Roman medicine: everything you wanted to know

Summary

History Extra Podcast: Roman Medicine – Everything You Wanted to Know Release Date: March 9, 2025

In this enlightening episode of the History Extra Podcast, host Emily Griffith engages in a comprehensive discussion with Dr. Patti Baker, a renowned specialist in Roman medicine. Drawing from Dr. Baker's extensive research, including her PhD thesis on medical care in the Roman army, the conversation delves deep into the complexities and advancements of medical practices in ancient Rome. This summary captures the essence of their dialogue, highlighting key topics, insights, and intriguing anecdotes that shed light on how Romans approached health and healing.

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Introduction to Roman Medicine

Emily Griffith opens the episode by posing fundamental questions about the survivability of illnesses in ancient Rome and the mechanisms the Roman army employed to handle ailments and injuries on the battlefield. She intriguingly compares Roman medical practitioners to the snake oil peddlers of the American Wild West, setting the stage for a nuanced exploration of Roman medical practices.

Key Points:

• Overview of Roman medical survival rates.
• Comparison between professional Roman doctors and local healers.
• Introduction to the Roman army's medical strategies.

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Core Beliefs and the Humoral System

Dr. Patti Baker explains that Roman medicine was predominantly influenced by the humoral system, a concept inherited from Greek medicine. This system posited that the human body was composed of four humors: black bile, yellow bile, phlegm, and blood. Health was perceived as a balance among these humors, and illness was a result of their imbalance.

“They believed that a good balance of those meant that you were healthy, and if they were not in balance, then you were unhealthy.” (03:22)

Key Points:

• Explanation of the four humors and their characteristics.
• The role of balance in maintaining health.
• Influence of religion and varying beliefs across the expansive Roman Empire.

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Regional Variations in Medical Practices

Given the vast expanse of the Roman Empire, Dr. Baker highlights the regional differences in medical practices. While Rome and Greece served as the central hubs for medical knowledge, provinces like Gallia Belgica (modern-day Belgium) showed unique medical focuses, such as eye care.

“Certain units adopted what we would call Roman medicine... but not all units did.” (04:35)

Key Points:

• The peripatetic nature of Roman doctors and their exposure to diverse medical traditions.
• Influence of local practices and environmental factors on medical treatments.
• Variation in the adoption of Roman medical terminology and practices across different army units.

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Greek Influence: Hippocrates and Galen

The episode underscores the profound impact of Greek physicians like Hippocrates and Galen on Roman medicine. Dr. Baker notes that educated Roman doctors extensively studied Greek medical texts, which significantly shaped their medical theories and practices.

“Galen himself actually was in Rome for a while. So a lot of the literature starts with the Hippocratics or even earlier.” (06:54)

Key Points:

• Transmission of Greek medical knowledge to Rome.
• The enduring legacy of Hippocratic and Galenic theories.
• The evolution of medical literature and its influence on subsequent generations.

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Practitioners of Roman Medicine

The medical landscape in Rome was a diverse ecosystem comprising professional doctors, local healers, midwives, and religious healers. Dr. Baker elaborates on the various roles within Roman medicine and their societal receptions.

“There is papyrus evidence from Egypt where we know about like city doctors. So there are professional doctors like that.” (08:20)

Key Points:

• Distinction between professional physicians and folk healers.
• The significant role of women as midwives and non-female related medical practitioners (medica).
• The integration of religious practices in healing, including the use of sanctuaries and priestly interventions.

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Education and Training of Roman Doctors

Dr. Baker describes the apprenticeship model prevalent in Roman medical training, where knowledge was passed down through families or through apprenticeships with established physicians. Additionally, wealthy doctors had access to extensive libraries, such as those in Alexandria, enhancing their medical expertise.

“If you had some money, then you could go off to a larger city like Rome or especially Alexandria in Egypt, with huge libraries...” (10:44)

Key Points:

• Informal medical education through family and apprenticeships.
• Access to medical literature and practical experience in major cities.
• The role of lectures and demonstrations in medical training.

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Surgical Procedures and Tools

The conversation transitions to the surgical advancements of Roman medicine. Dr. Baker details various surgical techniques, tools, and the inherent risks associated with these procedures.

“They could definitely perform an amputation... But there would be no painkillers involved. Or very minimal painkillers.” (14:47)

Key Points:

• Common surgical procedures: setting bones, amputations, cataract couching, and trepanation.
• Description of surgical tools like scalpels, probes, hooks, and cupping vessels.
• Risks of infection and lack of effective anesthesia during surgeries.

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Understanding of Germs and Public Health

While Romans did not comprehend germ theory, they had a rudimentary understanding of hygiene and cleanliness as essential to health. Dr. Baker explains how concepts like miasma (bad air) influenced their perceptions of disease transmission.

“They do talk about cleaning it. They say, you know, use honey and sometimes wine or vinegar, which are antiseptic.” (19:18)

Key Points:

• The miasma theory and its impact on public health practices.
• Implementation of sanitation systems like sewers to maintain public health.
• Absence of formal quarantine measures, unlike later periods such as the Middle Ages.

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Religion, Superstition, and Medicine

Religion and superstitious beliefs were deeply intertwined with medical practices. Dr. Baker elucidates the role of healing sanctuaries, votive offerings, and the invocation of deities like Asclepius in the healing process.

