founded that branch of
medicine
called 'clinical.
Voices of Ancient Greece and Rome_nodrm
Natural History 28.
26; tr.
Jones.
]
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Voices of Ancient Greece and Rome
? ? ? ? DYE IT PURPLE
The color purple as a sign of royalty dates back to the earliest days of Roman history. Pliny writes that the first Roman king, Romulus (reigned 753-714 BCE), owned purple cloaks, but by the time of the third king, Tullus Hostilius (reigned 671-642 BCE), kings were wearing purple-bordered robes; perhaps the contrast of the purple border with lighter colors elsewhere emphasized the king's majesty. The historian Cornelius Nepos (d. first cen- tury CE) states that when he was a young man, purple dye was considered the peak of fashion, but later, reddish- purple dyes became popular. He also reports that "double-dyed" clothing gained favor.
The first-century BCE politician and orator Cicero wrote a letter to his friend Caelius in the year 49 in which he described some of the political maneuvering of the time: "I expect that you have been told that Oppius is having a toga praetexta [an embroidered robe worn by Roman magistrates] woven for him; for our friend Curtius has set his heart on a double-dyed robe [i. e. , a kind of robe called a trabea, one of purple and saffron, worn by augurs, priests who interpreted signs and omens from the gods]. But he finds his dyer's 'job' takes time. " [Cicero. Letters to His Friends 2. 16; tr. Williams. ] W. Glynn Williams, the translator of the passage, notes that the literal translation of the final sentence is "his dyer [i. e. , Julius Caesar] keeps him waiting," and that the operative verb has the double meaning of "waiting" and "corrupting. " The implication: that Curtius has accepted a bribe to support Caesar's political aspirations, but that Caesar has been slow to pay up.
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Rackham, H. (tr. ). Pliny: Natural History. Volume III. [LCL. ] London and Cambridge, 1940.
Williams, W. Glynn (tr. ). Cicero: The Letters to His Friends. Volume I. [LCL. ] Cambridge and London, 1927.
17. CONTROLLING APPETITE AND CURBING WEIGHT GAIN
INTRODUCTION
The essayist Aulus Gellius was nothing if not a diversified writer. The document below, one of his essays, touches upon two topics that seem very contemporary: artificial stomach con- traction as a dieting and weight control method, and bulimia.
KEEP IN MIND AS YOU READ
1. Erasistratus, whom Aulus Gellius quotes at length in the document, was a third- century BCE Greek physician. His writings no longer exist except in fragmentary form, but his influence on subsequent physicians was considerable.
2. Neither the Greeks nor the Romans, of course, had developed bariatric surgery as a way to control appetite and weight gain, but Aulus Gellius seems to be describing a similar method, whereby the stomach is artificially contracted to make difficult the passage of food into it.
Document: Aulus Gellius and Erasistratus
on Dietary Issues
I often spent whole days in Rome with Favorinus. His delightful conversation held my mind enthralled, and I attended him wherever he went, as if actually taken prisoner by his eloquence; to such a degree did he constantly delight me with his most agreeable discourse. Once when he had gone to visit a sick man, and I had entered with him, having conversed for some time in Greek about the man's illness with the physicians who chanced to be there at the time, he said: "This ought not to seem surprising either, that although previously he was always eager for food, now after an enforced fast of three days all his former appetite is lost. For what Erasistratus has written is pretty nearly true," said he, "that the empty and open fibers of the intestines, the hollowness of the belly within
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AFTERMATH
and the empty and yawning cavity of the stomach, cause hunger. But when these are either filled with food or are contracted and brought together by continued fasting, then, since the place into which the food is received is either filled or made smaller, the impulse to take food, or to crave it, is destroyed. " He declared that Erasistratus also said that the Scythians too, when it was necessary for them to endure protracted hunger, bound a very tight bandage around their bellies. That by such compression of the belly it was believed that hunger could be prevented.
These things and many others of the kind Favorinus said most entertainingly on that occasion. But later, when I chanced to be reading the first book of Erasistratus's Distinctions, I found in that book the very passage which I had heard Favorinus quote. The words of Erasistratus on the subject are as follows: "I reasoned therefore that the ability to fast for a long time is caused by strong compression of the belly; for with those who voluntarily fast for a long time, at first hunger ensues, but later it passes away . . . And the Scythians also are accustomed, when on any occasion it is necessary to fast, to bind up the belly with broad belts, in the belief that the hunger thus troubles them less. And one may almost say too that when the stomach is full, [people] feel no hunger for the reason that there is no vacuity in it, and likewise when it is greatly compressed, there is no vacuity. "
In the same book, Erasistratus declares that a kind of irresistibly violent hunger, which the Greeks call bou- limos, or "ox-hunger," is much more apt to be felt on very cold days than when the weather is calm and pleas- ant, and that the reasons why this disorder prevails espe- cially at such times have not yet become clear to him. The words which he uses are these: "It is unknown and requires investigation, both in reference to the case in question and in that of others who suffer from ox- hunger, why this symptom appears rather on cold days than in warm weather. " [Tr. John C. Rolfe. The Attic Nights of Aulus Gellius (15. 1-10). Volume III. LCL, 1927. Page numbers: 135, 137, 139. ]
? ? ? ? ? ? ? ? ? empty and open fibers etc. : Erasistratus was known more as a medical re- searcher than as a practicing phy- sician, and this section of Aulus Gellius's essay reveals that Erasis- tratus had a solid knowledge of human anatomy.
