at a crucial period, namely the first century BC. 10  The individual members of this second group remain relatively understudied, although Heinrich von Staden’s work on the Herophileans has amply demonstrated what rewards are to be gained: von Staden 1982 and 1989, 445–578. Deichgräber 1965 is also sensitive to the contributions of individual Empiricists; for the influential Empiricist doctors Heraclides of Tarentum and Menodotus of Nicomedia, see also the dedicated studies in Guardasole 1997 and Perilli 2004 respectively. For the Methodists, see Tecusan 2004, 12–21, and for Soranus of Ephesus in particular, Hanson and Green 1994.

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attract elite patients, I want to emphasise that we have no reason to believe that they were not also treating various other strata of society. Since the evidence is considerably richer, I shall begin with the Roman period, and then make some observations on the Hellenistic period in the latter part of the paper in light of this.

Medical Sects in the Roman Period

It makes sense to start with Galen, who is our main source for the medical sects in general. The overall impression he gives is of a broad dissemination of sectarian doctors in various corners of the Empire. Here are two representative passages: Doctors and philosophers form admirations for other doctors and philosophers without having learned their doctrines, and without practising that logical method which would enable them to sort false arguments from true ones. It is just that their father, or teacher, or friend—or some other person who gained a following in their city—happened to be an Empiricist, or Dogmatist, or Methodist. So too with the different philosophical sects: there used to be a variety of reasons why one man became a Platonist, another a Peripatetic, or Stoic, or Epicurean; but now, just as there are successions in each sect (διαδοχαὶ αἱρέσεων), in the same way many people simply call themselves after the sect in which they were brought up—especially people who cannot think of any other basis for their approach to life. —Galen, On the Order of My Own Books 1.3–4 (xix 50 K.), trans. Singer

And being such men as that, they (sc. ostentatious doctors) do not shrink from further enormities. They announce that they can teach their arts in a very short time and so assemble a host of pupils through whom they themselves acquire influence in the cities where they live. —Galen, On Prognosis 1.4 (p. 68 Nutton CMG V 8, 1), trans. Nutton

As the first passage suggests, Galen takes it that, just as with the principal philosophical schools, representatives of the main medical sects are to be found in many cities. Thus prospective medical students are often led astray by the fame of local individuals. Hence these people ‘simply call themselves after the sect in which they were brought up’. He likewise complains, in the second passage, about how doctors deliberately use their numerous pupils to

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gain some political influence in the various home cities to which they eventually return. The picture is of prominent sectarian physicians gathering large numbers of pupils who often subsequently return to their home cities, but who maintain links with their master and extend his influence. These pupils then have their own pupils in turn, who continue to identify themselves as members of their teacher’s sect. This coheres very well with Galen’s own experiences. He tells us that in his youth in Pergamum he was taught by various sectarian doctors: the Empiricist doctor Aeschrion, an anonymous Pneumatist, one Stratonicus who had been a pupil of the Hippocratic Sabinus, as well as by Satyrus, who seems to have travelled to Pergamum from Rome in the entourage of L. Cuspius Pactumeius Rufinus, consul in 142.11 Likewise, subsequently in Smyrna, Galen witnessed, and recorded in his treatise On Medical Experience, a public sectarian debate between his Dogmatist teacher Pelops and the Empiricist Philip.12 Hence Galen encountered doctors of various sects in the cities of Asia Minor to which he travelled, some of them having come from Rome, and all engaged in teaching the particular approach to medicine that their sects promoted. And Galen makes it clear that pupils carried their sect identity with them when they went on to set up their own practice. The pervasiveness and influence of sectarian doctors were phenomena which Galen very much regretted, of course, and the figure he selected above all others as the focus of his disapproval was the Methodist physician Thessalus of Tralles.13 Thessalus was an extremely successful doctor, working in Rome during the reign of Nero. Galen condemned him, among many other things, for his claim to be able to teach his Method in a matter of six months. This, Galen maintained, naturally attracted a huge number of pupils, including people he regarded as unsuited to the art, practitioners of less prestigious crafts, such as carpenters and so on.14 The Elder Pliny corroborates this general 11  Aeschrion the Empiricist: Galen, De simpl. med. 11.34 (xii 356 K.). Unnamed Pneumatist: De elem. sec. Hipp. 6.16–26 (i 460–465 K. = CMG V 1, 2 pp. 104–110). Stratonicus: De atra bile 4 (v 119 K.). Satyrus and Rufinus: De anat. admin. 1.2 (ii 224–225 K.). Cf. Nutton 1973, 162, and Mattern 2013, 39–41. 12   Lib. Prop. 2 (xix 16–17 K.). 13  On Thessalus and his Methodism, see Diller 1936 and Pigeaud 1993, 594–599. 14  Galen, De meth. med. 1.1 (x 4–5 K. = fr. 155 Tecusan), ‘Because that man Thessalus recognised this, he not only used to flatter the rich in Rome in various ways but also, by promising to teach the art in six months, readily attracted a great number of students. . . . Because of this, cobblers, carpenters, dyers, and blacksmiths may now leap into the practices of medicine, forsaking their own original crafts. And these men, when they have displayed their meagre talents, also contend for preeminence.’ (trans. Johnston and Horsley). Cf. De sectis 6 (i 81–83 K. = fr. 203 Tecusan).