“People would go and flock to healing sanctuaries and they're found throughout the empire... they could be healed through incubation.” (31:05)

Key Points:

• The significance of healing temples and religious rituals in treatment.
• Votive offerings as expressions of gratitude for healing.
• The balance between medical treatments and religious interventions.

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Mental Health in Roman Medicine

Dr. Baker highlights that Romans recognized mental health issues and attributed them to imbalances in the humors. Treatments often involved environmental and sensory interventions such as music therapy.

“Melancholy, for example, is a good example where somebody has too much black bile... music is often used as a way to get people's mental balance back into place.” (24:26)

Key Points:

• Recognition of psychological ailments within the humoral framework.
• Therapeutic use of music and environmental modifications to restore mental balance.
• Early concepts akin to modern holistic approaches to mental well-being.

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Public Health Initiatives and Accessibility

While not standardized, the Romans implemented certain public health measures like public baths and sanitation systems to mitigate disease spread. Dr. Baker discusses the accessibility of medical treatments across different societal strata.

“They did have public baths all over the Roman Empire. And that's a good place to exercise, to just have your daily bath and also CC people.” (38:39)

Key Points:

• Existence of facilities like public baths as centers for hygiene and social interaction.
• Variability in access to medical care based on location and social status.
• The presence of both paid and uncharged medical services, despite the Hippocratic oath advocating for non-payment.

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Battlefield Medicine and the Roman Army

A significant portion of the dialogue focuses on medical practices within the Roman military. Dr. Baker describes how battlefield injuries were treated, the presence of military doctors, and the strategic importance of medical care in maintaining army efficacy.

“We know that there were doctors in the army because we have inscriptions on tombstones and burial monuments that mention them.” (44:02)

Key Points:

• Treatment of battlefield injuries such as wounds and fractures.
• Role of Medicus as military physicians within legions.
• Emperor-led initiatives to attend to the wounded, enhancing soldier morale and survival rates.

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Fascinating and Gruesome Treatments

Dr. Baker does not shy away from discussing some of the more grim and unconventional medical treatments of ancient Rome, providing a stark contrast to modern medical ethics and practices.

“Another one that's a little, very gruesome, and I apologize to any man listening here, but was reverse circumcision...” (35:03)

Key Points:

• Description of procedures like amputation without anesthesia, cataract couching, and embryotomy.
• Cosmetic surgeries and gender-specific treatments.
• The use of pain management techniques, albeit primitive, to balance patient comfort during surgeries.

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Legacy of Roman Medicine in Modern Times

Concluding the episode, Dr. Baker reflects on the enduring legacy of Roman medical practices and their influence on contemporary medicine. She emphasizes the sophistication of Roman medical theories and the holistic approach to health that resonates with modern wellness concepts.

“The concept of balance... is still with us. So this idea of balance is still with us.” (38:39)

Key Points:

• Continuation of surgical tool designs and medical instruments.
• The persistent relevance of balance and holistic health approaches.
• Inspiration drawn from Roman practices in areas like garden therapy and forest bathing.

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Final Reflections and Takeaways

Dr. Patti Baker underscores the importance of recognizing the advanced nature of Roman medicine, advocating for a deeper appreciation of their medical knowledge and practices. She encourages modern audiences to consider the holistic perspectives Romans held towards health and well-being.

“I think just that a, it's much more advanced than I think people give it credit for.” (46:36)

Key Points:

• Encouragement to view Roman medicine within its historical and cultural context.
• The interconnectedness of physical, mental, and environmental health in Roman thought.
• The value of historical medical practices in informing and enriching modern healthcare paradigms.

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Conclusion

This episode of the History Extra Podcast offers a thorough exploration of Roman medicine, revealing a civilization with complex medical theories, diverse practices, and a lasting influence on the field of medicine. Through Dr. Patti Baker's expert analysis, listeners gain a nuanced understanding of how Romans approached health, illness, and the intricate balance required to maintain well-being in an ancient world.

Podcast produced by Lewis Dobbs.

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Note: For full access to episodes and additional historical insights, visit HistoryExtra.com.

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Timestamps Reference:

• 03:22: Dr. Baker discusses the humoral system.
• 04:35: Regional variations in Roman medicine.
• 06:54: Greek influence on Roman medicine.
• 08:20: Practitioners of Roman medicine.
• 10:44: Education and training of Roman doctors.
• 14:47: Surgical procedures and tools.
• 19:18: Understanding of germs and public health.
• 24:26: Mental health in Roman medicine.
• 29:32: Role of religion and superstition.
• 31:05: Medical debates and conflicting schools of thought.
• 35:03: Gruesome and unconventional treatments.
• 38:39: Legacy of Roman medicine in modern times.
• 46:36: Final reflections and takeaways.
• 44:02: Battlefield medicine and the Roman army.

Transcript

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[Emily Griffith]

Welcome to the History Extra podcast. Fascinating historical conversations from the makers of BBC History magazine. What were your chances of surviving an illness in ancient Rome? How did the Roman army deal with ailments and injuries on the go? And in what way were the medical practitioners of this ancient civilization similar to the snake oil peddlers of the American Wild West? Well, Emily Brifitt spoke to Dr. Patti Baker, a specialist in Roman medicine, to get the answers to all of your questions about the treatments, cures and surgical operations of ancient Rome. And please be aware this episode does contain explicit medical details, including about fetal death. Hi, Patty. Welcome to the History Extra podcast. Thank you so much for joining me today.

