Earthworms and Honey

One of the most interesting questions for anyone who studies the ancient world is, I think, this one: to what extent were the Greeks and Romans much like us, and how far were they really different? If they were completely unlike us in the way they thought and reacted, then it’s difficult to claim that we can ever understand the ancient world. But if they were just like us, then where is the fun in studying them?

One area where we may expect a lot of similarity is in their approach to disease and medicine. Surely a headache is much the same, whether it happened in 27 BC or in 2007, even if what is available to make it go away is rather different? In his Natural History, an encyclopaedic work aimed at the elite Roman man, Pliny the Elder (24-79 AD) describes a cure for headaches which he himself can recommend. It’s quite simple: you just wear a bra on your head. The purpose of my article is not to explain why on earth this seemed like a good idea – Amy Richlin has already written a chapter on ‘Pliny’s brassiere’ in Roman Sexualities (eds J.P. Hallett and M.B Skinner, Princeton 1997) – but I think it shows not just that life before paracetamol was always challenging, but also that the whole way of thinking about disease and the body could be very different.

The most famous way of thinking about the body in the ancient – and medieval – world was ‘humoral medicine’. The main form of this was to think of the body as made up of four ‘humours’, fluids which were made from food and which needed to be kept in balance if the person was to stay healthy. The four humours were blood, phlegm, yellow bile and black bile. Where we are used to thinking about our bodies as organs, people in the ancient world were aware of them as fluids, with the organs being seen mostly as factories to make fluids, or containers to keep them in. As well as the humours, doctors were interested in other things that came out of the body, such as urine, vomit and spit. Because what came out was the best clue to what was happening inside, medical writing from the ancient world is full of disgusting descriptions of ‘vomit that was bilious, yellow, and frequent, and soon turned to a green colour’, ‘coughed-up sputum which has a heavy smell when poured upon coals’ and ‘urine with a red, smooth sediment’. Doctors in the ancient world believed that many conditions would develop a ‘crisis’ when everything became really bad; the events on the ‘crisis’ day determined whether you would live or die. A good crisis was when you had a really high fever and evacuated something – the more the merrier – and were then better. If you could ‘bleed’ the patient to let out excess blood from a vein, and then the patient vomited, had diarrhoea and broke out in a sweat, then they would probably recover. Women’s bodies were generally seen as ‘wetter’ than those of men but, because the production of humours was influenced by what you ate and drank, how much exercise you took, and the climate and season, men could also develop excess humours and so become ill.

Medicine, then, could be very different in its assumptions about what bodies are made of, and how best to treat them. Who treated disease? Doctors could learn from an established doctor – perhaps a family member – or could simply announce that they could cure disease. There were no medical schools, exams or licences, so you could never be sure what you were getting. Many Greek doctors travelled from town to town, which was convenient if a patient died and they needed to leave in a hurry. In the Roman Empire, most doctors were Greek slaves; and being in the hands of a conquered enemy when sick was not something that Romans felt happy about.

Someone like Pliny represents a strong strand of Roman unease about what Greek doctors get up to. Several writers from the early Roman Empire talk about the huge fees Greek doctors charge for questionable treatments like rolling in the snow or restricting the diet of their patients to only a few foods. For modern readers, these treatments may seem a lot more pleasant than the ‘good solid traditional remedies’ that Roman writers love; such as the use of cabbage to cure a vast range of problems, with the urine of someone who has eaten cabbage being the best treatment of all, or keeping some earthworms in a jar of honey so that they are readily available to be used in treatments.

Probably the most famous doctor from the ancient world was Galen, He was a really unusual doctor even for the Roman Empire in that he made it to the top of society, becoming doctor to the emperor Marcus Aurelius and his family. He was also more highly trained than most, having travelled around the Mediterranean learning everything he could. But the sort of things he tells us about his patients give a real sense of the life of any doctor. His patients included a snake-catcher bitten by a viper; this must have been an occupational hazard. He also treated another ‘occupational injury’, a schoolboy pierced by a stylus. As doctor to the gladiators in his home town of Pergamum, he treated various gladiators suffering grisly wounds, and enjoyed the opportunities this gave him to see inside bodies through a sort of ‘accidental’ dissection. Cutting up dead people to find out how they worked was not acceptable in the ancient world, except for a brief period in Alexandria in the third century BC. Possibly awareness of Egyptian embalming processes helps explain the Alexandrian experience, but equally important was the fact that the Greeks ruling Egypt at that time had access to Egyptians to use as the object of their experiments. Cutting up animals was a different matter. In the fourth century BC, Aristotle systematically dissected a wide range of animal species in order to find out about humans, who were seen as being at the top of the animal kingdom. However, knowledge about animal bodies also came from other areas of ancient life: butchery and sacrifice. There were also specialist vets in the ancient world.

Galen’s patients did not only suffer from physical complaints, and the line between physical and mental illness was in any case drawn very differently in the ancient world, because humours could cause both types of illness. The word for ‘black bile’ gives us our word ‘melancholy’, and an excess of black bile gave symptoms that we would call ‘depression’. Galen treated a steward stealing money from his employer, who was suffering from anxiety and insomnia, and also an augur who predicted his own death, and then scared himself so much that he died!

How did Galen find out what was the cause of a patient’s symptoms? As well as examining the patient, and talking to their family, he asked a lot of questions. When he found a man who was otherwise quite healthy was vomiting blood, he asked him what he had eaten and drunk in the last few days. Galen found out that the man had been thirsty in the night and had asked a servant to bring him water; this came from a well. Galen asked if leeches had ever been seen in the water at the well and, when he heard that they had, he gave the man a medicine to make him sick, so that the leeches he had swallowed came out.

It is clear that the doctor would not be the only person at the bedside. In the elite circles in which Galen moved, other doctors would also be competing with him. In addition, family members, midwives and wise-women could be present. Alongside the sort of medicine practised by doctors, many ancient cults also offered healing, most notably that of the god Asclepius. If you could afford the journey, you could make a pilgrimage to a distant temple.

Some of the remedies on offer from doctors like Galen make earthworms in honey seem suddenly desirable. Galen tells us of a time when his servants found that a cheese had gone off, and asked him what to do with it. By chance, a patient with arthritis came to see him, so Galen used it in a plaster to cure him. On another occasion, he prescribed donkey’s milk, but brought the donkey into the room in which the patient was lying so that he could drink the milk straight from the donkey. Other treatments involved plant or animal extracts given in a drink, and may seem more like what we expect from our doctors. People in the ancient world were well aware of the risks of some plants available. In a mild dose, the drug would relax the patient, or send her to sleep: but in high doses a drug could kill. There is a famous Athenian law court case where a woman gave her lover a love potion, but put in a little more of the drug in order to make him love her even more, but thus inadvertently killed him. From the Roman world, there’s a story in Galen of a concubine who tries to poison her lover but cures him instead!