Favorinus: Favorinus, a native of Gaul, lived in Rome during the second century CE; charming and sophisti- cated, he was a friend of both Aulus Gellius and Plutarch. He was reputedly born a eunuch, and yet at one point was accused of adultery, which gave rise to a famous boast of his: that even though he was a eunuch, he was capable of adultery; even though a Gaul, he could speak and write Greek; and even though he some- times offended the emperor, he lived to tell about it.
ox-hunger: This is a rather odd transla- tion for the word boulimos; appa- rently, some editors see an etymological connection between this word and the Greek word for ox, bous. Others reject that inter- pretation. One of Plutarch's dinner-conversation dialogues (693F ff. ) consists of a long conver- sation about the nature and causes of boulimos, including the notion that it is a cold-weather affliction.
Scythians: A nomadic people who lived in the Black Sea region, expert equestrians, as would be expected of a people who were often on the move.
? ? ? ? ? Although the date of Aulus Gellius's essay is unknown, the fate of his friend Favorinus is more certain. As mentioned earlier, Favorinus had somehow offended the emperor Hadrian (ruled 117-138 CE). As a result, statues of him that had been set up in Athens were
removed by the Greeks. Nonetheless, he willed his extensive library, and his mansion in Rome, to the Greek rhetorician Herodes Atticus.
ASK YOURSELF
1. It makes sense that gorging oneself with food would destroy feelings of hunger, but why does Erasistratus claim that fasting can have the same effect?
2. How did the Scythians prevent hunger? Do you think their method would work?
TOPICS TO CONSIDER
e AulusGelliusdoesnotdirectlyrevealtothereaderwhetherheagreeswith the descriptions of Favorinus (and by extension, Erasistratus) on the mat- ters of stomach constriction and bulimia, but is it possible to read between the lines and speculate on his views?
Controlling Appetite and Curbing Weight Gain
? ? ? ? APICIUS'S COOKBOOK
The early first-century CE gourmand Apicius wrote extensively on foods, cooking, and recipes. These writings were later collected and published under the title De Re Coquinaria (On Cooking). The book is divided into 10 chapters and encompasses a wide variety of culinary themes, including wines; spices; minces; puddings; veg- etables (such as asparagus, squash, beets, carrots, peas, and beans); duck, pheasant, goose, and chicken dishes; meats (including wild boar, venison, beef, veal, and hare); and seafood dishes (including shellfish, oysters, sar- dines, and mussels).
Several writers, including Seneca and Martial, report that Apicius spent 100,000,000 sesterces on fancy foods and other extravagances. When Apicius took an inventory of his finances and discovered a balance of "only" 10,000,000 sesterces, he reputedly poisoned himself (at a banquet, of course) because he believed that no gourmet worth his salt could possibly live appropriately on such a paltry sum.
? ? ? ? ? ? ? ? ? ? A DIFFERENT KIND OF RAVENOUS HUNGER
The Greek historian Xenophon, when describing the hardships of a military march that he helped to lead and that he detailed in a famous historical work entitled Anabasis (The Expedition), relates a slightly different account of excessive hunger:
[T]hey marched . . . through snow, and many of the men fell ill with hunger-faintness [the boulimia referenced in the document, and confirming the statement that this disorder tends to occur more often in cold weather]. And Xenophon . . . [in the rear] . . . did not know what the trouble was. But as soon as a person who was acquainted with the disease had told him that they manifestly had hunger-faintness, and if they were given something to eat would be able to get up, he went around among the baggage animals, and wherever he saw something that was edible, he would distribute it among the sick men, or send [here and there] people who had the strength to run along the lines, to give it to them. And when they had eaten something, they would get up and continue with the march. [Xenophon. Anabasis 4. 5; tr. Brownson. ]
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e TheEnglishword"bulimia"derivesfromtheGreekwordboulimos,which is generally defined in Greek-English lexicons as "extreme hunger" or "rav- enous hunger. " However, John C. Rolfe, the translator of the Aulus Gellius essay, renders boulimos as "ox-hunger," which is the literal meaning of the Greek word. Can you discover what the connection might be between extreme hunger and oxen?
e Why do you think that boulimos was more common in cold weather than in warmer weather?
Further Information
Holford-Strevens, Leofranc. Aulus Gellius: An Antonine Scholar and His Achievement. Oxford, 2003.
Vehling, Joseph Dommers (ed. /trans. ). Apicius: Cookery and Dining in Imperial Rome. Chicago, 1936.
Website
Aulus Gellius. Biography. http://www. bookrags. com/biography/aulus-gellius-dlb/
Bibliography for Document
Brownson, Carleton L. (tr. ) Xenophon: Anabasis. Volume III. [LCL. ] London and Cambridge, 1922.
Matz, David. Ancient World Lists and Numbers. Numerical Phrases and Rosters in the Greco-Roman Civilizations, Jefferson, NC, 1995.
Rolfe, John C. (tr. ) The Attic Nights of Aulus Gellius. Volume I. [LCL. ] Cambridge and London, 1927.
HEALTH CARE
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18. HIPPOCRATES AND THE ETHICS OF THE MEDICAL PROFESSION
INTRODUCTION
The most famous name in the history of ancient medicine is undoubtedly Hippocrates, from the island of Cos, off the coast of modern-day Turkey. Hippocrates (ca. 460-370 BCE) came from a family of physicians; both his father and his grandfather practiced medicine, and his father served as one of his instructors in the medical arts. Hippocrates is generally associated with a voluminous output of medical treatises, perhaps 60. However, modern scholars doubt that he himself wrote all, or even any, of these; rather, it is thought that the works attributed to him were probably authored by a consortium of later physicians and then collected together in an anthology today known as the Hippocratic Corpus. Some of the major topics in this collection of medical writings include air, wind, and water, and their effects on health; epidemics; nutriments; the art of prognosis; epilepsy; fractures and dislocations; medical aphorisms; and treatments for various diseases and disorders.
