The Domus of the Surgeon Eutyches
The officer leaves the villa while the other guests continue singing and reciting verses together with their host. By now they have lost count of the cups of wine they’ve drunk. And our officer has lost count of the number of women he’s seduced. All he knows is that tonight he has added one more.
A slave has prepared his horse for him. He has even brushed him down. The officer is impressed by this unrequested service and he puts a hand in his purse. His manicured fingers pull out our sestertius and give it to the slave. Then he climbs up on his horse and vanishes into the night.
The slave’s robust fingers grasp the coin like the jaws of a predator and swallow it up, sliding it down into the palm of his hand. His grip is strong. It’s a rugged hand, the hand of a man who is used to working the land, its skin tough as leather, with wide, thick fingernails. In an instant our sestertius has entered a new world, the world of a slave who tomorrow will be involved in a delicate mission. His name is Lusius.
The Checkerboard of Civilization
The creaking and groaning of the small wagon moving across the terrain sounds like an old work song, keeping the travelers company. Nobody is talking; the conversation died out hours ago, like a used-up candle. On board this small, four-wheeled vehicle, pulled by two mules, are a man and woman with their ailing son, sleeping serenely for now in his mother’s arms, undisturbed by the constant jolts. Driving the wagon are two slaves; one of them is Lusius, certainly his master’s favorite servant, his jack-of-all-trades. Before we learn more about the parents’ journey, let’s consider for a moment the unusual landscape we are now crossing.
Both sides of the road are lined by a series of fields of identical size and appearance, arranged one after the other with surgical precision. If we were to do a flyover and gaze down at this place from above, the scene before us would be truly surprising: in place of pristine nature, with its forests, lakes, and rivers, there stretches out before us an immense checkerboard of identical cultivated fields. A checkerboard whose internal divisions are rigidly geometrical, reminiscent of a shopping mall parking lot. It’s a landscape that we are accustomed to seeing and that seems very much out of place in an era so distant from our own.
All of this is the result of a precise subdivision of the territory conquered by the legions that has been carried out by the Roman administration for the benefit of its new settlers. It is the so-called centuriation of the countryside, a land use policy that has been implemented in various parts of the empire.
The land has been subdivided into one hundred large squares of fifty hectares each. But the Romans would use another term; they would say that the squares were composed of two hundred iugera (yokes) each, the term taking its name from the piece of farm equipment that is used to join two oxen. A iugerum is the area that a yoke of oxen are able to plow in a day, about 22,500 square feet. As always, the Romans are very practical. In the mountains, where the land is harder to plow, the yoke is smaller (a detail to keep in mind if you want to buy some land in those parts).
Why is the subdivision process called centuriation? What does the number 100 have to do with it? We might say it’s a play on words. Each of these large squares is called a centuria because it contains approximately one hundred areas of two yokes each. Elsewhere, on lands assigned with less than full ownership rights, instead of squares the divisions are rectangles (strigae or scamna, depending on their orientation), but these are minor variations of the same system.
This checkerboard of land is crisscrossed by a uniform grid of larger and smaller roads, proper decumani (running east-west), and cardines (running north-south), just as in Roman cities. The end result is an extremely well-ordered subdivision, parceled into lots that the Roman state assigns to new settlers and that cannot be divided without the express authorization of the Senate. It is a new, unprecedented way of exploiting the natural landscape. Indeed, in many areas of the Roman Empire, centuriation redesigned nature in a way that had never been seen before. And this countryside of the future Italian region of Emilia Romagna is a prime example: the geometric fields that radiate out on both sides of the Via Emilia represent the Roman mentality that spread throughout the empire like seeping water, reshaping even the natural lay of the land.
Right now the wagon is passing some men with strange wooden instruments who are verifying the alignment of boundary stones and stakes, probably for a border dispute. Historical documents demonstrate that such disputes were frequent. It was quite common for boundary stones to be moved, allowing the culprits to steal a long slice of a neighbor’s field.
Here, the surveyors’ work is not all that difficult. The dispute will be resolved quickly. It is truly impressive to see such a precise grid of fields in such ancient times, when there are no computers, or aerial photographs, or lasers. How do they do it? Everything has been calculated using simple but effective instruments such as the groma, which you often see reproduced in books or displayed in museums. It looks a little like the skeleton of a small beach umbrella, only instead of spokes it has horizontal wooden crossbars with plumb lines hanging down from the end of each arm. It works like a rifle scope and makes it possible to plant border stones with great precision. All you have to do is line up two plumb lines of the groma with a stake planted in a field, even at a considerable distance. The virtual line that joins these three reference points will be traced on the terrain and it will be as straight as a laser beam.
