History is an art of forgetting as well as of remembrance. Many of the voices of the past, especially of the losers in any conflict, can be heard faintly at best, and the further back in time we go the larger the gaps in our understanding. The two millennia or more separating us from the ancient Greeks and Romans mean that any comprehensive reconstruction of their ideas on health and healing is fraught with problems. The vicissitudes of the written word over the centuries have drastically narrowed the range of material to a mere fraction of what once existed. As a result, the fact of survival has given prominence to certain documents and has imposed a way of thinking about them that at times distorts the historical reality. By looking back in this chapter at this process of destruction, and by setting out in general some of the consequences for our understanding of the past, I hope to stress both the fragility of our historical information and the need to be open to alternative interpretations of what does survive.1 Yet to begin by talking of written records is to risk forgetting that much of Greek and Roman medicine never made it into writing at all, for in a society where literacy was restricted on the whole to the higher echelons of male society oral communication predominated. The ‘little old woman’ from whom Scribonius Largus bought a remedy for stomachache around AD 40 and the peasants in Tuscany and on Corcyra from whom, five hundred years later, Alexander of Tralles gained information about their drugs were almost certainly illiterate.2 Many details of craft skills in particular – how to set a bone or remove a whitlow, how to recognise and cull healing herbs from the woods and fields, even how to diagnose a range of illnesses – were handed down by word of mouth and practical example alone, and were rarely committed to writing.3 We can no longer know what precisely the botanist Theophrastus learned from talking to rootcutters around 330 BC, nor how, and more importantly why, trepanation, the removal of small circles of bone from the skull, was performed in prehistoric Greece.4 We can only guess at many of the words uttered to repel illness by ancient exorcists, whose ministrations are derided by the author of The Sacred Disease in the fifth century BC and refused legal acknowledgment (‘although some have gained benefit thereby’) by a Roman
lawyer around AD 200.5 We can do no more than speculate on the contents of the medical lectures delivered by Asclepiades of Perge in the gymnasia of his home town and at neighbouring Seleucia (S. Turkey) that contributed to the offical grant to him of a gold crown and citizenship from the one and a public memorial from the other.6 Nor are we privileged to sit in on an ancient consultation or see an ancient operation taking place. They must be reconstructed imaginatively from case reports, educational treatises giving advice on what ought to happen, archaeological finds of instruments and drugs, and occasional artistic repre sentations of an idealised moment.7 Moreover, writing of itself did not guarantee the survival of all that was copied down. It was not just the recipes scratched on to broken pieces of potsherd that were at risk of being destroyed. The fragments of once luxurious herbals and substantial medical tracts on papyrus recovered from the sands of Egypt bear equal witness to the deadly ravages of time and neglect.8 Tantalising hints remain of an extensive literature now almost entirely lost. One would give much for the survival of a complete medical treatise by Diocles, Erasistratus or Asclepiades of Bithynia, for it would surely transform our views of these influential but controversial figures, whose opinions are preserved today only in the writings of others, often their opponents. Our understand ing of even so famous a figure as Hippocrates would be enriched by direct access to the archives at Cos, allegedly used by Soranus of Cos for his Life of Hippocrates, or to the far less respectful conclusions of Andreas in his The Descent of Medicine, both works known only from passing references in a later biography.9 Not just scholars but novelists and film directors could make much of the medical Memoirs of Dorotheus, with their gruesome story of a mummified child kept on display in Alexandria, or of the still more titillating reminiscences of Olympus, a doctor in attendance at the brilliant and short-lived court of Antony and Cleopatra in the 30s BC.10 Often we owe our knowledge of the existence of a work solely to another author who denigrated it or used it for a non-medical purpose. The forty-eight books in which the doctor Julian expounded the Aphorisms of Hippocrates in the second century are mentioned only by his opponent, Galen; while a few words quoted by a later writer on grammar are all that have come down to us of a treatise on medical matters by his con temporary, the famous Latin orator and author of The Golden Ass, Lucius Apuleius.11 This disappearance of much of ancient medical literature is partly the result of the relative absence of suitable repositories where books might be kept safe for centuries. With the possible exception of temple collections, major libraries were few and far between, the creation of the super-rich and of monarchs such as the rulers of Alexandria in the third century BC or of Pergamum a century later.12 The public library of Celsus at Ephesus flaunts the wealth, good taste and high imperial standing of its donor, Ti. Julius Aquila Polemeanus, consul in Rome in AD 110.13 On the other hand, most private libraries were small and liable to dispersal. A carving on a doctor’s
Figure 1.1 A page from an illuminated herbal, written on papyrus in Egypt c.AD 400, possibly showing symphytum officinale, comfrey. London, Wellcome Ms. 5753. Courtesy of Wellcome Library, London.