The noted Roman natural scientist Pliny the Elder certainly seemed to accept the his- torical reality of a physician named Hippocrates. He credits Hippocrates, during the time of the Peloponnesian War (431-404 BCE), with having revived the practice of medicine after a period of dormancy. He notes that Hippocrates hailed from the island of Cos, sacred to Asclepius, the god of medicine. In the temple dedicated to Asclepius there, it was customary for "patients recovered from illness to inscribe in the temple of that god an account of the help that they had received, so that afterward, similar remedies might be enjoyed [thus form- ing a sort of medical casebook]. Accordingly, Hippocrates . . . wrote out these inscriptions and . . .
founded that branch of medicine called 'clinical. ' " [Pliny the Elder. Natural History 29. 5; tr. Jones. ]
KEEP IN MIND AS YOU READ
1. The Hippocratic Oath is perhaps one of the most famous writings in all of ancient Greek literature, but a number of thorny questions surround the oath. Its date, for example, is unknown. Nor is it known whether all ancient physicians took the oath, or even subscribed to its principles. It is not certain whether physicians who violated one or more of the oath's injunctions would be punished in some way.
2. The oath is very short--only 250 words in Greek.
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? Document: The Hippocratic Oath
I swear by Apollo Physician, by Asclepius, by Health [Hygiea], by Panacea and by all the gods and god- desses, making them my witnesses, that I will carry out, according to my ability and judgment, this oath and this indenture. To hold my teacher in this art equal to my own parents; to make him partner in my liveli- hood; when he is in need of money to share mine with him; to consider his family as my own brothers, and to teach them this art, if they want to learn it, without fee or indenture; to impart precept, oral instruction, and all other instruction to my own sons, the sons of my teacher, and to indentured pupils who have taken the physician's oath, but to nobody else. I will use treatment to help the sick according to my ability and judgment, but never with a view to injury and wrongdoing. Neither will I administer a poison to anybody when asked to do so, nor will I suggest such a course. Similarly, I will not give to a woman a [suppository] to cause abortion. But I will keep pure and holy both my life and my art. I will not use the knife, not even on suf- ferers from stone, but I will give place to such as are craftsmen therein. Into whatever houses I enter, I will enter to help the sick, and I will abstain from all inten- tional wrongdoing and harm, especially from abusing the bodies of man or woman, [slave] or free. And what- soever I shall see or hear in the course of my profes- sion, as well as outside my profession in my [dealings with individuals], if it be what should not be published abroad, I will never divulge, holding such things to be holy secrets. Now if I carry out this oath, and break it not, may I gain forever reputation among all men for my life and for my art. But if I transgress it and forswear myself, may the opposite befall me. [Tr. W. H. S. Jones. Hippocrates (11, 12). LCL, 1924. ]
AFTERMATH
The impact of Hippocrates's work is well summarized by the entry in the Oxford Classical Dictionary (s. v. Hippocrates): "If one asks what Hippocrates meant to the Greeks, the Middle Ages, the Renaissance, what he means even today, the answer is that by a complicated historical process he has become the embodiment of the ideal physician. "
? ? ? ? ? ? ? ? ? Apollo Physician, Asclepius, Health [Hygiea], Panacea: An invocation to the family of "healer deities" of Greek mythology: Apollo, the father of Asclepius, who was the god of medicine. Hygiea and Panacea, whose names mean "health" and "all-curing" respec- tively, were daughters of Asclepius.
indenture: The exact application or meaning of this word in the medical context is uncertain. The Greek word syngraphia (here translated as "indenture") literally means "a writ- ing together," and is generally understood to refer to a contract. It may here denote an agreement between teacher and student: the student's main responsibilities are to respect the teacher and to be will- ing to share his medical knowledge with other students; the teacher's responsibility is to instruct the stu- dent, possibly free of charge.
partner: This probably refers to a con- tinued sharing of knowledge and expertise, rather than a more nar- rowly defined, shared professional medical practice.
stone: Presumably bladder or kidney stones.
And whatsoever I shall see or hear:
The translator of the passage, W. H. S. Jones, comments: "This remarkable addition is worthy of a passing notice. The physician must not gossip, no matter how or where the subject matter for gossip may have been acquired; whether it be in practice or in private life makes no difference. "
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Hippocrates and the Ethics of the Medical Profession
? ? ? ? HIPPOCRATES WAS NOT THE ONLY NOTABLE GREEK PHYSICIAN
The fifth-century BCE historian Herodotus relates a story about the powerful and much-feared (by the Greeks) Persian king Darius (sixth century BCE). It seems that Darius was out hunting one day, when he dismounted awkwardly from his horse and badly sprained his ankle. The Egyptian physicians who were called in to treat him only made matters worse by their inept methods. But someone in the royal entourage knew of a Greek cap- tive by the name of Democedes, from the city of Croton, and that this Democedes was a skilled medical practi- tioner. Democedes was summoned, and, after some cajoling, he agreed to attend to the king, who soon recovered, thanks to the care he had received from his Greek doctor. According to Herodotus, "it was chiefly because of Democedes' success [not only in treating Darius, but in his medical practice on the islands of Aegina and Samos] that Crotoniate doctors came to have such a high reputation. Darius' accident happened during the period when the physicians of Croton were considered the best in Greece, and those of Cyrene the next best. " [Herodotus. The Histories 3. 131; tr. de Selincourt. ] An interesting side note: Democedes married the daughter of Milo of Croton, who was the finest Olympic athlete of his era and one of the best in all of ancient Olympic history.
? ? ? ASK YOURSELF
1. What differences do you notice between the ways in which ancient and modern physicians viewed the practice of medicine?