Amazingly, this subdivision of the fields is still visible today. When you fly over a part of Emilia Romagna, for example, it looks like you’re flying over an immense patchwork quilt. In his famous memoir of the 1930s, Christ Stopped at Eboli, Carlo Levi writes about trains crossing the “mathematical countryside of Romagna.” The ancient centuriation is evident even in the names of many of the small towns in present-day Emilia Romagna: Cento, Nonantola (from nonaginta, ninety), Ducenta, etc.
Underlying this surgical subdivision of the terrain is a precise Roman strategy of conquest. Veteran legionnaires are assigned a piece of land, a form of severance pay, where they can live with their families. In this fashion, generations of retired soldiers, together with ordinary citizens, colonized territories conquered by the legions, expanding Roman civilization.
These new settlements were insurance. They functioned as outposts on the borders to warn of imminent invasions, but first and foremost they exported “Romanness” to barbarian territories, absorbing the local populations into the economic and cultural orbit of Rome. Just as a piece of uncultivated land can become a field of grain, the newly settled barbarian lands were transformed into the living fabric of the empire.
Journey of Hope
The child’s cry suddenly interrupts the silence in the wagon. The little boy is wailing, his face contorted with pain. His mother tries futilely to calm him. He puts his little hands on his head and thrusts his face amid the folds of his mother’s dress in search of maternal comfort. He’s four years old, five at the most, and the right side of his head is bigger than the left. He suffers from hydrocephaly (water on the brain), but what makes his situation so desperate is the tumor that is causing it; a tumor that has developed slowly, making his brain asymmetrical. His skull has been forced to adapt to the greater volume on the right side, gradually becoming deformed as the boy has grown.
But the immediate problem is the violent headaches caused by the pressure that continues to build inside his cranium. It’s a real torture that has become almost constant in recent days, even waking him from a deep sleep. His parents have tried everything to cure his illness, from medicines prepared by physicians to improbable remedies suggested by conjure women specializing in incantations and magic spells. They have even appealed to the goddess Carna, often called upon by mothers and caregivers to ward off thestriges, nocturnal birds—tawny owls, snow owls, and other nocturnal predators—which in ancient times were thought to be the equivalent of our vampires. It was believed that they entered houses under cover of darkness to suck the blood of babies and nourish themselves on their flesh and internal organs. The boy’s parents performed the ritual to drive away the birds. After scoring the door to the boy’s room three times with a branch of a strawberry bush, they sprayed the threshold with purifying water while holding in their hands the entrails of a young sow to offer to the striges in place of those of their son. Finally, they hung a branch of a hawthorn bush on the window frame in his bedroom. But nothing worked.
Now the only solution is an expert surgeon. They have been told that the surgeon will have to make a hole in his skull to let out the “evil” that is pressing up against it on the inside. But it’s not easy to find a surgeon who is skilled and reliable, and the cost of the operation is very high. Or rather, for this family, the cost is unimaginable. They belong to the lowest rung of Roman society: farm slaves. They are part of the community of slaves of a large farm near Bologna. Yet now they are on their way to one of the best surgeons available who operates in Ariminum (present-day Rimini). How is this possible? Who helped them pay for it?
They are the beneficiaries of a small miracle. Their master, moved by their dramatic situation, has provided for this journey of hope, paying for it all out of his own pocket: the journey, the operation, and the surgeon’s fee. Why did he do it? Maybe he was just living up to his role as master and father of his community of slaves, honoring the duties that were incumbent upon him in the Roman system as paterfamilias.
But maybe there is also another reason that runs counter to our clichés about the master-slave relationship. It is simply not the case that all masters were violent and inhumane. Masters often had relationships of mutual respect with their slaves, and in some cases friendship and even love. That’s the reason why so many slaves were freed, or why sometimes the master-slave relationship blossomed into matrimony.
