Ancient medicine: how was illness treated in the Greco-Roman era?

Medicine in ancient Greece and Rome

For a long time, medicine retained a certain mystical dimension. Illness was commonly seen as an expression of divine anger which had to be silenced at all costs. Thus treatments mainly took the form of incantations, ablutions, purifications and offerings, presided over by priest-doctors in special sanctuaries (like that of the God of Medicine, Asclepius, in Epidaurus).

In Greece, the first person to eschew any consideration of deities in the practice of medicine was Hippocrates (460 BC-377 BC) who gave his name to the ethical oath still taken today by young Western medics (1).

Medical knowledge, which had hitherto not been rooted in any teaching, then became structured around the Library of Alexandria around 285 BC. This great institution housed the most important treatises on medicine from the Eastern Mediterranean, and was considered a major research centre. It spawned eminent figures such as Herophilos, Celsus and Dioscorides.

Though it differed from Greek practices, Roman medicine initially took its lead from the Greeks in that people prayed to their gods to ward off plagues. Medicine was practised in temples as well as in private clinics (iatreia) or by itinerant doctors. Some had their own specialties such as treating gladiators wounded in combat, or were affiliated to guilds or colleges in clinic-like settings (schola), and military hospitals (valetudinaria) also came into being.

De materia medica from Dioscorides: ancient use of medicinal plants

Born around the year 25 BC, Dioscorides is today regarded as the father of pharmacology. His work De materia medica, used by apothecaries until the 16^th century, lists more than 800 mainly plant substances (2).

Combining his experience as a doctor, pharmacologist and botanist, he proceeded to painstakingly classify the ‘simples’ (the old name for medicinal plants), listing their names, species, geographical origins, parts used, preparations and methods of administration. Therapeutic indications and dosages were all carefully detailed in his pharmacopoeia (3).

Plants, fruits and flowers were prepared in multiple forms: the more familiar herbal teas (infusions, decoctions…), but also herbal baths and enemas, powders, pastes and plasters.

At that time, camomile, rue and saffron were considered effective at regulating the menstrual cycle (4-5). Castor oil was used as a laxative (6), fennel was popular for its diuretic properties (7), while pomegranate was believed to eradicate tapeworm (8). Widely consumed as a spice by the Greeks and Romans, ginger was much-praised for its digestive benefits (9).

And even then, willow bark had been identified as a natural ‘aspirin’, validated by its effective salicylic acid content (10).

The place for animals and minerals in ancient medicine

In ancient times, animals were involved in the healing process in one of two ways: either by taking on the ill person’s sickness (acting as a scapegoat), or by providing therapeutic substances.

Though butter, beehive products (such as honey and royal jelly) and milk are the best-known examples of these, other far more unusual remedies – more magical than scientific – are mentioned in the literature, such as cobwebs or hare and sheep droppings (11). Of these unlikely therapies, only castoreum (secreted by beavers) really proved its worth: it was prized by our ancient forebears for treating epilepsy, fever, headaches and uterine pain.

In terms of minerals, iron salts were mentioned by Dioscorides as being powerful haemostatics able to stem the flow of blood from wounds (12). Indeed, the image on many Greek vases of Achilles rubbing the rust of his spear onto Telephus’ wound would appear to confirm the ancient origins of this discovery.

And mercury, copper, lead and sulphur salts had many applications in ophthalmology. Combined with various plant extracts, box leaves, celandine or rosemary, they were used to form pressed tablets or cakes of paste which were then scraped or diluted and used for treating eye discharge, burning or suppuration (13-14).

The basics of mycology

Rarely studied before the 17^th century, mushrooms make a modest appearance in the writings of Pliny and Dioscorides. De materia medica devotes a paragraph to agarikon, also known as larch polypore.

Regarded by the Ancient Greeks as the elixir of long life, this wood-decay fungus was defined therein as ‘astringent’ and ‘warming’ (15-16). Its entry states that it offers remarkable efficacy against “all internal conditions if given taking account of effect and age, one with water, the other with wine, with sour honey or mead”.

Surgical procedures in ancient times

Archaeological digs carried out at the site of Pompeii have revealed an extraordinary variety of surgical instruments: lancet, scalpel, hook, cautery, forceps, ventouse, syringe, trephine…

While it is difficult to place these elements in context, evidence suggests that Greco-Roman practitioners mastered the intricacies of many surgical procedures. These ranged from the relatively simple fracture fixation by ‘resetting’ bones, to more complex visceral surgery and tricky cataract operations. Equally remarkable were the creation of fully-functional dentures (made from gold during the Etruscan period) to replace teeth that had been damaged most often by millstone residues inadvertently left in bread.

And how did they put patients to sleep? In the absence of actual anaesthesia, doctors used sedative drinks. While decoctions made from hemp and opium were used abundantly in Eastern Antiquity, the Romans preferred wine or alcohol mixed with various plants such as belladonna, poppy juice, Indian hemp or mandrake (17-19), even though some of these, such as aconite, posed a serious risk to the patient regaining consciousness (20)…