2. Why do you think there seemed to be such a strong link between medicine and reli- gion in the ancient Greek world?
TOPICS TO CONSIDER
e AlthoughtheHippocraticOathisveryshort,itcontainsafairlylargenum- ber of principles relating to the practice of medicine. Which of these prin- ciples would still be doable by modern physicians? Which ones do you think that many modern physicians might avoid or even outwardly oppose?
e How many medical schools today still require graduating students to take the Hippocratic Oath? If this information is not readily available, try doing a random survey of select medical schools to see which ones require it.
e ItwasmentionedintheintroductionthatHippocratesmaynothavewrit- ten all of the entries in the Hippocratic Corpus, and that he perhaps did not author any of them. What evidence leads modern scholars to these conclu- sions? Does it seem likely that there never existed an ancient physician named Hippocrates, and that the medical texts bearing his name were actually written by a consortium of now-unknown doctors?
e The document contains fairly straightforward condemnations of both euthanasia and abortion. What were the attitudes of other ancient physi- cians and philosophers about these issues? In particular, find out what Plato, Socrates, and Aristotle might have written.
Further Information
Cantor, David, ed. Reinventing Hippocrates. Burlington, VT, 2002. Jouanna, Jacques. Hippocrates. Baltimore, 1999.
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Levine, Edwin Burton. Hippocrates. New York, 1971. Smith, Wesley D. Hippocratic Tradition. Ithaca, NY, 1979.
Website
Hippocrates. http://www. notablebiographies. com/He-Ho/Hippocrates. html
Bibliography for Document
de Selincourt, Aubrey (tr. ); revised by A. R. Burn. Herodotus: The Histories. Baltimore, 1954. Jones, W. H. S. (tr. ). Pliny: Natural History. Volume VIII. [LCL. ] London and Cambridge,
1963.
Jones, W. H. S. (tr. ). Hippocrates. Volume I. [LCL. ] Cambridge and London, 1923.
19. A MEDICAL MIRACLE MAN WHO DECLINED TO GIVE AN ENCORE PERFORMANCE
INTRODUCTION
This document comes to us by way of the second-century CE Greek satirist and essayist Lucian, who authored works on rhetoric, literature, and philosophy, as well as numerous satirical dialogues. He was born in Syria, but as a young man, he immigrated to the Greco-Roman world, where he traveled widely, both in Greece and Italy. Eventually, he gave up his travels, settled in Athens, and focused on his literary career.
KEEP IN MIND AS YOU READ
1. Lucian wrote over 60 dialogues and sketches; The Disowned Son is one of these. The narrator is a young man who, after being disowned by his father, studied medicine and became a physician. Meanwhile, his father fell ill with a mental disease that puzzled the doctors who were summoned to treat him. The disowned son, however, was able to cure his father, who, in gratitude, revoked his son's expulsion from the family. But in a cruel twist of fate, the young man's stepmother (his father's wife) was also victimized by some sort of mental ailment. When the father commanded his son to work another miracle cure, the son refused, saying that in his medical opinion, his stepmother's illness was different than the one suffered by his father, and likely incurable. For that refusal, the father disowned his son a second time.
2. This fictitious sketch is cast in the form of a legal action, with the son pleading his case in court that his disownment is unjust. As far as is known, no formal disown- ment case ever reached Athenian law courts, but the philosopher Plato writes that provisions for such an action did exist: "Between fathers and their children, and children and their fathers, there arise differences greater than is right, in the course of which fathers, on the one hand, are liable to suppose that the lawgiver should give them legal permission to proclaim publicly by herald, if they so wish, that their sons have legally ceased to be their sons . . . " [Plato. Laws 11. 928D; tr. Bury. ]
3. In the modern world, the mantra to which the medical profession seems to pay homage is "medicine by template": each disease has certain symptoms, courses, and outcomes and must be treated in much the same way, regardless of the specific circumstances of the individual patient. The disowned son refused to be bound by such restrictions. He realized that there were subtle differences in the afflictions of
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his father and stepmother, and that the remedies that worked in his father's case would be ineffectual in treating his stepmother.
Document: No Physician--Not Even a Miracle
Worker--Can Cure All Ills
There is . . . something of a novelty in my present plight [i. e. , his second disown- ment], in that I am under no personal charge, but am in jeopardy of punishment on behalf of my profession because it cannot in every particular obey [my father's demands]. But what could be more absurd than to give treatment under orders, in accordance, not with the powers of the profession, but with the desires of my father? I could wish, to be sure, that medical science had a remedy of such sort that it could check not only insanity but unjust anger, in order that I might cure my father of this disorder also. As things are, his madness has been completely assuaged, but his anger is growing worse, and (what is hardest of all) he is sane to everyone and insane towards me alone, his physician. You see, therefore, what fee I receive for my attendance. I am disowned by him once more and put away from my family a second time, as if I had been taken back for a brief space merely that I might be more disgraced by being turned out of the household repeatedly.
For my part, in cases which can be cured, I do not wait to be summoned. On the previous occasion, for instance, I came to his relief uncalled. But when a case is perfectly desperate, I am unwilling even to [take it on]. And in respect to this woman I am with good reason even less venturesome, since I take into consider- ation how I should be treated by my father if I were to fail, when without having so much as begun treating her, I am disowned. I am indeed pained . . . at my stepmother's serious condition (for she was a good woman), at my father's dis- tress on her account, and most of all at my own apparent disobedience and real inability to do the service which is enjoined upon me, both because of the extraordinary violence of the illness and the ineffectiveness of the art of healing. I do not think, however, that it is just to disown a man who declines at the outset to promise what he cannot perform . . .