The little boy vents his pain in tears and screams. He’s drenched in sweat. The wagon stops. His father and mother both try to reassure him, caressing him and holding him in their arms. During this unplanned stop, Lusius jumps down from the wagon to take a look around. Fate has determined that they have stopped right in the area of a small temple dedicated to healing. There must be a spring in the vicinity because we are in the middle of nowhere. The temple is reminiscent of those little churches or chapels that are sometimes seen by the side of the road here in Europe; in many cases they are the descendants of pagan temples that were built on the same spot. Indeed, sacred places often “change costumes,” but their role remains the same.
The slave approaches the temple and climbs the stairs. There’s nobody there. The walls, however, are covered with votive offerings. Anatomical parts and bodily organs made from clay, stone, or wood (elsewhere, in more important temples, they might be made out of copper, silver, or gold): heads, eyes, breasts, arms, legs, feet, fingers, hands, ears, intestines, and even genitals. These votive offerings (donari) have been brought here by people who want to ask for a blessing or who have received one and have been healed. You see a lot of them today in archaeological museums.
Lusius, exactly like museum visitors today, observes each offering, surprised by the variety of illnesses represented. Here’s a votive offering with two ears made of stone and an inscription explaining that the Gaul Cuzius wishes to thank the gods for restoring his hearing. Nearby there’s a terra-cotta arm with some circular reliefs about half an inch in diameter. In all likelihood they represent psoriasis, a disease already known by the time of the Egyptians. Now his gaze turns to the clay head of a woman. She has clumps of hair rooted in her scalp only in a few places on her head. Lusius has never seen a disease like this. Today we know it is alopecia areata, a disease that causes hair loss in specific points of the scalp but not in others. Lusius is even more surprised by the problems related to the genitals. Here’s an incredibly oversized scrotum and, not far away, a penis, with another smaller one beside it. His eyes bulge out of their sockets.
It must be said that these votive offerings are a testimony to the Romans’ relationship to the various illnesses represented. Since there was very little medical knowledge in Roman times, they faced disease by turning simultaneously to two types of medicine: “sacred” medicine directed to the gods, as demonstrated by this temple, and “scientific” medicine, as demonstrated by the wagon on its journey to the surgeon. Actually, this is still true even today. All you have to do is go into a church or a shrine anywhere in Italy and you will see the same votive offerings, usually in the form of silver-plated legs, eyes, or internal organs.
The principle divinities that people turned to for intervention were Minerva, Carna, Mephite (the goddess associated with poisonous gases rising up from the ground), and Febris. Then there was a real dynasty of healing divinities: Apollo the physician, his son Aesculapius, and Aesculapius’s daughter, Salus, the goddess of health.
To placate the gods when an epidemic broke out, the Senate ordered the performance of rituals such as the lectisternium, a propitiatory banquet arranged in solemn fashion with the only guests at the table being statues or images of the divinities, the gods on triclinia and the goddesses on chairs, in accordance with the strict etiquette of archaic Rome.
And it doesn’t end there. There are also specific feast days to ask the divinities for protection from illness and disease. December 21, for example, is the date of the divalia vel Angeronalia—the feast of the Angeronalia—dedicated to the goddess Angerona, whose name sounds familiar to us because it derives from angor (angst, anguish), which corresponds to the sense of suffocation associated with angina. The goddess Angerona, in fact, cured heart disease.
Lusius is now looking at a pair of gladiators in combat. They are pictured on a little lead mold representing a Thracian and a Murmillo fighting each other with helmets and shields decorated with marine figures. What is it doing here? Probably a wounded gladiator wanted to thank the gods for healing his wound.
The slave is startled by a thin, bony hand that reaches out and grabs onto his arm. It belongs to one of the custodians of the temple. The priest is not present. He’s gone to bury the surplus votive offerings in a sacred hole (a periodic cleanup, necessary in all ancient temples, which has rewarded archaeologists with huge collections of votive offerings).
In the priest’s absence, oversight of the temple has been left in the hands of this half-blind slave. He’s thin and bald, with a long beard and a very few misshapen teeth; one of his eyes is so clouded it’s almost white, giving him a sinister look. Frightened, Lusius makes a quick getaway and climbs back up on the wagon.
Traveling to Rimini in the Roman Era
The wagon is now moving onto a long, white bridge. The underlying water sends back a perfect reflection of its five arches, creating a beautiful visual effect of five different-sized circles. This bridge is one of the attractions of the city of Ariminum. It was commissioned by Augustus and completed under Tiberius, and it is a true masterwork, built so well that it will survive more than two thousand years of history (including an attempt by the retreating Nazis to blow it up during World War II). Today, it is still a precious artery for automobile traffic.
