Philosophy of science and medicine series — V: Roman period

Philip R. Liebson, MD
Rush University, Chicago, Illinois, United States

 

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Aesclepius, taken from Wikipedia

With the Romans, there was a general decline in theoretical science. It was applied science that interested them. Despite the assimilation of Alexandria into the Empire, no outstanding creative scientists appeared in Rome. It was in the distribution and dissemination of the Greek and Alexandrian wisdom rather than in its development that we see the role of Rome. The Greek physician Galen spent time in ancient Rome (see Essay II).

The Romans had a different attitude toward nature than the Greeks. They studied nature more closely, but for practical utility, not for generalized knowledge. Encyclopedias and compilations describing facts about animals and plants and depicting them in minute detail are found more and more commonly in this period. Experiment gave way to categorization. As to why the Romans and Alexandrians did not continue the traditions of the Athenians and Alexandrians there is some question. It is thought by some that the reason was lack of precision instruments. This hardly explains it as instruments are as much the result as the cause. The answer most probably lies in the Roman nature of stoicism. Whereas there was a trend toward specialization in science with the Alexandrians, the Romans produced works on general science.The Stoics presented their philosophy that to live a good life one had to understand the rules of the natural order since they taught that everything was rooted in nature.

The works on general science seldom involve any expert knowledge of natural phenomena and are concerned with the philosophical implications of the science of the day rather than with expanding scientific findings. Three names are characteristic of this type of Roman study: Marcus Varro, Pliny, and Seneca.

Marcus Varro (116-27 BC) was influenced by Plato and the Stoics. He studied under the Roman philologist Lucius Aelius Stilo and later at Athens under the Academic philosopher Antiochus of Ascalon. He wrote encyclopedically on the sciences and his works were the prototypes of the many medieval works on liberal arts. His Nine Books of Disciplines became a model for later encyclopedists, especially for Pliny the Elder. In this work, he shows concern for etymology, separations and divisions of subjects.He distinguished nine studies: grammar, dialectic, rhetoric, geometry, arithmetic, astronomy, music, medicine, and architecture. All but two were carried over into the middle ages as basic liberal arts (trivium and quadrivium). In the Renaissance his text was widely circulated after the development of printing. His Res Rusticae or Rerum Rusticarum Libri Tres (Three Books on Agriculture)was a systematic compendium of agricultural topics including definition of agriculture, conformation of the land affecting agriculture, characteristics of the soil, location with regard to health, and times for planting and harvesting.One noteworthy aspect of the work is his anticipation of microbiology and epidemiology. Varro warned his contemporaries to avoid swamps and marshland, since in such areas

“… there are bred certain minute creatures which cannot be seen by the eyes, but which float in the air and enter the body through the mouth and nose and cause serious diseases.”(The Mole magazine, Royal Society of Chemistry, March 2014 issue, p. 3)

He showed a tendency among the Roman writers of scientific topics in deriving most of his material from the writings of others. He compiled a chronology that was an attempt to determine an exact year-by-year timeline of Roman history up to his time. It is based on the traditional sequence of the consuls of the Roman Republic.

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Pliny the Elder, taken from Wikimedia

Pliny the Elder (AD 23-79)was naturalist and natural philosopher, a naval and army commander of the early Roman Empire, and personal friend of emperor Vespasian. Greatly interested in natural phenomena, he traveled extensively to observe nature but his work is entirely devoid of critical faculty. In his Naturalis Historia he discussed cosmology, geography, anthropology, zoology, botany, medicine, mineralogy, and art. It is one of the largest single works to have survived from the Roman Empire to the modern day and purports to cover all of the ancient knowledge based on the best authorities available at the time. He tried to relate nature to the service of man and in his encyclopedia used some material from his memories of earlier times and from his earlier works. Most of the references in the encyclopedia must have come from his extracts, which he kept on an ongoing basis, using a slave as reader and a separate slave as the secretary to document them. The extracts collected for this purpose filled almost 160 volumes. He may have been the only Roman ever to have undertaken such a work. It encompasses the fields of botany, zoology, astronomy, geology and mineralogy as well as the exploitation of those resources. It remains a standard work for the Roman period and the advances in technology and understanding of natural phenomena at the time. His discussions of some technical advances are the only sources for those inventions, such as mining technology or the use of water mills for crushing or grinding corn. It is virtually the only work which describes the work of artists of the time and is a reference work for the history of art.The work became a model for all later encyclopedias in terms of the breadth of subject matter examined, the need to reference original authors and a comprehensive index of the contents. Medical plants are treated in great detail and he held the view that all plants had their own special medical powers. This concept of the herbal, or medicinal plant, was developed in the medieval period by Hildegarde de Bingen, among others. His philosophy, which is essentially stoic, was often submerged in detail of description and rhetoric.