[Dr. Patti Baker]

Thank you, Emily, and thank you so much for the invitation. I'm really looking forward to it.

[Emily Griffith]

We are delving into the world of Roman medicine today. Now, I've got to ask you, how did the Romans approach medicine? Were there any core beliefs behind it?

[Dr. Patti Baker]

There are multiple beliefs behind it, and there are many ways I could answer this question, which could go on and on forever. But in general, the easiest way for me to describe it is that ultimately, they believed in the humoral system, where the body was made up of black bile, yellow bile, phlegm and blood. And I'll probably come along and talk about those later. But they believed that a good balance of those meant that you were healthy, and if they were not in balance, then you were unhealthy. And they came up with ways to do this. But also, religion played a large part of medicine. They had surgical procedures that we still practice today, and they had folk remedies and pharmacology. So it's a mix. But also, the Roman Empire was made up of a. It was very large, with people of many different beliefs. So there could be people with very different beliefs about the body and how it worked within the same empire.

[Emily Griffith]

This brings us onto a question you've actually had from one of our listeners, andresito83, on Instagram, who have actually asked us, given the large swathes of land controlled by Rome at its height, given what exactly was Roman in inverted commas? Medicine.

[Dr. Patti Baker]

That's actually an excellent question. So I think the easiest way to call it Roman would be to think about what was happening in Rome and in Greece as the core medical beliefs. And then as you go out, doctors were peripatetic, which means that they traveled. Doctors were told by writers like Celsus, who wrote in the first century A.D. on medicine, that a good doctor would go around and have different experiences to see different diseases in different areas, and they would probably learn what pharmacological procedures there were, what plants there were, and they would encounter different views about the body. So, for example, in Gallia Belgica, which is pretty much modern Belgium today, there seems to be a lot of evidence that they were very concerned about eye care, and that comes from the archaeology and the inscriptions. So there may be regional differences. Celsus, the writer I mentioned previously, also says that, you know, they may have same diseases with different names or different versions of the same disease. So it is hard to say that there's one Roman medicine with one core uniform belief. But there definitely were different practices. And we even see this in the Roman army. It seems that certain units adopted what we would call Roman medicine, where they had Roman surgical tools, schools. We have inscriptions with Latin titles such as medicus for doctor or physician. But not all units did. And the ones that tended to have them were from Gaul, so France, and a little bit from Spain, and then of course, what would be Italy, but like Britain, very few. So it's interesting that there are different.

[Emily Griffith]

Beliefs, so care was far more localized than being this one giant entity.

[Dr. Patti Baker]

That's the way I would say it. I mean, you'll definitely get input from other regions. And so people are talking to each other. It does seem like that humoral system I mentioned was pretty common, but we can't prove that for places where there's no literature, so we assume it. But then they have other evidence for medical treatment through their archaeological remains that suggest maybe they were practicing something else.

[Emily Griffith]

Could we talk a bit about the influence of the Greeks, particularly Hippocrates, Galen? How did they influence Roman medicine?

[Dr. Patti Baker]

Definitely for the literate Roman doctors who had the ability to travel, they would read the Hippocratic writers. And Galen himself actually was in Rome for a while. So a lot of the literature starts with the Hippocratics or even earlier. We could start with the pre Socratic philosophers in about the early 5th century BC with Empedocles, who starts to talk about the makeup of the cosmos. So he says everything has earth, air, fire and water in it. And then we start seeing the Hippocratic writers pull this out into the humoral system, where they have yellow bile, black bile, phlegm and blood, which is related to the four elements. And then we just see additions of this in literature. But by the time Kalin's writing in the second century ad, this seems to become pretty uniform in medical literature. And again, it's not to say that people didn't have beliefs, but definitely the literature writers comment on it. And we see this Even in the 7th century with Paula Vagina. He's basically plagiarizing some of the writers. Other Greek writers like Serranus, we have a whole host of writers. And this goes on into the Middle Ages and even Renaissance. So where we hear Galen's name. So people are definitely reading these writers.

[Emily Griffith]

Who practiced medicine in ancient Rome. Was it professional doctors? Was it local healers? What was the balance?

[Dr. Patti Baker]

I can't say what the balance actually was. We have no statistics, but I can definitely say it's a mixture. There is papyrus evidence from Egypt where we know about like city doctors. So there are professional doctors like that. We know that certain units in the Roman army definitely had military doctors, so they travel around. I think Galen even says it's good for a doctor to join the army for a little bit so they can see how to heal wounds. Women practice medicine both as midwives. And then there's the Latin inscription medica, which is the feminine form for physician. We're curious why does she not have the same term as obstetrics, which is the Latin for midwife? So women seem to have been practicing non female related medicine, so that possible? So, yeah, it's a whole host. And then there are folk healers and then people would go to healing sanctuaries. So they may have had a priest laying hands on them or something like that. Yes, so it's a whole mix of people practicing.

[Emily Griffith]

One of our listeners has sent in a question on Instagram to ask about women practicing medicine and actually how were they received in that practice?