Modern-day Rimini is an enormously popular beach resort, yet most of its millions of Italian and European visitors never stop to consider that it was once the land of barbarians. We are accustomed to thinking that the barbarians lived very far from Rome, in the forests of Germany or perhaps in the arid regions of North Africa (the name of the Berber people comes from the Greek word for barbarian, barbaros), or still farther off in the deserts of the Middle East. At the beginning of its history, however, Rome had to fight the barbarians right at home on the Italian peninsula. Some generations back (until 268 BCE) the region of Romagna that we have just crossed on board this little wagon was a foreign land, inhabited by strong tribes of Gauls. In its war of conquest to the north, the Senate of Rome decided to send six thousand soldiers to found a new city, a colony in the middle of Gallic territory, as a stronghold to support Roman expansion in the Po River valley. In reality, the members of the expedition were farmers as much as they were soldiers—settlers as much as combatants—and they came from Lazio and Campania accompanied by their families. They decided to build the new city at the mouth of a river, the Ariminus (the present-day Marecchia), and so they called the city Ariminum.
Having gone through the checkpoint at the entrance to the city, the wagon is proceeding toward its center. The noise of the wheels has changed; the road surface is no longer the gravel of the Via Emilia, the long consular road on which they crossed the countryside. In Rimini the road is paved and the wheels feel the resistance of the hard stone, sending it up the spines of the passengers. At regular intervals some small noises can be heard as the wheels roll over the gaps between the paving stones. It’s the Roman equivalent of the rhythmic sound a train makes when its wheels move from one track to another.
The wagon is now heading down one of the main streets, with porticoes on either side, under which are located a never-ending line of shops and stores. Lusius observes every detail: three men chatting, leaning against one of the columns of the portico; a class of schoolchildren sitting on the ground, under a canopy, listening to their teacher with his unmistakable stick slicing the air; an old blind man with his hand on the shoulder of a young boy, his slave, who helps him make his way through the people and the merchandise displayed on the sidewalk (the equivalent of a seeing-eye dog); two boys using little stones to play at marbles.
He smiles at the futile struggle of a fat man trying to unhook a straw-covered amphora hanging from the door frame of a shop. The worried shopkeeper runs over to help him, but it’s too late. The customer’s massive body has already set off a domino effect on a series of amphoras placed on the ground, which are now rolling out into the street.
Lusius is surprised by the geometry of the streets. They intersect at right angles, and the houses are just as orderly. He has never seen such a city before. He has always lived on the plantation and has only a vague childhood memory of the serpentine streets of his birthplace. The son of slaves, he was sold at birth by his parents’ master to his current owner. The rule is simple: the children of a slave couple belong to their master, who can sell them at his pleasure, exactly as we do with the puppies and kittens of our pet dog or cat. In this era, a segment of society not only has no possessions; they can’t even raise their own children.
Slaves have a very limited view of the world. Their living conditions make it difficult for them to get to know what lies beyond the house and the neighborhood where they work. And slaves who live on farms in the middle of the countryside are tantamount to exiles, more often than not born, living, and dying in the same place without ever leaving it. Naturally, this is not always the case. A lot of slaves are sold, move from one place to another, or from time to time are sent to work in different places by order of their masters. A special category of slaves consists of those who have won the trust of their master and who act on his behalf in doing errands, making purchases, transporting goods, visiting his various properties, and so forth. This is exactly the case with Lusius, but he has never been sent on such a distant mission as this. Even though today an automobile would cover the distance from Reggio Emilia to Rimini in less than an hour, for him the wagon’s journey is a real trip abroad.
Now his eyes meet those of a young woman sitting on a wooden bench. From the way she’s dressed, she doesn’t seem to be a slave. Maybe she’s a liberta or a Roman woman, in which case he certainly shouldn’t be staring at her like this. But instinct doesn’t respect social conventions. She stares back at him and offers a daring smile. As though hypnotized, the blue eyes of the young slave don’t leave hers for an instant. Just as he is about to say something to her, the wagon goes around the corner and the sea comes into view at the end of the street, and he is hypnotized anew. The slave has never seen the sea before, and he can’t take his eyes off it, his mouth half open and his blond curls blowing in the wind. Some rectangular sails dot the horizon. He has heard so much talk about it in the stories of his fellow slaves and now there it is, just yards away, but he can’t go touch it. He’s a slave and he has to obey orders. A hand lands brusquely on his shoulder. It’s the father of the sick child, wanting to know the way to the surgeon’s house.