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picture, describing Thessalus’ huge entourage of hangers-on when he came out in public: Then there arose Vettius Valens, celebrated for his intrigue with Messalina, wife of Claudius Caesar, and equally so for his eloquence. Chancing to gain followers and power he founded a new sect (novam instituit sectam). The same generation in the principate of Nero rushed over to Thessalus, who swept away all received doctrines, and preached against the physicians of every age with a sort of rabid frenzy. . . . No actor, no driver of a three-horse chariot, was attended by greater crowds as he walked abroad in public. —Pliny, Natural History 29.8–9 (fr. 265 Tecusan), trans. Jones

We also learn from Galen that Thessalus, in a letter to Nero, had claimed to have passed on, or bequeathed, a new sect. In all his other works (Thessalus) does not cease his insults, as for example, I believe, in his Letter to Nero, where right at the beginning he writes in these very words: ‘Having passed down a new sect (παραδεδωκὼς νέαν αἵρεσιν), and the only true one, since all previous doctors passed down (παραδοῦναι) nothing useful for the preservation of health or the removal of disease, . . .’. —Galen, De meth. med. 1.2 (x 7–8 K. = fr. 156 Tecusan)

Thessalus was not thereby claiming to have invented Methodism, although it is clear that he introduced several important revisions to his predecessor Themison’s system.15 Rather, Thessalus must be referring to the physical group of followers he had assembled, and to whom he had passed on his Methodist teaching. One may compare both the similar claim made by Vettius Valens in this same period (Pliny, just quoted) and the contemporary inscription, quoted below, in which Menecrates is hailed by his followers explicitly as a heresiarch and founder of a rational and lucid medical art. This is the context for Thessalus’ claims to a new sect: not a new set of doctrines, but a new and cohesive group of followers trained in his particular Method of healing.

15  Prioreschi 1998, 105–113, criticises the arguments of Edelstein 1967b that Thessalus was the founder of Methodism, rather than Themison; see also Tecusan 2004, 12–13. On Thessalus’ revisions to Themison’s Methodism, see Pigeaud 1993. Thessalus’ success may well have revived Methodism, but he was certainly working within, and consciously modifying, an already established Methodist tradition.

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Given that Thessalus had attracted so many pupils, we must wonder what exactly happened to them. We know absolutely nothing of them, yet they must have gone somewhere. The impression we have from Galen, of course, is that if they were unable to practise successfully at Rome, they are likely to have returned to their native cities or some other place in which they could make a living. Although Methodism is typically associated with Rome, Vivian Nutton has emphasised that it was far from restricted to the capital.16 As the inscription quoted below concerning Asiaticus shows, by around AD 100 there were certainly Methodists in Smyrna, for example, and of course by the time of Caelius Aurelianus, probably some time in the fifth century, it was firmly installed in North Africa. There is also evidence for the fairly early spread of Methodism to Alexandria and Egypt. Galen tells us that he had met the Methodist doctor Julian during his stay in Alexandria in around AD 150–157, and he seems to imply that the latter spent his whole career there.17 Julian’s teacher, so Galen tells, was the Methodist Apollonides of Cyprus. Galen also refers to Julian’s ‘pedagogical grandfather’, one Olympicus, who had been the teacher of Apollonides:18 (I) was compelled to say to him this much at least—that he seemed to me to differ from Olympicus, although the latter was the grandfather of his teaching (πάππον αὐτοῦ τῆς διδασκαλίας). For this Julian was a pupil (μαθητής) of Apollonides of Cyprus, while the latter was a disciple (φοιτητής) of Olympicus. —Galen, De meth. med. 1.7 (x 54 K. = fr. 162 Tecusan), trans. Johnston & Horsley