[Dr. Patti Baker]

Well, I mentioned the medica, so I'll start with those. We don't know too much about them, but since they take that different Latin term, it does suggest that they probably were well received. There are about 20 inscriptions that mention them on tombstone funerary inscriptions. And they're from around the empire. So that gives us an impression that at least in some places they were well received. Definitely women who practice midwifery were well received. And there's a book by a writer named Soranis. He was a Greek writer, he lived in the second century A.D. and he wrote a book on gynecology. And in there he mentions that a good midwife had to know how to read, should be very calm. He has a whole list of how a good midwife would work. So. And definitely they need a midwife. So they were, as far as I can tell, definitely seen as very important. But the fact that he says they have to be literate suggests that they were receiving an education.

[Emily Griffith]

Touching on that point about education, was there a formal training, a way in which a doctor could learn or a healer could learn their trade?

[Dr. Patti Baker]

There's a couple different ways. I mean, as far as we know, there's no medical exam like people have to practice now, but you could join a family of healers. So there does seem to be that if somebody, if, say the father, mother were a doctor, then their children could learn with them. And if you were from outside the family, you could go and join them and just learn like an apprentice. It seems most of it was apprenticeship. So if you knew of a doctor, you could follow him or her around. You could learn from them. If you had some money, then you could go off to a larger city like Rome or especially Alexandria in Egypt, with huge libraries, so you could read books, papyrus. And also there would be doctors around those places where you could join with them. So there could be some. I would call it classroom education. Would be. You could go and observe or hear these people lecture. Whether they set it up formally, like you go from 9 to 10 in the morning. I don't think it was like that. But Galen, the writer that I mentioned earlier, he wrote copious amounts and he was a bit arrogant, but he said that he could demand such large audiences that he needed an auditorium to fill it up. We do know that in some cases that doctors would have an auditorium or a little theater space and they could lecture there. And at different time periods, basically, they would do experiments on animals, unfortunately, live. I know it's not very nice to hear about, but this is how medicine's learned. But they would do these demonstrations so people could learn something. And they were learning something as well. So multiple ways you could do it, but anybody could say they were a doctor. So if I want to just come along and needed some money, I could do that. But probably not very well received.

[Emily Griffith]

I need to ask you, was it better to avoid a Roman doctor altogether? Then what were your chances of survival?

[Dr. Patti Baker]

Okay, again, no statistics, so I can't give you actual numbers, but it depends on what you were being treated for. We know that people definitely did survive doctors, at least in the Hippocratic writers. We have doctors taking notes and they tell us that somebody survived one of their treatments or didn't, unfortunately. I think if it was something like a fever, you might want to consult a doctor. And they could recommend some medicines or just such as a protocol on what to eat, when to go to the baths, how to rest. Something like that would probably be pretty safe, though you had to make sure the doses of the medicines weren't too strong because you risk being poisoned. But it's a possibility. But they were very good about distinguishing between poisoners and medicine. But there's some pretty gory surgeries if you broke a limb or something. And I speak from experience. I broke my wrist a few weeks ago. The first I thought was, thank gosh, we have anesthesia. But the way they describe the surgical procedures for setting bones is just pretty much like doctors do today. But there would be no painkillers involved. Or very minimal painkillers. So you would probably not want it. But they did have the ability to treat certain things that you would survive. It would just be painful for a while. But there are some gruesome surgeries described in Calcis about removing stones from the urinary tract. And he even says it's the last resort because it's extremely painful and people did risk infections and shock. So there were always those risks as well.

[Emily Griffith]

Okay, that's really answered a question that we've had from Pamela Buffington Iric on Facebook, who was asking all about surgery and surgical procedures. What other kinds of surgeries could be performed? This sounds really gruesome.

[Dr. Patti Baker]

Okay, so I'll start with the bones and military surgery. So basically, as I said, they could set bones, though sometimes setting bones, if it's an extreme fracture, they may not be able to fix it perfectly. They did do amputations and without anesthesia. But the amputations they described are pretty similar to how a doctor would do it today. Sorry, it's going to get a little gruesome, but without the electric stalls that they use. And we do know that people survive, though, so if you had a severe break or gangrene or something, they could perform an amputation. But again, whether or not the patient survived the shock of it or if an infection followed from, we don't know. But there are definitely people who survived that they could remove, like, arrowheads, spearheads from the bones. And there are a couple different ways they would do that. The doctor who was skilled in that would either just if it was on a clear trajectory, the best case scenario was to actually push it straight through. Spearheads are usually barbed, so if you pull it out, you can actually do more damage. So one way, if it was safe to do so, if the doctors thought it was safe to do so, just push it through. If they couldn't do that, they would take a speculum and just spread open the skin, and you could pull it out that way and then clean it up. Suturing is very common. They could do that. Other surgical procedures for the eyes, they did actually do something called couching a cataract, which apparently doesn't hurt, but basically they would take people and try to move the cataract out of the way of the eye using very thin needles. And apparently that was done until very recently in certain countries. It doesn't remove the cataract, but at least it kind of moves it out from vision. But apparently it doesn't hurt. But I cannot imagine somebody coming at me with a little needle so they would have people holding the patient down. Other surgical procedures, most of it was just removing growths and things on the surface. They didn't do open heart surgery or brain surgery, anything like that, though they did do trepanation where you drill a hole in the bone of the head. And there are a couple different theories about why they might have done this, but part of it was to actually maybe to relieve pressure or get rid of a bad humor or something like that. But there have been some skulls found with the bone growing back so that we know that people did survive this. So yeah, it was mainly those types of procedures that they followed. If you're very interested, I suggest reading book 7 of Celsus dei Medicina or on Medicine because there he describes lots of different procedures.

