The Greatest Benefit to Mankind: A Medical History of Humanity. Roy Porter

different sorts of medical care were available. Self-help was universal; Celsus’ On Medicine was written for a non-professional readership willing to wield the scalpel as well as the plough and sword. Some healers in Italy were slaves or ex-slaves; others, especially in Asia Minor, hailed from medical dynasties or, like Galen, from prosperous backgrounds. In large cities there were swarms of healers, reputable and dubious, including body-builders, schoolteachers, ‘wise women’, root-gatherers and hucksters. Women were not confined to treating female troubles, and both Soranus and Galen expressed respect for good midwives and nurses; one of Herophilus’ pupils, according to legend, was the Athenian Agnodice, who, distressed by the anguish of women who would rather die than be examined by a man, cross-dressed so as to study and practise medicine. She became a heroine among those rallying support for female medical education in the nineteenth century.

      The affluent sick could receive treatment in a doctor’s house, while the poor might hobble to a shrine. In big households there were slave physicians caring for their sick fellows in valetudinaria (hospitals). And in the Roman army, buildings were set aside for treating the sick and wounded. A standard military hospital plan evolved, with individual cells off a long corridor, a large top-lit hall, latrines and baths. A good example has been excavated at Inchtuthil in Scotland. In Rome itself, civil engineering and public works helped to maintain health. Fourteen great aqueducts (some still in use today) brought millions of gallons of fresh water to the capital; public lavatories were installed; dwellings were provided with plumbed sanitation; and civic officials oversaw the water and sewage systems and the public granaries. Vitruvius’ On Architecture (c. 27 BC) set out sanitary ideals for towns, stressing the need for good water supplies.

      With the exception of the great plague of Athens in 430 BC, the diseases of the Greek world seem to have been local. This pattern changed with the Roman empire, however, once smallpox, brought back from Mesopotamia by the legions, ravaged the entire Mediterranean. This Antonine plague was the most lethal disease invasion in antiquity.

      Disease explanations changed little. Public authorities still ascribed famines and pestilences to the gods, and during the Antonine plague processions were staged, with sacrifices to city-protecting deities. Latter-day Hippocratics continued to emphasize individual susceptibility and bad air (miasma), and stressed dietetics. Galen reiterated a personal, constitutional medicine and said nothing on contagion. Astrology had its devotees, though Galen rejected divination while making use of dream prognostication. What truth there was in astrology and bird divination was explained naturalistically: the flight of birds indicated changes in the weather. He similarly rationalized the use of amulets.

      Therapeutics, too, changed little, and the old predilections for diet over drugs and drugs over surgery continued. The range of drugs reaching great cities increased, leading to more complex compounds. For example, theriac, originally prescribed as a snakebite antidote and used as a general tonic, grew extremely elaborate. In the version associated with Mithridates VI, King of Pontus (132–63 BC), it had forty-one ingredients, but Galen’s recipe had swollen to seventy-one ingredients, including vipers’ flesh, ground-up lizard and other animal ingredients. Princes had an interest in such remedies, since they lived in fear of poisoning. Mithridates swallowed antidotes to make himself immune to all known poisons; when his son staged a coup, he sensibly had his father stabbed.

      Antiquity produced two writers who put the study of materia medica on a systematic basis. Theophrastus (c. 371-c. 287 BC), a pupil of Aristotle, took over as head of the Peripatetic school of Athens. His two treatises on plants deal respectively with their description (the De historia plantarum [Investigations into Plants]) and their aetiology (the Causis plantarum [Explanations of Plants]). Using as his model Aristotle’s writings on the animal kingdom, he laid the groundwork for botany.

      The Investigations classifies plants into trees, shrubs and herbs. Some 550 species and varieties are described, with habitats ranging from the Atlantic to India (his Indian material being gathered by members of Alexander’s expedition in the 320s BC). The second treatise on botany in seven books is intended to account for the common characteristics of plants. His rediscovery in the Renaissance led to the revival of medical botany and botanical gardens.

      The other notable writer was Dioscorides (c. AD 40-c. 90), a Greek surgeon to Nero’s army. His De materia medica (written in Greek, but known by its Latin title) is in five books. Book I deals with aromatics like saffron, oils, salves, shrubs and trees; Book II with animals, cereals, and herbs; Book III with roots, juices, herbs and seeds; Book IV with other roots and herbs; and Book V with wines and minerals, including salts of lead and copper. Providing detailed descriptions based largely on external appearance, Dioscorides aimed to enable the doctor to choose the right plant, listed by its pharmacological properties. He noted the various plant names, their uses in treatments, techniques of harvesting, modes of storage and possible adulterants. From an early date, these verbal descriptions were supplemented by drawings. Many of his remedies were common herbs and spices: cinnamon and cassia for instance were said to be valuable for internal inflammations, snake bites, runny nose and menstrual disorders; others were bizarre, like bed bugs mashed with meat and beans for malarial fevers. Some herbs had many properties. The bramble (‘batos’, Rubus fruticosus), according to an early translation,

      binds and drys; it dyes ye hair. But the decoction of the tops of it being drank stops ye belly, & restrains ye flux of women, & is convenient for ye biting of ye Prester. And the leaves being chewed do strengthen ye gums, and heal ye Apthae. And ye leaves being applied, do restrain ye Herpetas, & heal ye running ulcers which are in ye head, & ye falling down of the eyes.

      Galen described 473 drugs of vegetable, animal and mineral origin as well as a large number of compound drugs. Together with theriac, he recommended two remedies that became universally celebrated, hiera picra and terra sigillata. His hiera picra formula called for aloes, spices and herbs; the compound was made into an electuary. Its ‘signal Virtues’ according to William Salmon, a seventeenth-century commentator, were that it was ‘a good thing to loosen the body … It heats … drys … opens obstruction, and urges thick Phlegmatick humours.’ Terra sigillata (sealed earth) was a greasy clay, containing silica, alumina, chalk, magnesia and oxide of iron, found on the Greek islands of Lemnos, Melos, and Samos. It was formed into large tablet-like units upon which the seal of the place of origin was impressed. It was meant to be drying and binding, and useful against poisons.

      INSANITY

      Throughout antiquity, one disorder provoked divergent responses, paving the way for lasting controversy. Madness was, of course, well known within the general culture. Herodotus described the mad destructive King Cambyses of Persia mocking religion – who but a madman would dishonour the gods? The deranged Ajax slaughtered sheep in the belief that they were enemy soldiers, a scene presaging Don Quixote’s tilting at windmills. Violence, grief, blood-lust and cannibalism were commonly taken as signs of insanity.

      Graeco-Roman law sought to prevent the mad from destroying life, limb and property, and made provision for guardians for the insane. Insanity was a family responsibility and there were no lunatic asylums. The seriously disturbed were restrained at home, while others were allowed to wander, though, as evil spirits (keres) might fly out of them to possess other people, the crazed were feared and shunned.

      Madness found medical explanations. In the Hippocratic tradition the most common labels for such conditions were mania and melancholia, the former characterized by excitement, the latter by depression. Both were marked by delusions, and, like all other maladies, were understood Immorally, usually in terms of choler and black bile. In On the Sacred Disease, which claimed madness as well as epilepsy for medicine, the Hippocratic author stated that ‘those maddened through bile are noisy, evil-doers and restless, always doing something inopportune … But if terrors and fears attack, they are due to a change in the brain.’

      Hippocratic medicine thus did not envisage an independent discipline of psychiatry, but it did accept certain psychological elements. In one case, a woman with symptoms of depression and incoherent speech was explained as suffering from ‘grief, while another, ‘after a grief, would