Seneca (3 BC- AD 65) was even more fully influenced by the Greeks than Varro or Pliny. He work was less typical of the Roman attitude although he was indeed influenced by the Stoics. His Questiones Naturales is a Latin encyclopedia of the natural world written by Seneca just before his death. Much shorter than the Naturalis Historia produced by Pliny the Elder some ten years later,it is one of the few Roman works dealing with scientific matters through a collection of facts of nature from various writers, Greek and Roman. Moral remarks are scattered through the work and the intent of the encyclopedia appears to be to discover a foundation for ethics in the knowledge of nature.

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Plan of the birdhouse at Casinum designed and built by Varro, taken from Wikimedia

Seneca’s observations placed fact next to the weirdest fiction, as did others of that period. His work, exhibiting the attitude of the more philosophical Romans of the day, is a general account of natural phenomena, dealing chiefly with astronomy, meteorology, and physical geography, with a special interest in earthquakes. Seneca often did not distinguish philosophy from science, typical of the lack of distinction considered during that period and the preceding Athenian era. He considered phenomena in relation to his own conception of the world, as opposed to certain Alexandrians like Hipparchus (viz. Essay IV) who displayed few such prejudices in his work. Seneca was especially interested in morality, which pervaded his writings. Every phenomenon of nature had a moral purpose. Here we begin to see the symbolism found later in the herbals and bestiaries of the medieval period. His writings reflected themes of Stoic philosophy: the universe is governed for the best by rationalism, and contentment is achieved through a simple, unperturbed life in accordance with nature and duty to the state. Study and learning are important. Seneca wrote many tragedies which influenced playwriting in the Renaissance. Some of these have been presented up to the present.

Unlike many of the works of authors of antiquity, some of Varro, Pliny, and Seneca were never lost and constituted an important part of medieval philosophy and cosmology.

In medicine there was not much theoretical progress. Some Romans even opposed the practice of medicine. There were legal prohibitions against certain classes who could not therefore practice medicine. Medicine took an eminent place in Rome when Greek physicians journeyed there. Asclepiades (c.124-40 BC) was one such Greek physician who established Greek medicine in Rome. In fact, he may have settled in Rome as a rhetorician. He rejected certain Hippocratic attitudes, specifically relating to the healing power of nature and the notion of critical days during disease, meaning that illnesses do not end at a definite time. He also discarded Hippocrates’ humoral doctrine as well as the principles and practices of his predecessors, but considered the flow of atoms through pores in the body a significant factor in disease, especially when they were irregular or inharmonious. However, he did not pursue any effort to investigate the structure of the body. He classified diseases based on acuteness or chronicity. Acute diseases were caused essentially by a constriction of the pores or an obstruction of them by an excess of atoms. Chronic ones were caused by a relaxation of the pores or a deficiency of atoms. He separated illnesses into three separate categories: status strictus (too tightly held), status laxus (too loosely held), and status mixtus (a bit of each). He also believed that there are no critical days of diseases, meaning that illnesses do not end at a definite time.

Asclepiades believed in the power of diet, exercise, and bathing as a means of establishing harmony and preventing disease. He directed his remedies to the restoration of harmony,and used emetics and bleeding. His reputation among his patients depended upon his liberal use of wine and food, and he liberally used enemas but did not believe in the use of drugs. Unlike many physicians of that era, he was kind to his patients. He saw digestion as a primary factor in his theory and considered larger size particles of food as a main cause of indigestion.

He used music to treat the mentally ill (and also illness resulting from insect bites), exposing the manics to gentle music and the depressives to music in the Phyrigian mode. He freed the insane from confinement, treating them with music, diet, and massage. He is believed to have been the first physician to perform elective tracheotomy.

 

Aulus Cornelius Celsus (c25 BC-ADc50) was an encylopedist and perhaps the greatest of the Latin physicians, a great compiler whose main work was a collection of Greek medical knowledge, the history of medicine and therapeutics. He professed himself a follower of Asclepiades but did not agree with condemnation of critical days for a disease. De Medicina is a primary source on diet, pharmacy, surgery and related fields and it is one of the best sources for medical knowledge in the Roman world. The work referred to eighty medical authors in providing a history of medicine. The work was further divided into area of general pathology, specific diseases, and parts of the body, pharmacology, surgery, and orthopedics. The introduction to this work discussed the role of theory in medical practice and the value of animal and human experimentation. He detailed considerably the preparation of numerous ancient medicinal remedies including the preparation of opioids. He also described many first century Roman surgical procedures such as removing a cataract, treating bladder stones, and setting fractures.