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[Emily Griffith]

Bk.Com terms certainly something for listeners to go and maybe do a bit of research on later. This goes beyond surgery. Obviously it's particularly important while we're here. Did Romans have an understanding of germs contagion infection at all?

[Dr. Patti Baker]

Not in the sense that we do. Definitely not germ theory. They do have an explanation for contagion and they were aware that you did have to keep a wound area clean. They do talk about cleaning it. They say, you know, use honey and sometimes wine or vinegar, which are antiseptic. But whether they knew it as antiseptic like we do, I don't know for sure. But they definitely recommend that. And just keeping things clean, they sort of understood. But whether they understood it the way we do, probably not. Now, in terms of contagion, what's very interesting is they talked about one way to get disease was you could get a bad disease through a bad smell. And they called it miasma, or Greek is miasma. And it was just that if you could smell something bad in the air and you breathe this in, you're actually taking it into your body. And that could cause an imbalance in the humors. So, you know, if you think if you smell something really bad, you may want to feel. You may feel a bit nauseous. So I think that's where that comes from. But they really believe that you are taking the body and it's a bad smell. And they always say, avoid marshy areas because there are bad smells there. Too much smoke, they say, is bad from the kitchens and people cooking sewers, places like that aren't healthy because of the smoke, the smell. So that is a way they understood contagion. So it is a miasma.

[Emily Griffith]

Were there any public health initiatives or regulations that could prevent the spread if it's all about miasmas?

[Dr. Patti Baker]

I don't know there's any formal initiatives. I mean, the Romans had sewers, and definitely things like that are public health. In fact, they have a goddess named Salis, which means health. We get salubrious from it. And so in a way, yeah, they did. If you have big cities, they knew to get rid of the waste and street runoff, but that's not everywhere. So people did live with, you know, dirty environments. But yes, they did have stores and wastes to. To get rid of things like that. For when there were disease outbreaks, the suggestion might be go out to the countryside, get a. But that's because the air is fresher and it's not as crowded. Don't know about whether there were any official notices to. To quarantine yourself. We definitely know about that in Europe during the Middle Ages with the plague. But I can't think of anything offhand where the Romans actually said quarantine to.

[Emily Griffith]

Continue talking about their understanding of health. How would a Roman doctor or healer diagnose illnesses and ailments? How could they tell?

[Dr. Patti Baker]

Okay, so this is when we go back to the humoral system. And so I'll explain that first, just a little bit more detail and then explain what a Doctor might do. So, as I mentioned, people were made up of a balance of yellow bile, which was hot and dry, black bile, which was cold and dry, phlegm, which was cold and moist, and blood, which was hot and moist. So ideally, you have a perfect balance of these. Now, that balance differs depending on your age and your gender. And so children are much more warm and moist because they're very flexible and. Yeah, whereas the older you get, everybody gets a little cooler and drier and you're inflexible. But women tend to be moister than men and are harder, so they're more solid. But just everybody has a particular balance. But as long as you're in balance, that's fine. But when you get sick, so say, for example, you suddenly have a very high fever, but you're really dry. So the doctor would say that you have too much yellow bile or bile in your system. So therefore the doctor would recommend that you have an opposite treatment. So they would say that you have. So if you're hot and dry, you want something that's cool and moist. So cold drinks, cool baths, that might balance that out. So everything is in opposition. As for naming diseases, they do it. Sometimes it's hard for us to. To know what they're talking about because it's something called retrospective diagnosis. So they may describe something like, well, they had a rash and a fever, but we don't know how high the fever was. We don't know what the rash looked like. And so that's where we get into all sorts of difficulties of trying to figure out what the disease was. The one that seems fairly certain is something called the Sacred Disease, and it's written about, described by a Hippocratic writer in a book called the Sacred Disease. It seems to be epilepsy, but he says you have too much phlegm and that's what causes fits. So, yeah, they can definitely try and figure out where your balance is out, but naming diseases is probably a bit more difficult.

[Emily Griffith]

That's a great introduction to the theory. Now, obviously that's all about the physical ailments and physical illnesses. Did the Romans have understanding of mental health at all, or is this something that they don't really cover?

[Dr. Patti Baker]

They do, actually, and there's something called phronesis, but they do talk about mental imbalances, and again, it probably goes back to the humor. So there's something out of balance in you. There's something out of balance in your brain or your emotions. So, yes, they're definitely aware of it. And melancholy, for example, is a Good example where somebody has too much black bile in them, so they're cold and they're dry, so they're sad. And later writers, especially Arabic writers, talk about this, and they say, one way to calm this is you want to listen to uplifting music. So music is often used as a way to get people's mental balance back into place. So if you're very excitable, you want calm music. If you're very down, you want uplifting music, for example, or you want to look at something that's very pleasant. So it's all about changing your environment.

[Emily Griffith]

If we come back to the Roman medical professional, or maybe not professional, as you said, what might have been in their Roman first aid kit if they had one, what tools and herbs and medicines would they have?