The young slave has a flash of intuition. He jumps down off the wagon and goes over to the girl who had left him spellbound. He approaches her with his eyes cast down in a sign of respect. He knows he’s risking a lot if he behaves wrongly. But he also knows that their gazes have established something between them. The girl is surprised to see him approaching, even though she had been hoping it would happen. And she fixes him with her eyes, dark and luminous and framed by dark hair with copper highlights. She’s wearing a strange metallic pendant that glistens in the sunlight. He asks her if she knows the house of the famous surgeon, and she smiles, showing brilliant white teeth that stand out against her Mediterranean olive complexion. She offers to accompany them. The slave is walking beside her now. He’s holding the horse’s bridle in his hand and is leading the wagon on foot. He can’t help noticing the girl’s body, which with every step sways sinuously under her tunic. She’s Venus in person, he thinks to himself.
On the way, their hands brush up against each other several times, hidden by the crowd. He explains to her why they are here and she listens in silence, time and again casting a compassionate glance toward the child in the arms of his mother.
Now the group is walking through the Forum, which is a pedestrian zone. The wagon has been left in a nearby street, watched by the slave-coachman.
The forum is crowded. It’s a little like walking through a train station at rush hour: well-dressed men chatting, teenage ne’er-do-wells jostling and scuffling, fathers with their children. One thing is unmistakable: there are more men than women. That’s the way it is in the forum and on the streets of all the cities in the empire. Despite the emancipation achieved by women in this second century CE, the world beyond the walls of the home is still dominated by men.
They have now arrived in the center of the forum, at the point where the main streets of the city, the decumanus and the cardo, intersect. Lusius notices a pillar with a statue on top. There are others in the piazza, but this one is special. It’s a statue of Julius Caesar. He hears the voice of a young lad who is guiding some out-of-town visitors: on this spot in 49 BCE Caesar addressed his troops after crossing the Rubicon, ready to march on Rome. This pillar still exists today, and there is always someone ready to tell its story to visiting tourists.
Crossing the piazza of the forum our group has several encounters with litters carrying aristocratic men and women with vitreous gazes, stretched out in affected poses. When a litter passes by the intense perfume of the mistress combines with the pungent odor of the sweat of the slaves who are carrying the litter. The mixture creates an indescribably odorous wake, the “exhaust fumes” of this ancient means of transport.
Almost like an opening theater curtain, a passing litter reveals to us an unusual scene: a group of old men in togas is gathered in front of a milky-white wall. They remind us a little of travelers checking the arrival and departure times in our train stations. Actually, however, they are reading edicts and announcements that the city administration has written for citizens on this glowing white wall. Similar walls can be found in all the cities of the empire. When the announcements are out of date and more room is needed for new ones, the administration has the wall whitewashed. And it is the Latin word for this white hue (albus) that gave us the official name for this type of wall: album. Yes, the word we currently use to indicate a collection of photographs, souvenirs, figures, even recorded songs, has its origins in the Roman piazzas of two thousand years ago. Over time, in fact, the word album became a generic term for any surface on which to write or leave accounts or recollections, right down to our own time.
Entering the Surgeon’s House
Now our little group has turned down a side street, passing in front of a popina. The unmistakable smell of grilled sausage wafts out of the tavern. It’s a real temptation for them all, but they don’t have time to lose. The black-eyed girl advances quickly, making her way through the people huddled around the marble-topped counter from whose round openings issue forth liters of wine and big ladles of seasoned olives. Some of the people notice the bundle that the woman is carrying with the little feet sticking out, and they immediately understand and step to the side. They all know that the famous surgeon lives at the end of the street and scenes like this one are a daily occurrence.
It’s not hard to figure out which house is the surgeon’s. The masonry benches on either side of it are occupied by a small silent crowd waiting for an appointment. When the group gets to the big green door with two bronze rings, Lusius stops for a moment and looks for his master’s letter of introduction, a sheet of papyrus bearing the seal of his personal ring. But the black-eyed girl beats him to it. She knows one of the slaves of the house who is in charge of the administration of this clinic. Meeting her really was a nice piece of luck. In just a few seconds, one side of the double door opens and a smiling face looks out. It’s a young man with a clean tunic and a gentle manner. All it takes is a few words and the group is inside the door.