It is not implausible to suppose that all three Methodists were based in Alexandria. If so, Olympicus would have known the famous Methodist Soranus, who spent time in Alexandria in the early second century.19 Indeed, Galen mentions all four Methodists together in the same breath shortly before the 16  Nutton 2013, 192; cf. Tecusan 2004, 15–17. 17   De meth. med. 1.7 (x 53–54 K. = fr. 162 Tecusan). Galen devoted a whole tract, Adv. Jul. (xviii/A 246–299 K. = CMG V 10, 3), to an attack on Julian’s commentary on the Hippocratic Aphorisms, and there Julian is identified as a contemporary living in Alexandria (xviii/A 248 K. = CMG V 10, 3, p. 34 = fr. 111 Tecusan), though we do not know when Galen composed the work. 18  Cf. also the reference, at De meth. med. 1.7 (x 57–58 K.), to Olympicus’ having had ‘so many pupils’ (ἑαυτοῦ τοσούτους εἶχε μαθητάς). 19  As we are told at Suda Σ 851: Σωρανός, Μενάνδρου καὶ Φοίβης, Ἐφέσιος, ἰατρός, διατρίψας ἐν Ἀλεξανδρείᾳ καὶ ἐν τῇͅ Ῥώμῃ δὲ ἰατρεύσας ἐπὶ Τραϊανοῦ καὶ Ἀδριανοῦ τῶν βασιλέων.

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passage quoted, in a way which might well suggest the cohesion of a closelyknit group: . . . and (the works of) the frivolous Olympicus, and his successors Apollonides, Soranus, and Julian who is still alive today. —Galen, De meth. med. 1.7 (x 53 K. = fr. 162 Tecusan), trans. Johnston & Horsley

It seems unlikely to be a coincidence, then, that it is precisely at this time, around AD 100, that evidence for Methodist influence starts cropping up in the papyri. These reveal that Methodism was of interest not just to the Alexandrian medical elite, but also to people in provincial Egypt. In an important papyrus of the late first, or perhaps early second, century, edited by Isabella Andorlini, we find a reference to the Methodist therapeutic principle of the diatritus, or ‘recurrent third day’ of illness, as well as to the Methodist common condition of constriction, or stegnôsis.20 A contemporary papyrus from Oxyrhynchus likewise describes treatment which appears to rely on the diatritus system.21 The diatritus is a therapeutic development of Thessalus himself, as Galen tells us, so that these fragments indicate the influence of his teaching in Egypt within just a few decades of his death.22 Thessalus clearly enjoyed continued popularity in Egypt. From around AD 200 we have a title tag for a bookroll attesting to an unknown work by him, with the inscription ‘Thessalus, On Medical Interests among the Nobility’.23 Works by him and by his predecessor Themison are listed in a third century papyrus from the Arsinoite nome, apparently an inventory of the contents of a library.24 The Methodists as a group are explicitly mentioned in two papyri from Oxyrhynchus, and the same city has yielded a Methodist treatise on acute diseases, surviving in two separate copies, again mentioning the diatritus.25 We also have a fragment of Soranus’ Gynaecia of the third century,26 and there

20  P SI inv. CNR 85/86, partially edited in Andorlini 1997. 21   P. Oxy. LXXIV 4971 (MP3 2384.01), of the late first or early second century AD. 22  On the origins, function, and purpose of the diatritus system, see Leith 2008. It is also probably mentioned on the third century Greek medical fragment P. Golenischeff: see Leith 2009. 23   P. Horak 2 (MP3 1503.11), Θεσσαλοῦ, Περὶ | τ̣οῦ φιλιατρεῖν | τοὺς εὐσχήμονα̣ς ̣ | ἄνδρας. 24   P. Vars. 5 (MP3 2088), ll. 23–24. On the papyrus, see most recently Puglia 2013, 77–83. 25  Explicit mentions of Methodists: P. Oxy. LII 3654 (MP3 2360.2), of the second century AD, and P. Mil. Vogl. I 15 (MP3 2340), of the early fourth century. Methodist treatise on acute diseases: P. Oxy. LXXX 5233 and 5234, of the second/third and second centuries respectively. 26  P SI II 117 (MP3 1483).