[Dr. Patti Baker]

Okay, so let's go for the tools. Now, whether or not every doctor or physician had the same tools, I cannot say. But most of the tools we have are very common ones that most doctors today would recognize. So scalpels. Scalpels have a sharp end and a blunt end, and they're mentioned over and over again for multiple procedures. So just general cutting or removal of warts, for example, something like that. You use a scalpel and chew if you needed. As I said before, amputations, things like that. Scalpels are very common. Another two common instruments are what are called spoon and spatula probes. So they're about 8 to 10 inches in length, roughly. And one end of one of these probes will be very flat, and it's a thin leaf shape. And that could be used for tongue depressor, putting ointments on your body, or even cauterization, where you heat it up and then burn something if you need it to stop bleeding. The spoon probe that I mentioned looks very similar, but it's just a long, thin spoon. And that was probably used more for mixing, but you usually find those. And at the ends of both of these probes are very thin. They call them Olivary ends. It looks like a tiny olive pit, and that could be used for probing or very small cautery. So these tools are multifunctional. Another common tool was oligula, which is actually used for cleaning the ears. But we find those, and a doctor could use that as a probe. Sometimes you find hooks, which are basically, if you need to hold skin back, you would put a hook in the skin. This is for surgical procedures. They had hooks, blunt and even sharp ones. Most of the time, you just find random instruments. If you're lucky, you find a whole bunch. But most of the time, it's just an odd instrument here or there. Sometimes they have these round cylindrical bronze containers which are probably about an inch in diameter, maybe a little more, may, maybe an inch and a half, something like that. And sometimes they just have needles in them which were used for eye surgery while pouching cataracts. So sometimes you get specialized kits like that. But most of the time it's the general tools. Another one that is important for Roman doctors and Greek doctors as well was a cupping vessel. So cupping was used again to balance the humors. So they would use cupping quite a bit for that. Both dry, which is just heated up, or where you make a small incision, and then you use a cupping vessel to remove either blood or pus or something like that. The cupping vessel would be used for more specialized procedures. Solves for amputation and trepanation. Also, they had vaginal and rectal specula as well. So most of the tools are generally very common, multifunctional. As for medicines, there are some medicines that survive. Most of the time, what we have are stamps. So what stamps were used for is when somebody was mixing up a paste or something, and before it hardened, you would put a stamp in and it would usually have the doctor's name on it or the surgeon's name or the pharmacist's name, who's ever making it, maybe, and then what it was used for and what it's called. So, and that was tended to be used for eye medicines, they're called, and you would stamp whatever the ingredients were. There have been very few of these medicines found, but most of the part we just know from literature. Sometimes there's some vials that survive, but they had all sorts of remedies and recipes. The Hippocratics have lots of recipes with lots of different herbs and sometimes minerals used for all sorts of procedures.

[Emily Griffith]

Do we get a sense of what type of ingredients they used?

[Dr. Patti Baker]

Yes, sometimes, yeah. They're very specific about different plants. So all sorts of plants can be used, but opium seeds, pepper, you name it. If it's in the garden, they could probably use it. And they talk about cucumbers. Again, what they're really looking for are the properties. So is it something that can heat you up? For example, is it something really spicy, or is it something more juicy and plain that would calm down the heat in your body? So it's again, all this humoral stuff. It comes back into the remedies as well. They do talk about wearing amulets, and I think the writer Pliny the Elder, for example, Talks about wearing. I think it's amber in certain places they wear amber for throat. You know, you have a sore throat. Look at green emeralds if your eyes are really tired. So green was good for the eyes. So it's color. It's the extent of how spicy something was or bland something was. But they have also. Yeah, actually a woman you must read is Laurence Totolon's work on all of this. She is the expert, so I put a plug in there for her.

[Emily Griffith]

Excellent. We've got a question from a listener here, maxhfquigley on Instagram, and he's asked about the role religion and superstition played in Roman medicine. I know we've said we can't talk about exact stats and figures here, but what was the rough ratio of medicine to prayer?

[Dr. Patti Baker]

I think I'm going to come out. People probably won't like this, but I'll say 50, 50, just to keep an equal balance. Because even when, depending on who's prescribing the medicine, they may actually prescribe it. Prayer with that. So. But some doctors didn't. It just depends on who you're reading. I mentioned Serranus earlier, the person who wrote on gynecology, and he says he didn't believe in any religion, but as long as if it made the patient, everything for him was very practical. But if it made the patient feel good and gave them, you know, hope, then he by all means do it. But we know that people went and flock to healing sanctuaries and they're found throughout the empire, but particularly Greece, Epidaurus being one of the largest. And it was the goddess Glapius who was worshiped there. He was main God of healing in Greece and Rome. And people would go there generally for chronic. Well, we think are chronic problems, eyesight, anything that a doctor couldn't heal. If they could make it to one of these healing sanctuaries, they could be healed through incubation, where they would sleep somewhere in the sanctuary, either in the temple itself or in separate rooms. And then the God Asclepius would come to them at night in a vision or in a dream and heal them. And there are some great stories about the person had an arrowhead in their body and they couldn't remove it, and then they woke up and the arrowheads next to them. So things like that. There's all these fantastic prayers. But in general, people did pray. They went to sanctuaries. They often gave votive offerings that look like different parts of the body. So you get eyes, genitalia, hands Feet, legs, and sometimes one of them in Greek actually says, thank you, Tyche. Thanks to Asclepius and Hygiea, who's Asclepius's daughter. And there's a picture of a leg on it. So we assume that Asclepius possibly healed the leg, whatever the problem was, or that they were going there to ask for help. So here's, you know, my vision's going bad and what can I do? So please help. So definitely there is religion all around, so I cannot say, but I'll say 50, 50 split just to say that some doctors say yes, others don't mention it, but it's there.