In the case of the medical profession, the more distinguished it is and the more serviceable to the world, the more unrestricted it should be for those who practice it. It is only just that the art of healing should carry with it some privilege
in respect to the liberty of practicing it; that no compul- sion and no commands should be put upon a holy call- ing, taught by the gods and exercised by men of learning; that it should not be subject to enslavement by the law, or to voting and judicial punishment, or to fear and a father's threats and a layman's wrath . . . The physician ought to be persuaded, not ordered. He ought to be willing, not fearful. He ought not to be hailed to the bedside, but to take pleasure in coming of his own accord. Surely his calling is exempt from paternal com- pulsion in view of the fact that physicians have honors, precedence, immunities, and privileges publicly
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? ? ? ? DYE IT PURPLE
The color purple as a sign of royalty dates back to the earliest days of Roman history. Pliny writes that the first Roman king, Romulus (reigned 753-714 BCE), owned purple cloaks, but by the time of the third king, Tullus Hostilius (reigned 671-642 BCE), kings were wearing purple-bordered robes; perhaps the contrast of the purple border with lighter colors elsewhere emphasized the king's majesty. The historian Cornelius Nepos (d. first cen- tury CE) states that when he was a young man, purple dye was considered the peak of fashion, but later, reddish- purple dyes became popular. He also reports that "double-dyed" clothing gained favor.
The first-century BCE politician and orator Cicero wrote a letter to his friend Caelius in the year 49 in which he described some of the political maneuvering of the time: "I expect that you have been told that Oppius is having a toga praetexta [an embroidered robe worn by Roman magistrates] woven for him; for our friend Curtius has set his heart on a double-dyed robe [i. e. , a kind of robe called a trabea, one of purple and saffron, worn by augurs, priests who interpreted signs and omens from the gods]. But he finds his dyer's 'job' takes time. " [Cicero. Letters to His Friends 2. 16; tr. Williams. ] W. Glynn Williams, the translator of the passage, notes that the literal translation of the final sentence is "his dyer [i. e. , Julius Caesar] keeps him waiting," and that the operative verb has the double meaning of "waiting" and "corrupting. " The implication: that Curtius has accepted a bribe to support Caesar's political aspirations, but that Caesar has been slow to pay up.
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Rackham, H. (tr. ). Pliny: Natural History. Volume III. [LCL. ] London and Cambridge, 1940.
Williams, W. Glynn (tr. ). Cicero: The Letters to His Friends. Volume I. [LCL. ] Cambridge and London, 1927.
17. CONTROLLING APPETITE AND CURBING WEIGHT GAIN
INTRODUCTION
The essayist Aulus Gellius was nothing if not a diversified writer. The document below, one of his essays, touches upon two topics that seem very contemporary: artificial stomach con- traction as a dieting and weight control method, and bulimia.
KEEP IN MIND AS YOU READ
1. Erasistratus, whom Aulus Gellius quotes at length in the document, was a third- century BCE Greek physician. His writings no longer exist except in fragmentary form, but his influence on subsequent physicians was considerable.
2. Neither the Greeks nor the Romans, of course, had developed bariatric surgery as a way to control appetite and weight gain, but Aulus Gellius seems to be describing a similar method, whereby the stomach is artificially contracted to make difficult the passage of food into it.
Document: Aulus Gellius and Erasistratus
on Dietary Issues
I often spent whole days in Rome with Favorinus. His delightful conversation held my mind enthralled, and I attended him wherever he went, as if actually taken prisoner by his eloquence; to such a degree did he constantly delight me with his most agreeable discourse. Once when he had gone to visit a sick man, and I had entered with him, having conversed for some time in Greek about the man's illness with the physicians who chanced to be there at the time, he said: "This ought not to seem surprising either, that although previously he was always eager for food, now after an enforced fast of three days all his former appetite is lost. For what Erasistratus has written is pretty nearly true," said he, "that the empty and open fibers of the intestines, the hollowness of the belly within
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AFTERMATH
and the empty and yawning cavity of the stomach, cause hunger. But when these are either filled with food or are contracted and brought together by continued fasting, then, since the place into which the food is received is either filled or made smaller, the impulse to take food, or to crave it, is destroyed. " He declared that Erasistratus also said that the Scythians too, when it was necessary for them to endure protracted hunger, bound a very tight bandage around their bellies. That by such compression of the belly it was believed that hunger could be prevented.
These things and many others of the kind Favorinus said most entertainingly on that occasion. But later, when I chanced to be reading the first book of Erasistratus's Distinctions, I found in that book the very passage which I had heard Favorinus quote. The words of Erasistratus on the subject are as follows: "I reasoned therefore that the ability to fast for a long time is caused by strong compression of the belly; for with those who voluntarily fast for a long time, at first hunger ensues, but later it passes away . . . And the Scythians also are accustomed, when on any occasion it is necessary to fast, to bind up the belly with broad belts, in the belief that the hunger thus troubles them less. And one may almost say too that when the stomach is full, [people] feel no hunger for the reason that there is no vacuity in it, and likewise when it is greatly compressed, there is no vacuity. "
In the same book, Erasistratus declares that a kind of irresistibly violent hunger, which the Greeks call bou- limos, or "ox-hunger," is much more apt to be felt on very cold days than when the weather is calm and pleas- ant, and that the reasons why this disorder prevails espe- cially at such times have not yet become clear to him. The words which he uses are these: "It is unknown and requires investigation, both in reference to the case in question and in that of others who suffer from ox- hunger, why this symptom appears rather on cold days than in warm weather. " [Tr. John C. Rolfe. The Attic Nights of Aulus Gellius (15. 1-10). Volume III. LCL, 1927. Page numbers: 135, 137, 139. ]
? ? ? ? ? ? ? ? ? empty and open fibers etc. : Erasistratus was known more as a medical re- searcher than as a practicing phy- sician, and this section of Aulus Gellius's essay reveals that Erasis- tratus had a solid knowledge of human anatomy.
Favorinus: Favorinus, a native of Gaul, lived in Rome during the second century CE; charming and sophisti- cated, he was a friend of both Aulus Gellius and Plutarch. He was reputedly born a eunuch, and yet at one point was accused of adultery, which gave rise to a famous boast of his: that even though he was a eunuch, he was capable of adultery; even though a Gaul, he could speak and write Greek; and even though he some- times offended the emperor, he lived to tell about it.
ox-hunger: This is a rather odd transla- tion for the word boulimos; appa- rently, some editors see an etymological connection between this word and the Greek word for ox, bous. Others reject that inter- pretation. One of Plutarch's dinner-conversation dialogues (693F ff. ) consists of a long conver- sation about the nature and causes of boulimos, including the notion that it is a cold-weather affliction.