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are several other papyri with less clear-cut indications of Methodist influence,27 all of which together point to a considerable and apparently sustained interest in Methodism in the Egyptian chōra from very soon after Thessalus’ floruit. It might of course be objected that these written texts need not represent evidence for the presence of Methodist practitioners in such towns, but it scarcely rules it out, and if there is evidence at least for interest in Methodist medicine, then it may be expected that there will have been opportunistic doctors around to exploit it. So Thessalus, as an example of a heresiarch, seems to have been highly successful in spreading his medical teaching throughout the Mediterranean within a few decades, not just to centres such as Smyrna and Alexandria, but also to much less prominent areas of the provinces. And even if he were rather unusual in the huge number of his students, and in the nature of his recruitment campaign, there is no reason to doubt the general pattern, which Galen assumes, of the spread of sect medicine through little-known pupils moving widely throughout the Empire. It is a pattern which can also be documented for the immediate circle of Asclepiades of Bithynia, in the early first century BC.28 There are only four direct pupils of Asclepiades whose names we come across in the sources, all of whom he presumably taught in Rome,29 though it is surely unbelievable that he only ever had four pupils altogether throughout his career. Besides Themison, the founder of Methodism, we know something of the later fortunes only of Philonides of Dyrrachium. Stephanus of Byzantium preserves a unique reference from Herennius Philo, and this we have solely due to the unusual form of the ethnic he had employed. Philonides, it seems, later returned to his native city of Dyrrachium, set up a successful practice there, and became a prolific author: And Herennius Philo in his Physicians records Philonides as ‘Dyrrachene’ (Δυρραχηνόν) thus: ‘Asclepiades had as pupils (ἀκουστάς) Titus Aufidius Siculus, Philonides the Dyrrachene and Nicon the Acragantine.’ And 27  See e.g. BKT III 19–21 (MP3 2378), P. Turner 14 (MP3 2340.1) with Leith 2007, and P. Oxy. LXXX 5238. 28  On Asclepiades’ life and career, see esp. Rawson 1982 and Flemming 2012. 29  This is suggested by the fact that, of these four, two came from Sicily and one from Dyrrachium: it seems on balance more likely that Asclepiades should have come across them at Rome rather than in the other places in which we know that Asclepiades was working, viz. Athens and the area around the Hellespont (see esp. Caelius Aurelianus, Cel. Pass. 2.22.129).

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again: ‘Philonides the Dyrrachene was Asclepiades’ pupil (ἤκουσε μὲν Ἀσκληπιάδου). He had a reputable practice in his homeland (ἰατρεύσας δὲ ἐν τῇ πατρίδι ἐνδόξως) and composed 45 volumes’. —Stephanus Byzantinus, Ethnica s.v. Δυρράχιον (p. 244.13–245.6 Meineke) = F 3c, 790, F fr. 53 Jacoby

Parallels may also be drawn with the circle of the anatomist Marinus, if we may think of this as a kind of ‘anatomist sect’.30 Marinus, working in the time of Galen’s grandfathers, and so around AD 100, seems to have been the first doctor to revive the practice of systematic dissection since the pioneering work of Herophilus and Erasistratus in early third century BC Alexandria.31 Based on his dissections of animals, he compiled a huge, twenty-volume anatomical handbook, which Galen summarised in On My Own Books.32 His renewed interest in anatomy appears to have sparked something of a medical fad in the second century, among doctors and members of the ruling classes alike, and Galen was to participate in it with great success. By the time of Galen’s youth, Marinus’ pupils, and their pupils in turn, were numerous and dotted around various parts of the Mediterranean. We know of them because Galen’s education was in large part a matter of trying to track them down in order to gain anatomical expertise. Marinus’ direct pupil Quintus was certainly based in Rome during the reign of Hadrian, and therefore Marinus himself may well have been based there too, for there is nothing in the ancient evidence, as Heinrich von Staden has shown, to link him with Alexandria.33 Quintus had taught Satyrus, Galen’s teacher at Pergamum. His most famous student, however, was Numisianus, who had taught Pelops, Galen’s teacher in Smyrna. It was in order to find Numisianus himself that Galen then travelled first to Corinth and on to Alexandria and certain other unnamed places: I had indeed written it (sc. On the Motion of the Thorax and Lungs) while still in Smyrna, to be with Pelops, my teacher after Satyrus, the pupil of 30  On a few occasions, Galen refers to a group which he designates ‘the modern anatomists’ (neōteroi / neōterikoi anatomikoi), a coinage comparable to e.g. Methodikoi or Dogmatikoi, and these people may perhaps be identifiable with the anatomical experts who were taught by Marinus and his pupils: De anat. admin. 6.10, 7.1 (ii 574, 590 K.); De ossibus. 3 (ii 746 K.). 31  See Grmek and Gourevitch 1994. 32  The Greek text of the lacuna in Galen’s synopsis of Marinus’ work has now been recovered thanks to the recent discovery by Antoine Pietrobelli of the MS Vlatadon 14: see the edition of Lib. prop. in Boudon-Millot 2007. 33  Von Staden 2004, esp. 209–212.