[Emily Griffith]

Were there any medical debates, conflicting schools of thought on treatment methods?

[Dr. Patti Baker]

Oh, yes, it's never changed. But yeah, there's different schools of thought, especially we know through Greek literature, but empiricists, which talk about observation, Methodists like both practice and observation, for example. And you get all the different writers will mention other doctors and say they practice this. I don't agree. Or yes, it works. So there are always debates and people are trying to understand how the body's working. So there will be different theories about that. I mean, if I were to put you in a classroom and you knew nothing about the body and to say, well, tell me about it, where would you even start? So this is what they're trying to do, and they do disagree, but ultimately they learn from each other and they learn from mistakes or sometimes, you know, some of the theories they came up with were used well into the early modern period. Sometimes we still even talk about balance today, but in general, yeah, they definitely debated and have different theories. And if you're really interested in reading lots of medical literature, you can see the different points of view and the different schools of thought to bring it.

[Emily Griffith]

Back to the treatment. Just briefly, are there any particular strange, unconventional, or really fascinating treatments that have intrigued you?

[Dr. Patti Baker]

I think some are just horrified, but as I said. Well, the horrifying one was the one about the removal of the stone from the urinary tract. I won't go into it, but that just sounds so painful. Another one that Calcis recommends is actually that they did do a little bit of cosmetic surgery. One is mentions that if your earlobe, say your earlobes start drooping because you're wearing heavy earrings, since you can fix it, you just cut off the earlobe and stitch it up, and that's an easy fix. Another one that's a little, very gruesome, and I apologize to any man listening here, but was reverse CIRCUMCISION and that was if, say, you were born Jewish and you had circumcision. The idea is, if you want to go to the Roman baths and look more like a Roman, basically you make incision in the skin above the glans, the part of the head of the penis, and then hang weights on that skin and eventually it should lengthen out. This is what Celsus described. Whether anybody actually went through this, I don't know, but that one's particularly gruesome. And Soranis describes what you can do if a childbirth should go wrong. So this is apologies to any woman listening out there. They did practice something called embryotomy, which is, unfortunately, if a baby dies during childbirth, but the woman still hasn't delivered, sometimes they have to use hooks and rake it up. And the whole point is you save the mother's life. Unfortunately, it is very gruesome, but Serranus describes it. So there are some gruesome things out there which horrify me and also make me very happy that we have anesthesia. Another thing that I'm just amazed at. The health surgery could be performed without much of any kind of anesthesia. When I say much, I remember there is a little discussion that there are some opium medicines that people might have been able to take, but usually it's wine or try to relax the Reiter. Kelsis does say that a really good surgeon is someone who will work fast enough to try to relieve the pain of the patient, but slow enough that the screams of the patient won't bother them, so that they'll do a good job. So it's even the doctor had to get that balance right. So that's what's horrified me, was just some of these procedures they describe. But what fascinates me, and I like going back and looking at it, is some recent work I did not too long ago was looking at how sensory experiences were good for health and keeping a healthy balance. And I really like that because I think there is definitely something to that. You know, there's so much more on garden therapy and forest bathing today. And actually the Romans talk about this. You want to put yourself in a good environment, feel really good physical and mental balance. So you surround yourself with pleasant sense or no scent at all. Just the vision, how you want to see lots of greenery and plants and beautiful views of the mountain and sea. This is all good for you. And I definitely think they're onto something there. And how they describe it is very different. It's about their philosophies, about how the senses work and how things come directly to you into your brain. But I just. It's something that I think we should all be going back to and just slowing down. And so I like that very much.

[Emily Griffith]

Are there any aspects of Roman medicine that we can actually still see today at all?

[Dr. Patti Baker]

Well, definitely with the surgical tools I mentioned, if you were to look at them, they're very similar shapes. So especially like scalpels. I forgot to mention tweezers or forceps. They're the exact same thing doctors have today. Some of the probes look very similar. They're not exactly the same, but any modern doctor would recommend recognize and probably know how to just grab them and use them for the most part. As I mentioned, this concept of balance, although we describe it differently, that's still there. And, you know, I need to get a good work life balance or anything. And we do that because we want something healthy and calm. And so they mentioned that dietetics, or on regimen, this is how you keep yourself healthy. So this is one way to avoid going to a doctor, is that doctors write a lot of how to stay healthy books. A lot of them is have a good diet for whether you're male or female. You know, to keep those humors in balance. Make sure you get the right amount of exercise. Don't overdo it, but unless you're an athlete, in which case there's a whole different regimen for you. Make sure you go to the baths. Bathing was really important. So they had public baths all over the Roman Empire. And that's a good place to exercise, to just have your daily bath and also CC people. So it's a whole combination of things. So this idea of balance is still with us.

[Emily Griffith]

Did everyone have access to treatment? Was this for everybody?