Scythians: A nomadic people who lived in the Black Sea region, expert equestrians, as would be expected of a people who were often on the move.
? ? ? ? ? Although the date of Aulus Gellius's essay is unknown, the fate of his friend Favorinus is more certain. As mentioned earlier, Favorinus had somehow offended the emperor Hadrian (ruled 117-138 CE). As a result, statues of him that had been set up in Athens were
removed by the Greeks. Nonetheless, he willed his extensive library, and his mansion in Rome, to the Greek rhetorician Herodes Atticus.
ASK YOURSELF
1. It makes sense that gorging oneself with food would destroy feelings of hunger, but why does Erasistratus claim that fasting can have the same effect?
2. How did the Scythians prevent hunger? Do you think their method would work?
TOPICS TO CONSIDER
e AulusGelliusdoesnotdirectlyrevealtothereaderwhetherheagreeswith the descriptions of Favorinus (and by extension, Erasistratus) on the mat- ters of stomach constriction and bulimia, but is it possible to read between the lines and speculate on his views?
Controlling Appetite and Curbing Weight Gain
? ? ? ? APICIUS'S COOKBOOK
The early first-century CE gourmand Apicius wrote extensively on foods, cooking, and recipes. These writings were later collected and published under the title De Re Coquinaria (On Cooking). The book is divided into 10 chapters and encompasses a wide variety of culinary themes, including wines; spices; minces; puddings; veg- etables (such as asparagus, squash, beets, carrots, peas, and beans); duck, pheasant, goose, and chicken dishes; meats (including wild boar, venison, beef, veal, and hare); and seafood dishes (including shellfish, oysters, sar- dines, and mussels).
Several writers, including Seneca and Martial, report that Apicius spent 100,000,000 sesterces on fancy foods and other extravagances. When Apicius took an inventory of his finances and discovered a balance of "only" 10,000,000 sesterces, he reputedly poisoned himself (at a banquet, of course) because he believed that no gourmet worth his salt could possibly live appropriately on such a paltry sum.
? ? ? ? ? ? ? ? ? ? A DIFFERENT KIND OF RAVENOUS HUNGER
The Greek historian Xenophon, when describing the hardships of a military march that he helped to lead and that he detailed in a famous historical work entitled Anabasis (The Expedition), relates a slightly different account of excessive hunger:
[T]hey marched . . . through snow, and many of the men fell ill with hunger-faintness [the boulimia referenced in the document, and confirming the statement that this disorder tends to occur more often in cold weather]. And Xenophon . . . [in the rear] . . . did not know what the trouble was. But as soon as a person who was acquainted with the disease had told him that they manifestly had hunger-faintness, and if they were given something to eat would be able to get up, he went around among the baggage animals, and wherever he saw something that was edible, he would distribute it among the sick men, or send [here and there] people who had the strength to run along the lines, to give it to them. And when they had eaten something, they would get up and continue with the march. [Xenophon. Anabasis 4. 5; tr. Brownson. ]
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e TheEnglishword"bulimia"derivesfromtheGreekwordboulimos,which is generally defined in Greek-English lexicons as "extreme hunger" or "rav- enous hunger. " However, John C. Rolfe, the translator of the Aulus Gellius essay, renders boulimos as "ox-hunger," which is the literal meaning of the Greek word. Can you discover what the connection might be between extreme hunger and oxen?
e Why do you think that boulimos was more common in cold weather than in warmer weather?
Further Information
Holford-Strevens, Leofranc. Aulus Gellius: An Antonine Scholar and His Achievement. Oxford, 2003.
Vehling, Joseph Dommers (ed. /trans. ). Apicius: Cookery and Dining in Imperial Rome. Chicago, 1936.
Website
Aulus Gellius. Biography. http://www. bookrags. com/biography/aulus-gellius-dlb/
Bibliography for Document
Brownson, Carleton L. (tr. ) Xenophon: Anabasis. Volume III. [LCL. ] London and Cambridge, 1922.
Matz, David. Ancient World Lists and Numbers. Numerical Phrases and Rosters in the Greco-Roman Civilizations, Jefferson, NC, 1995.
Rolfe, John C. (tr. ) The Attic Nights of Aulus Gellius. Volume I. [LCL. ] Cambridge and London, 1927.
HEALTH CARE
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18. HIPPOCRATES AND THE ETHICS OF THE MEDICAL PROFESSION
INTRODUCTION
The most famous name in the history of ancient medicine is undoubtedly Hippocrates, from the island of Cos, off the coast of modern-day Turkey. Hippocrates (ca. 460-370 BCE) came from a family of physicians; both his father and his grandfather practiced medicine, and his father served as one of his instructors in the medical arts. Hippocrates is generally associated with a voluminous output of medical treatises, perhaps 60. However, modern scholars doubt that he himself wrote all, or even any, of these; rather, it is thought that the works attributed to him were probably authored by a consortium of later physicians and then collected together in an anthology today known as the Hippocratic Corpus. Some of the major topics in this collection of medical writings include air, wind, and water, and their effects on health; epidemics; nutriments; the art of prognosis; epilepsy; fractures and dislocations; medical aphorisms; and treatments for various diseases and disorders.