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Quintus, before I had made any important or original contribution. Later I went to Corinth, to hear Numisianus, the most famous pupil of Quintus. Then I visited Alexandria and several other places where I heard that Numisianus was living. Next I went home, but after no long time came to Rome. —Galen, De anat. admin. 1.1 (ii 217–218 K.), trans. C. Singer.

In fact, Galen found at Alexandria not Numisianus, but his son Heraclianus.34 However, the point is that within two pedagogical generations the followers of Marinus had spread, perhaps from Rome, to most of the main centres of medicine, Smyrna, Alexandria, and Pergamum, as well as cities in mainland Greece such as Corinth. Galen’s presumption, then, of the wide availability of sectarian doctors, and their attraction of large numbers of pupils, seems to find a measure of corroboration in the surviving evidence. But again, it must be emphasised that we hear only of the very successful doctors in our literary sources, those who were able to make a major impact, and even these leave only the scantiest of traces. For every Philonides or Heraclianus, there must have been many more second or third rank pupils, who nevertheless went on to practise and pass on their master’s teachings, outside of the main centres. One obvious means of tracking these lesser-known members of medical sects would be to look more closely at the epigraphical evidence, in the expectation that ordinary, individual sectarian doctors might be interested in having themselves identified as such. Interpreting the significance of this evidence, however, is far from straightforward. It is in fact only a small minority of inscriptions that refer to a doctor’s adherence to one of the main medical sects. These are nevertheless of considerable interest.35 To begin with, we have two inscriptions which I have already referred to briefly. From first century AD Rome, we have a commemorative inscription to one Tiberius Claudius Menecrates, who is described as a ‘founder of his own rational and lucid medicine’, which he apparently set out in 156 volumes.36 Those who set up the inscription were clearly Menecrates’ pupils or followers, referring to themselves at the end as his friends, and to Menecrates as ‘their heresiarch’. 34  Nutton 1993 explores the circumstances of and possible reasons for Galen’s lengthy stay in Alexandria. 35  What follows does not pretend to be a comprehensive list of inscriptions mentioning doctors and their sect allegiance, and is not the result of a systematic search, though I have greatly benefited from the collection in Samama 2003. 36  C IG 6607 = IGUR 686 (Samama no. 461).

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Τιβερίωι Κλαυδίωι Κουιρείναι Μενεκράτει ἰατρῶι Καισάρων καὶ ἰδίας λογικῆς ἐναργοῦς ἰατρικῆς κτίστηι ἐν βιβλίοις ρνς΄ δι’ ὧν ἐτειμήθη ὑπὸ τῶν ἐνλογίμων πόλεων ψηφίσμασιν ἐντελέσι, οἱ γνώριμοι τῶι ἑαυτῶν αἱρεσιάρχηι τὸ ἡρῶον. For Tiberius Claudius Menecrates, of the Tribus Quirina, physician to the Caesars, founder of his own rational and lucid medicine in 156 volumes, for which he was honoured by highly regarded cities with complete decrees, his friends (set up) the Heröon as their heresiarch. Menecrates is otherwise known to us principally as a pharmacologist, being mentioned on several occasions by Galen in his drug compilations.37 But here we learn that his interests were much more wide-ranging, and indeed that he formed his own sect, that is, a group of followers who were committed to the kind of medical approach he developed. This will presumably have been basically similar to Thessalus’ sect in Rome in the same period. Yet we would otherwise have had no indication that Menecrates had a following of this sort. His pupils, again, will have continued to practise Menecratean medicine somewhere, though they were ultimately to have much less impact than Thessalus’ followers. Another interesting example is a dedication on a bust of the Methodist Asiaticus, from Smyrna around AD 100.38 ἰητὴρ μεθόδου, Ἀσιατικέ, προστάτα, χαῖρε· πολλὰ μὲν ἐσθλὰ παθὼν φρεσί, πολλὰ δὲ λυγρά. Μ(ᾶρκος) Μόδιος Ἀσιατικός, ἰατρὸς Μεθοδικός.