[Dr. Patti Baker]

Yeah, that's really another one of those. Can't give you a full answer, but definitely there's treatments available. So doctors, according to the Hippocratic oath. Now, whether every doctor took that is questionable. We definitely have. The oath says that you shouldn't charge anybody. So technically, doctors shouldn't be charged. But doctors like Galen like to have wealthy patients so clear they're making some money. And if you're in the army, technically, depending on your unit, there's not enough evidence to say that every unit had a military doctor, but there were doctors in health care available. Now, whether the units brought, say they were from a province like Britannia, whether they brought their own medical doctor with them or had their own practices, they could have had those with them. As I said in Alexandria, we have evidence for city doctors. And also I said the doctors traveled around. So the way I always describe this of my students is if you can think of the Wild west in America with somebody pulling up and it's like Dr. Feelgood's Panacea Elixir for everything feeling. A lot of doctors would just pull up into town and then treat people. And then if something didn't go too well, they could sneak off into the middle of the night. And who would know? So, and definitely midwives were around and women would know help with childbirth. So there's definitely medicine around. But it's again, it just depends on where you live. If you're in a city, obviously there's going to be more available to you. If you're in a very rural area, it could be just the local wise woman, wise man.

[Emily Griffith]

Did the Romans have hospitals at all?

[Dr. Patti Baker]

There is a term for hospitals called valetudinarium. And the old theory was that this particularly goes back to the Roman army. And in 1908, 1909, somebody in Germany wanted a military fort found. Fort was Neuss or Novaezium, and it's in northwest Germany. It was a maiden legionary fortress. And an archaeologist digging there found this courtyard style building with little rooms all around it and found one room with some surgical tools in it. And then said this must be the hospital or the valetudinarium, which makes sense. You know, at that time military units had hospitals. And when you look at the design of this building, it looks very much like German hospitals at the turn of the 20th century. So I could see where he's coming from. But to base that whole theory on a couple medical tools found in one room. And then other buildings with similar designs were described as being hospitals with no medical tools in them or indications that they were doing extreme high level burning, like blacksmithry and things, but still called a hospital. I don't think there was one design for hospitals is what I'm trying to say. I think we just have to be very careful about identifying one structure as having one function. It could have been that there are a couple rooms in this building where the medical tools were that maybe a doctor worked out of and maybe had a few rooms for really sick patients. Especially when you start seeing in the same fort medical tools all over the place. So it's just like, well, why are they in the barracks and you know, other buildings as well. So I think that's. This is. Yeah, it's a bit controversial as whether or not we've identified a hospital. I'm the one that came out and said, I don't think we have. I'm not saying that they're definitely not hospitals, but I just want to make it clear that perhaps we just should just be a bit cautious about how we just say this is definitely one building for one function. And especially in the ancient world, when they're doing lots of different. Different things in lots of different buildings.

[Emily Griffith]

Obviously, we need to talk about the Roman army here. What was battlefield medicine like? What was medicine like more broadly for the Roman army?

[Dr. Patti Baker]

So battlefield medicine, from what we can tell, it was mainly treating wounds. When I've described those, removing arrowheads or broken bones. Trajan's Column in Rome. And you can see a really good cast of it in the victim vna. There's a couple images. One is showing a soldier sitting down. And it's either another soldier or somebody described as something called a capsarius wrapping another person's wound. So whether soldiers helped soldiers or it's just somebody specifically there on the battlefield who had this, it's hard to say precisely, but we definitely have an image of that. And there's another image from a Greek vase painting. Vase painting, which also shows another soldier helping a soldier, or it looks that way. So it looks like soldiers would help each other. We do know that there were doctors in the army because we have inscriptions on tombstones and burial monuments that mention them. And then just say. It gives their name. It will say Medicus, which is a physician, and then it will say which unit they were associated with. But we don't have those for every single unit across the empire. But they are there particularly for units who were from Gaul and Spain and Italy, for the most part. And there are letters that we're fortunate to have of soldiers writing home. There's a papyrus letter just saying to his family, you know, I'm really sorry I didn't write, this is from Egypt. But the whole group of us got sick off of. He calls it. I think it was bad fish. So, yeah, the whole barracks, people were ill because of that. And so we do know that sometimes things just went around camp. But they said they stayed in their rooms for that, if what I remember correctly. And then there are just other histories that mention if the emperor was around after battle, the emperor would go into the tents of the wounded and look at them just like a general would go around today. Caesar, Julius Caesar said in some cases it's better to leave the soldiers behind if you're on campaign in a town where they're friendly so that they can recuperate and I guess they catch up with you later or go back to Italy. So there are multiple ways that people would get health treatment, but it's not like one uniform system. Like we, you know, have the medical course today. It's a little bit more ad hoc.

[Emily Griffith]

As a final question to you, what's one thing you think that we can learn from or take away from the Romans? Understanding of medicine and health.

[Dr. Patti Baker]

There's always more to learn, which is great. So there's always, there's always something new that people are finding out. So that keeps the subject of medical history alive, which is fantastic. But I think just that a, it's much more advanced than I think people give it credit for. We just can't say that they were so simple back then. I think that's always important. Just keep in mind these people have very sophisticated theories about how the body worked. Even if we don't agree with the Emerald Theory, if you look at it in a whole scientific context, it does make a lot of sense for how they understood the world. And I think that's really fascinating because everything seems to be interconnected. As I said, when you're taking medicines, it's about the balance. When you're in a certain environment, whether it's hot or cold or moist or dry, that will affect you. And so they sort of see health as something much more holistic. And I think perhaps we should take that on board a little bit more sometimes.

[Emily Griffith]

That was Dr. Patti Baker, a specialist in ancient medicine, speaking to Emily Griffith. Patty wrote her PhD thesis on medical care in the Roman army on the Rhine Danube and British frontiers. Thanks for listening. This podcast was produced by Lewis Dobbs.

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