The noted Roman natural scientist Pliny the Elder certainly seemed to accept the his- torical reality of a physician named Hippocrates. He credits Hippocrates, during the time of the Peloponnesian War (431-404 BCE), with having revived the practice of medicine after a period of dormancy. He notes that Hippocrates hailed from the island of Cos, sacred to Asclepius, the god of medicine. In the temple dedicated to Asclepius there, it was customary for "patients recovered from illness to inscribe in the temple of that god an account of the help that they had received, so that afterward, similar remedies might be enjoyed [thus form- ing a sort of medical casebook]. Accordingly, Hippocrates . . . wrote out these inscriptions and . . .
founded that branch of medicine called 'clinical. ' " [Pliny the Elder. Natural History 29. 5; tr. Jones. ]
KEEP IN MIND AS YOU READ
1. The Hippocratic Oath is perhaps one of the most famous writings in all of ancient Greek literature, but a number of thorny questions surround the oath. Its date, for example, is unknown. Nor is it known whether all ancient physicians took the oath, or even subscribed to its principles. It is not certain whether physicians who violated one or more of the oath's injunctions would be punished in some way.
2. The oath is very short--only 250 words in Greek.
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? Document: The Hippocratic Oath
I swear by Apollo Physician, by Asclepius, by Health [Hygiea], by Panacea and by all the gods and god- desses, making them my witnesses, that I will carry out, according to my ability and judgment, this oath and this indenture. To hold my teacher in this art equal to my own parents; to make him partner in my liveli- hood; when he is in need of money to share mine with him; to consider his family as my own brothers, and to teach them this art, if they want to learn it, without fee or indenture; to impart precept, oral instruction, and all other instruction to my own sons, the sons of my teacher, and to indentured pupils who have taken the physician's oath, but to nobody else. I will use treatment to help the sick according to my ability and judgment, but never with a view to injury and wrongdoing. Neither will I administer a poison to anybody when asked to do so, nor will I suggest such a course. Similarly, I will not give to a woman a [suppository] to cause abortion. But I will keep pure and holy both my life and my art. I will not use the knife, not even on suf- ferers from stone, but I will give place to such as are craftsmen therein. Into whatever houses I enter, I will enter to help the sick, and I will abstain from all inten- tional wrongdoing and harm, especially from abusing the bodies of man or woman, [slave] or free. And what- soever I shall see or hear in the course of my profes- sion, as well as outside my profession in my [dealings with individuals], if it be what should not be published abroad, I will never divulge, holding such things to be holy secrets. Now if I carry out this oath, and break it not, may I gain forever reputation among all men for my life and for my art. But if I transgress it and forswear myself, may the opposite befall me. [Tr. W. H. S. Jones. Hippocrates (11, 12). LCL, 1924. ]
AFTERMATH
The impact of Hippocrates's work is well summarized by the entry in the Oxford Classical Dictionary (s. v. Hippocrates): "If one asks what Hippocrates meant to the Greeks, the Middle Ages, the Renaissance, what he means even today, the answer is that by a complicated historical process he has become the embodiment of the ideal physician. "
? ? ? ? ? ? ? ? ? Apollo Physician, Asclepius, Health [Hygiea], Panacea: An invocation to the family of "healer deities" of Greek mythology: Apollo, the father of Asclepius, who was the god of medicine. Hygiea and Panacea, whose names mean "health" and "all-curing" respec- tively, were daughters of Asclepius.
indenture: The exact application or meaning of this word in the medical context is uncertain. The Greek word syngraphia (here translated as "indenture") literally means "a writ- ing together," and is generally understood to refer to a contract. It may here denote an agreement between teacher and student: the student's main responsibilities are to respect the teacher and to be will- ing to share his medical knowledge with other students; the teacher's responsibility is to instruct the stu- dent, possibly free of charge.
partner: This probably refers to a con- tinued sharing of knowledge and expertise, rather than a more nar- rowly defined, shared professional medical practice.
stone: Presumably bladder or kidney stones.
And whatsoever I shall see or hear:
The translator of the passage, W. H. S. Jones, comments: "This remarkable addition is worthy of a passing notice. The physician must not gossip, no matter how or where the subject matter for gossip may have been acquired; whether it be in practice or in private life makes no difference. "
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Hippocrates and the Ethics of the Medical Profession
? ? ? ? HIPPOCRATES WAS NOT THE ONLY NOTABLE GREEK PHYSICIAN
The fifth-century BCE historian Herodotus relates a story about the powerful and much-feared (by the Greeks) Persian king Darius (sixth century BCE). It seems that Darius was out hunting one day, when he dismounted awkwardly from his horse and badly sprained his ankle. The Egyptian physicians who were called in to treat him only made matters worse by their inept methods. But someone in the royal entourage knew of a Greek cap- tive by the name of Democedes, from the city of Croton, and that this Democedes was a skilled medical practi- tioner. Democedes was summoned, and, after some cajoling, he agreed to attend to the king, who soon recovered, thanks to the care he had received from his Greek doctor. According to Herodotus, "it was chiefly because of Democedes' success [not only in treating Darius, but in his medical practice on the islands of Aegina and Samos] that Crotoniate doctors came to have such a high reputation. Darius' accident happened during the period when the physicians of Croton were considered the best in Greece, and those of Cyrene the next best. " [Herodotus. The Histories 3. 131; tr. de Selincourt. ] An interesting side note: Democedes married the daughter of Milo of Croton, who was the finest Olympic athlete of his era and one of the best in all of ancient Olympic history.
? ? ? ASK YOURSELF
1. What differences do you notice between the ways in which ancient and modern physicians viewed the practice of medicine?