37  E.g. Galen, Comp. med. gen. 2.5 (xiii 502–503 K.). Galen praises his policy of writing out the numbers in medical recipes in full to avoid confusion. 38  C IG 3283 = I. Smyrna (IGSK 23) 537 (Samama no. 195 = fr. 12 Tecusan).

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Champion physician of the Method, Asiaticus, farewell, having felt in your heart many blessings, and many sorrows. M. Modius Asiaticus, Methodist physician. Asiaticus’ sect credentials are clearly something of which he was proud, and they are emphatically asserted here, perhaps again by his own pupils. Given the importance of Smyrna as a medical centre, it is hardly surprising to see a prominent Methodist presence there in the late first century or early second, though it should be emphasised that this inscription is the only evidence we have for Methodist representation there. Perhaps more noteworthy is the presence of two Asclepiadean doctors in much less well known places. One Marcus Apronius Eutropus was honoured in an inscription of uncertain date found at Limony on the Rhone (south of Vienne), as an Asclepiadean doctor:39 M(arco) Apronio | Eutropo | medico Asclepi|adio IIIIIvir(o) | Aug(ustali) et | Clodiae eius. | Apronia Clodil(la) | parentib(us) optim(is). For Marcus Apronius Eutropus, Asclepiadean doctor, sevir Augustalis, and his wife Clodia. Apronia Clodilla for her excellent parents. Similarly, though this time far to the East, we see Aurelius Varianus Pantauchus honoured as an Asclepiadean archiatros in a small town in Pamphylia, around AD 300:40 [ἡ βου]λὴ καὶ ὁ δῆμ[ος ἐτεί-] [μη]σεν Αὐρ. Οὐαριανὸν [Πάν-] ταυχον, τὸν ἀξιο[λογώ-] τατον ἀρχιατρὸν Ἀσ[κλη-] πιάδιον, τὸν δὲ ἀνδριά[ν-] τα ἀνέστησαν Αὐρ. Π[αν-] ταυχιανὴ Νενα καὶ Αὐ[ρ.] [- - - - - - - - - - - - -]

39  C  IL XII 1804 = ILS 7790. See Rémy 1984, 122–124, who notes that the absence of a dedication dis manibus might suggest a date in the first century AD. 40  Bean and Mitford 1970, no. 38 (Samama no. 350); from Cibyra Minor in Pamphylia.

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The Council and People honoured Aurelius Varianus Pantauchus, most distinguished Asclepiadean archiatros. Aurelia Pantauchianē Nena and Aur[. . .] set up this statue. Even if the Asclepiadeans had begun to die out in Rome in the later second century, as Galen suggests, clearly there continued to be individuals in various, less prominent parts of the Empire who wanted to be identified, and were publicly recognised, as adhering to Asclepiades’ medical principles. These inscriptions attest in various ways to the widespread diffusion of sectarian doctors, in just the way that Galen suggests. However, this small minority of explicit sectarian identifiers might be taken to suggest that such physicians, although perhaps geographically quite widespread, were by no means numerous. Yet it may be more significant that we know of at least a further five inscriptions in which the doctors mentioned are not identified as belonging to a sect, but who, as we know from other sources, did in fact so belong. Thus we have three inscriptions mentioning two Asclepiadean doctors of the later first century BC who were close to Augustus.41 Αὐτοκράτορα Καίσαρα θεοῦ υἱὸν Ἀρτώριος [Ἀπόλλωνι, Ἀρτέμιδι], Λητο[ῖ]. Artorius (honoured) Imperator Caesar son of the divine (Julius) (and dedicated this) [to Apollo, Artemis] and Leto. ὁ δῆμος Μᾶρκον Ἀρτώριον εὐεργεσίας καὶ εὐνοίας ἕνεκα The (Athenian) people (honoured) Marcus Artorius for his benefaction and goodwill. [ὁ δῆμος ὁ] Σαμίων -.-