The servility stigma came from the accident of a more medically advanced society being conquered by a lesser. One of the cultural ironies of these circumstances is that free men sometimes found themselves in service to the enslaved professional or dignitary, or the power of the state was entrusted to foreigners who had been conquered in battle and were technically slaves. In Greek society, physicians tended to be regarded as noble. Asclepius in the Iliad is noble.
A signal event in the Roman medical community was the construction of the first Aesculapium in the city of Rome, on Tiber Island. In 293 BCE some officials consulted the Sibylline Books concerning measures to be taken against the plague and were advised to bring Aesculapius from Epidaurus to Rome. The sacred serpent from Epidaurus was conferred ritually on the new temple, or, in some accounts, the serpent escaped from the ship and swam to the island. Baths have been found there as well as votive offerings (donaria) in the shape of specific organs.
In classical times the center covered the entire island and included a long-term recovery center. The emperor Claudius had a law passed granting freedom to slaves who had been sent to the institution for cure but were abandoned there. This law probably facilitated state disposition of the patients and recovery of the beds they occupied. The details are not available.
It was not the first time a temple had been constructed at Rome to ward off plague. The consul, Gnaeus Julius Mento, one of two for the year 431 BCE, dedicated a temple to Apollo medicus (“the healer”).. There was also a temple to salus (“health”) on the Mons Salutaris, a spur of the Quirinal. There is no record that these earlier temples possessed the medical facilities associated with an Aesculapium; in that case, the later decision to bring them in presupposes a new understanding that scientific measures could be taken against plague. The memorable description of plague at Athens during the Peloponnesian War (430 BCE) by Thucydides does not mention any measures at all to relieve those stricken with it. The dying were allowed to accumulate at the wells, which they contaminated, and the deceased to pile up there. At Rome, Cicero criticized the worship of evil powers, such as Febris (“Fever”), Dea Mefitis (“Malaria”), Dea Angerona (“Sore Throat”) and Dea Scabies (“Rash”).
The medical art in early Rome was the responsibility of the pater familias, or patriarch. The last known public advocate of this point of view were the railings of Marcus Cato against Greek physicians and his insistence on passing on home remedies to his son.
The importation of the Aesculapium established medicine in the public domain. There is no record of fees being collected for a stay at one of them, at Rome or elsewhere. The expense of an Aesculapium must have been defrayed in the same way as all temple expenses: individuals vowed to perform certain actions or contribute a certain amount if certain events happened, some of which were healings. Such a system amounts to gradated contributions by income, as the contributor could only vow what he could provide. The building of a temple and its facilities on the other hand was the responsibility of the magistrates. The funds came from the state treasury or from taxes.
The doctor necessarily had many assistants. Some prepared and vended medicines and tended the herb garden. There were pharmacopolae (note the female ending), unguentarii and aromatarii, all of which names are easily understood by the English reader. Others attended the doctor when required (the capsarii; they prepared and carried the doctor’s capsa, or bag.). Jerome Carcopino’s study of occupational names in the Corpus Inscriptionum Latinarum turned up 51 medici, 4 medicae (female doctors), an obstetrix (“midwife”) and a nutrix (“nurse”) in the city of Rome. These numbers, of course, are at best proportional to the true populations, which were many times greater.
At the bottom of the scale were the ubiquitous discentes (“those learning”), or medical apprentices. Roman doctors of any stature combed the population for persons in any social setting who had an interest in and ability for practicing medicine. On the one hand the doctor used their services unremittingly. On the other they were treated like members of the family; i.e., they came to stay with the doctor and when they left they were themselves doctors. The best doctors were the former apprentices of the Aesculapia, who, in effect, served residencies there.
They understood generally that conditions of strength and wholeness were to some degree perpetuated by right living. The Hippocratic oath obliges doctors to live rightly (setting an example). The first cause thought of when people got sick was that they did not live rightly. Vegetius’ brief section on the health of a Roman legion states only that a legion can avoid disease by staying out of malarial swamps, working out regularly and living a healthy life.
Despite their best efforts people from time to time did become aeger, “sick”. They languished, had nausea (words of Roman extraction) or “fell” (incidere) in morbum. They were vexed and dolorous. At that point they were in need of the medica res, the men skilled in the ars medicus, who would curare morbum, “have a care for the disease”, who went by the name of medicus or medens. The root is *med-, “measure”. The medicus prescribed medicina or regimina as measures against the disease.
The fees charged were on a sliding scale according to assets. The physicians of the rich were themselves rich. For example, Antonius Musa treated Augustus’ nervous symptoms with cold baths and drugs. He was not only set free but he became Augustus’ physician. He received a salary of 300,000 sesterces. There is no evidence that he was other than a private physician; that is, he was not working for the Roman government.
This immunity applied only to mistakes made in the treatment of free men. By chance a law existed at Rome, the Lex Aquilia, passed about 286 BCE, which allowed the owners of slaves and animals to seek remedies for damage to their property, either malicious or negligent. Litigants used this law to proceed against the negligence of medici, such as the performance of an operation on a slave by an untrained surgeon resulting in death or other damage.