Celsus’ principal therapeutic method was to step back and let nature control the progress of the disease. For example, fever was necessary as an effort if the body were to get rid of a disease state. He would occasionally recommend the use of the scalpel, as well as bloodletting and purgatives. Many of these rules were still in effect in the nineteenth century. He is credited with recording the cardinal signs of inflammation known as “Celsus tetrad”: calor (warmth), dolor (pain), tumor (swelling) and rubor (redness and hyperaemia. It was Celsus who translated the Greek term carcinos into the Latin cancer.

The remaining writings of Rome were not of high scientific value. The Empirical School of physicians, classified disease according to its position in the body. The Methodists believed there were only three types of disease, one due to construction of the bodily canals, a second to dilatation, and a third a combination of both. Therapy included utilizing body tension or relaxation reciprocally. The Romans did achieve success in preventive medicine and sanitary systems, and were particularly famous for their public baths, called thermae, used for both hygienic and social purposes. Many Roman houses had flush toilets and indoor plumbing. A complex sewer system, the Cloaca Maxima, was used to drain the local marshes and carry waste into the Tiber River.

Tragic famines and plagues were often attributed to divine punishment and appeasing the deities through rituals was believed to alleviate such events. Poisonous atmospheres from swamps were perceived to be the root cause of many diseases, whether caused by famine, wars, or plague. The concept of contagion was formulated, resulting in practices of quarantine and improved sanitation, arising out of the Roman genius for organization. The importation of the Aesculapium from Greece established medicine in the public domain. These were essentially medical centers established initially in temples to isolate and treat patients with plague or other communicable diseases, but eventually to treat general medical conditions.

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Boethius Teaching His Students from a 1385 Italian manuscript of the Consolation of Philosophy, taken from Wikimedia

Systematic efforts to care for the wounded began in Caesar’s times, consisting of military “infirmaries” placed at strategic points and later moved into larger cities. These valetudinaria or military versions of the aesculapia became features of permanent camps. Caches of surgical instruments have been found in some of them. This indirect evidence suggests the existence of an otherwise unknown permanent medical corps. Corpsmen certainly existed at least for the administration of first aid and were enlisted soldiers rather than civilians. The commander of the legion was held responsible for removing the wounded from the field and ensuring that they got sufficient care and time to recover. It is also important to note that the variety and nature of the surgical instruments discovered in Roman remains indicate a good knowledge of surgery.

In mathematics and the physical sciences the Roman contribution is negligible. A great many instruments were invented for practical purposes but none brought about any extension of theoretical knowledge. Mechanical knowledge was quite evident as was knowledge of civil engineering. Roman numerals were not conducive to any studies of mathematical theory. The only mathematical work of note was written by Boethius (480-524) in the history of the Roman Empire and served to represent Greek mathematics to the medieval world. For him, the world elements were either discrete (multitudes) or continuous (magnitudes). Magnitudes at rest were to be treated by geometry and those in motion by astronomy. Astronomy, geometry, music, and arithmetic represented the quadrivium of the seven liberal arts. During the Middle Ages, Boethius was connected to several texts used to teach liberal arts. Although he did not address the subject of trivium, he did write many treatises explaining the principles of rhetoric, grammar, and logic. His works of these disciplines were commonly used when studying the three elementary arts. In the Roman era of Boethius, mathematics itself had no moral significance and seemed unworthy of attention for it was only in mysticism that numbers and numerical relationships were important. His work on mathematics, De arithmetica begins with modular arithmetic, such as even and odd, evenly even, evenly odd, and oddly even. He then turned to unpredicted complexity by categorizing numbers and parts of numbers. He translated Euclid on geometry and Ptolemy on astronomy.

Boethius’s best known work is the Consolation of Philosophy (De consolatione philosophiae), written most likely while under house arrest or in prison awaiting execution. His work reflects the Platonic concept of a higher power and everything else is secondary to that divine Providence. Boethius wrote on on mathematics, geometry, arithmetic, and music. His completed translations of Aristotle’s works on logic were the only significant portions of Aristotle available in the West from the sixth to the twelfth century.

The Roman tradition gradually ended in the pit of the Dark Ages and with the fall of the Empire came a period of setbacks in scientific ideas. It is here that we look to the East for the transmission of the scientific tradition.

 

Sources

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Philip R Liebson, MD, graduated from Columbia University and the State University of New York Downstate Medical Center. He received his cardiology training at Bellevue Hospital, New York and the New York Hospital Cornell Medical Center, where he also served as faculty for several years. A professor of medicine and preventive medicine, he has been on the faculty of Rush Medical College and Rush University Medical Center since 1972 and holds the McMullan-Eybel Chair of Excellence in Clinical Cardiology.