2. Why do you think there seemed to be such a strong link between medicine and reli- gion in the ancient Greek world?
TOPICS TO CONSIDER
e AlthoughtheHippocraticOathisveryshort,itcontainsafairlylargenum- ber of principles relating to the practice of medicine. Which of these prin- ciples would still be doable by modern physicians? Which ones do you think that many modern physicians might avoid or even outwardly oppose?
e How many medical schools today still require graduating students to take the Hippocratic Oath? If this information is not readily available, try doing a random survey of select medical schools to see which ones require it.
e ItwasmentionedintheintroductionthatHippocratesmaynothavewrit- ten all of the entries in the Hippocratic Corpus, and that he perhaps did not author any of them. What evidence leads modern scholars to these conclu- sions? Does it seem likely that there never existed an ancient physician named Hippocrates, and that the medical texts bearing his name were actually written by a consortium of now-unknown doctors?
e The document contains fairly straightforward condemnations of both euthanasia and abortion. What were the attitudes of other ancient physi- cians and philosophers about these issues? In particular, find out what Plato, Socrates, and Aristotle might have written.
Further Information
Cantor, David, ed. Reinventing Hippocrates. Burlington, VT, 2002. Jouanna, Jacques. Hippocrates. Baltimore, 1999.
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Levine, Edwin Burton. Hippocrates. New York, 1971. Smith, Wesley D. Hippocratic Tradition. Ithaca, NY, 1979.
Website
Hippocrates. http://www. notablebiographies. com/He-Ho/Hippocrates. html
Bibliography for Document
de Selincourt, Aubrey (tr. ); revised by A. R. Burn. Herodotus: The Histories. Baltimore, 1954. Jones, W. H. S. (tr. ). Pliny: Natural History. Volume VIII. [LCL. ] London and Cambridge,
1963.
Jones, W. H. S. (tr. ). Hippocrates. Volume I. [LCL. ] Cambridge and London, 1923.
19. A MEDICAL MIRACLE MAN WHO DECLINED TO GIVE AN ENCORE PERFORMANCE
INTRODUCTION
This document comes to us by way of the second-century CE Greek satirist and essayist Lucian, who authored works on rhetoric, literature, and philosophy, as well as numerous satirical dialogues. He was born in Syria, but as a young man, he immigrated to the Greco-Roman world, where he traveled widely, both in Greece and Italy. Eventually, he gave up his travels, settled in Athens, and focused on his literary career.
KEEP IN MIND AS YOU READ
1. Lucian wrote over 60 dialogues and sketches; The Disowned Son is one of these. The narrator is a young man who, after being disowned by his father, studied medicine and became a physician. Meanwhile, his father fell ill with a mental disease that puzzled the doctors who were summoned to treat him. The disowned son, however, was able to cure his father, who, in gratitude, revoked his son's expulsion from the family. But in a cruel twist of fate, the young man's stepmother (his father's wife) was also victimized by some sort of mental ailment. When the father commanded his son to work another miracle cure, the son refused, saying that in his medical opinion, his stepmother's illness was different than the one suffered by his father, and likely incurable. For that refusal, the father disowned his son a second time.
2. This fictitious sketch is cast in the form of a legal action, with the son pleading his case in court that his disownment is unjust. As far as is known, no formal disown- ment case ever reached Athenian law courts, but the philosopher Plato writes that provisions for such an action did exist: "Between fathers and their children, and children and their fathers, there arise differences greater than is right, in the course of which fathers, on the one hand, are liable to suppose that the lawgiver should give them legal permission to proclaim publicly by herald, if they so wish, that their sons have legally ceased to be their sons . . . " [Plato. Laws 11. 928D; tr. Bury. ]
3. In the modern world, the mantra to which the medical profession seems to pay homage is "medicine by template": each disease has certain symptoms, courses, and outcomes and must be treated in much the same way, regardless of the specific circumstances of the individual patient. The disowned son refused to be bound by such restrictions. He realized that there were subtle differences in the afflictions of
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his father and stepmother, and that the remedies that worked in his father's case would be ineffectual in treating his stepmother.
Document: No Physician--Not Even a Miracle
Worker--Can Cure All Ills
There is . . . something of a novelty in my present plight [i. e. , his second disown- ment], in that I am under no personal charge, but am in jeopardy of punishment on behalf of my profession because it cannot in every particular obey [my father's demands]. But what could be more absurd than to give treatment under orders, in accordance, not with the powers of the profession, but with the desires of my father? I could wish, to be sure, that medical science had a remedy of such sort that it could check not only insanity but unjust anger, in order that I might cure my father of this disorder also. As things are, his madness has been completely assuaged, but his anger is growing worse, and (what is hardest of all) he is sane to everyone and insane towards me alone, his physician. You see, therefore, what fee I receive for my attendance. I am disowned by him once more and put away from my family a second time, as if I had been taken back for a brief space merely that I might be more disgraced by being turned out of the household repeatedly.
For my part, in cases which can be cured, I do not wait to be summoned. On the previous occasion, for instance, I came to his relief uncalled. But when a case is perfectly desperate, I am unwilling even to [take it on]. And in respect to this woman I am with good reason even less venturesome, since I take into consider- ation how I should be treated by my father if I were to fail, when without having so much as begun treating her, I am disowned. I am indeed pained . . . at my stepmother's serious condition (for she was a good woman), at my father's dis- tress on her account, and most of all at my own apparent disobedience and real inability to do the service which is enjoined upon me, both because of the extraordinary violence of the illness and the ineffectiveness of the art of healing. I do not think, however, that it is just to disown a man who declines at the outset to promise what he cannot perform . . .
In the case of the medical profession, the more distinguished it is and the more serviceable to the world, the more unrestricted it should be for those who practice it. It is only just that the art of healing should carry with it some privilege
in respect to the liberty of practicing it; that no compul- sion and no commands should be put upon a holy call- ing, taught by the gods and exercised by men of learning; that it should not be subject to enslavement by the law, or to voting and judicial punishment, or to fear and a father's threats and a layman's wrath . . . The physician ought to be persuaded, not ordered. He ought to be willing, not fearful. He ought not to be hailed to the bedside, but to take pleasure in coming of his own accord. Surely his calling is exempt from paternal com- pulsion in view of the fact that physicians have honors, precedence, immunities, and privileges publicly
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