Doctors were nevertheless very influential. They liked to write. Compared to the number of books written, not many have survived; for example, Tiberius Claudius Menecrates composed 150 medical works, of which only a few fragments remain. Some that did remain almost in entirety are the works of Galen, Celsus, Hippocrates and the herbal expert, Pedanius Dioscorides. The Natural History (Naturalis Historia, typically abbreviated to NH) of Pliny the Elder became a paradigm for all subsequent works like it and gave its name to the topic, although Pliny was not a physician himself.
If military careers were now possible, so were careers for military specialists, such as medici. Under Augustus for the first time occupational names of officers and functions began to appear in inscriptions. The valetudinaria, or military versions of the aesculapia (the names mean the same thing) became features of permanent camps. Caches of surgical instruments have been found in some of them. From this indirect evidence it is possible to conclude to the formation of an otherwise unknown permanent medical corps.
In the early empire one finds milites medici who were immunes (“exempt”) from other duties. Some were staff of the hospital, which Pseudo-Hyginus mentions as being set apart from other buildings so that the patients can rest. The hospital administrator was an optio valetudinarii. The orderlies aren’t generally mentioned, but they must have existed, as the patients needed care and the doctors had more important duties. Perhaps they were servile or civilians, not worth mentioning. There were some noscomi, male nurses not in the army. Or, they could have been the milites medici. The latter term might be any military medic or it might be orderlies detailed from the legion. There were also medici castrorum. Not enough information survives in the sources to say for certain what distinctions existed, if any.
The army of Augustus featured a standardized officer corps, described by Vegetius. Among them were the Ordinarii, the officers of an Ordo or rank. In an acies triplex there were three such ordines, the centuries (companies) of which were commanded by centurions. The Ordinarii were therefore of the rank of a centurion but did not necessarily command one if they were staff.
The term medici ordinarii in the inscriptions must refer to the lowest ranking military physicians. No doctor was in any sense “ordinary”. They were to be feared and respected, just as they are today. During his reign, Augustus finally conferred the dignitas equestris, or social rank of knight, on all physicians, public or private. They were then full citizens (in case there were any Hellenic questions) and could wear the rings of knights. In the army there was at least one other rank of physician, the medicus duplicarius, “medic at double pay”, and, as the legion had milites sesquiplicarii, "soldiers at 1.5 pay", perhaps the medics had that pay grade as well.
Augustan posts were named according to a formula containing the name of the rank and the unit commanded in the genitive case; e.g., the commander of a legion, who was a legate; that is, an officer appointed by the emperor, was the legatus legionis, “the legate of the legion.” Those posts worked pretty much as today; a man on his way up the cursus honorum (“ladder of offices”, roughly) would command a legion for a certain term and then move on.
The posts of medicus legionis and a medicus cohortis were most likely to be commanders of the medici of the legion and its cohorts. They were all under the praetor or camp commander, who might be the legatus but more often was under the legatus himself. There was, then, a medical corps associated with each camp. The cavalry alae (“wings”) and the larger ships all had their medical officers, the medici alarum and the medici triremis respectively.
From the aid station the wounded went by horse-drawn ambulance to other locations, ultimately to the camp hospitals in the area. There they were seen by the medici vulnerarii, or surgeons, the main type of military doctor. They were given a bed in the hospital if they needed it and one was available. The larger hospitals could administer 400-500 beds. If these were insufficient the camp commander probably utilized civilian facilities in the region or quartered them in the vici, “villages”, as in the republic.
A base hospital was quadrangular with barracks-like wards surrounding a central courtyard. On the outside of the quadrangle were private rooms for the patients. Although unacquainted with bacteria, Roman medical doctors knew about contagion and did their best to prevent it. Rooms were isolated, running water carried the waste away, and the drinking and washing water was tapped up the slope from the latrines.
Within the hospital were operating rooms, kitchens, baths, a dispensary, latrines, a mortuary and herb gardens, as doctors relied heavily on herbs for drugs. The medici could treat any wound received in battle, as long as the patient was alive. They operated or otherwise treated with scalpels, hooks, levers, drills, probes, forceps, catheters and arrow-extractors on patients anesthetized with morphine (poppy extract) and scopolamine (henbane extract). Instruments were boiled before use. Wounds were washed in vinegar and stitched. Broken bones were placed in traction. There is, however, evidence of wider concerns. A vaginal speculum suggests gynecology was practiced, and an anal speculum implies knowledge that the size and condition of internal organs accessible through the orifices was an indication of health. They could extract eye cataracts with a special needle. Operating room amphitheaters indicate that medical education was ongoing. Many have proposed that the knowledge and practices of the medici were not exceeded until the 20th century CE.
Under the comes were a number of officials called the archiatri, or more popularly the protomedici, supra medicos, domini medicorum or superpositi medicorum. They were paid by the state. It was their function to supervise all the medici in their districts; i.e., they were the chief medical examiners. Their families were exempt from taxes. They could not be prosecuted nor could troops be quartered in their homes.
The archiatri were divided into two groups:
The archiatri settled all medical disputes. Rome had 14 of them; the number in other communities varied from 5 to 10 depending on the population.