It’s an odd house. It doesn’t have the typical layout of the domus from an earlier time, which can be seen today in Pompeii. With the passing decades, housing in Roman cities had to come to terms with a problem that we know very well today: the lack of space. The empire’s prosperity has increased the population of its cities, creating a boom in the demand for housing. Consequently, square footage in all the cities of Italy and throughout the empire has become too precious and costly to be wasted on nonfunctional spaces. In order to increase the number of rooms, the elegant domus has been refitted with partitions, walls, and upper floors, completely transforming its original layout.
So the atria with their pools of water have disappeared and been replaced by rooms and hallways. Those beautiful interior gardens that we are used to seeing in films and drawings, with their perfumed essences, fountains, and colonnades, have been downsized and transformed into simple courtyards overlooked by the floors above. And very often a rehabbed domus is divided into two or more independent houses. This house is an example: half of it has become a medical clinic.
Now our little group is going down a long corridor leading to the waiting room. They all feel they are in a place imbued with solemnity. The corridor is dark, dimly lit by a single multiflame oil lamp in the middle of the ceiling. And there’s a strong smell of incense, as in temples. Why do they burn incense in this house? The reason is simple: incense has mild antiseptic properties, and it is traditionally indicated for all those places with a high concentration of people in need of treatment: temples, shrines, and, obviously, medical clinics.
While Lusius speaks with his “colleague” from the administration, showing him the letter of introduction, the family of the little sick boy takes a place on the wooden bench in the waiting room. All around them are other patients waiting to be seen. The room is a perfect microcosm of the illnesses of the era.
A Toothache in Ancient Rome
It should be pointed out that in this era, and in general in the first few centuries after Christ, there is still not a precise distinction between physicians and surgeons. A good doctor has to be able to perform surgical operations and also prepare medicines like a pharmacist. There is a definition of the physician-surgeon that can help us understand the conditions in which surgery was performed. It was written by Aulus Cornelius Celsus, who lived two thousand years ago under Augustus and Tiberius, and who was the author of De Medicina, a very interesting treatise on medicine:
Now a surgeon should be youthful or at any rate nearer youth than age; with a strong and steady hand which never trembles, and ready to use the left hand as well as the right; with vision sharp and clear, and spirit undaunted; filled with pity, so that he wishes to cure his patient, yet is not moved by his cries, to go too fast, or cut less than is necessary; but he does everything just as if the cries of pain cause him no emotion. (Loeb Classical Library, 1935. Translated by W.G. Spencer)
Would you enter an operating room, today, knowing that the surgeon won’t pay any attention to your screams of pain? (A great invention, anesthesia.)
Two white-haired men are sitting opposite the sick boy’s family; one of the two has a conspicuous bandage that passes under his chin, goes up over his cheeks and finishes in a nice big knot on the top of his head. He looks like an Easter egg wrapped in a ribbon with a bow on top. With the palm of his hand he tries to protect his cheek, swollen from a painful toothache. The he turns to his friend and asks him, garbling his words:
“Are you sure we were right to come here instead of going to the other doctor, Dialus?”
His friend tries to encourage him with a wisecrack: “We sure were. A while ago Dialus was a doctor; now he’s an undertaker. He does the same things now as an undertaker as he did when he was a doctor!” And then he proclaims: Aegrescit medendo, which means, loosely translated, “The cure is worse than the disease.”
Indeed, by and large medical practitioners are not very popular for a lot of reasons. Their remedies are much less effective than modern ones and their knowledge of the pathologies they treat is still very rudimentary compared to today. Besides that, there are a lot of charlatans who take advantage of people’s trust, inventing false therapies and miracle cures.
As if to underline the popular prejudice about doctors, a female voice cuts through the silence in the waiting room. She’s launching into a tirade about another doctor by the name of Simmacus: “I was sick. Then Simmacus came to see me accompanied by a hundred of his disciples. Two hundred cold hands touched me all over. Before that I didn’t have a fever. Now, thanks to Simmacus, I do.”
What will happen to the patient with the toothache? He has come to the clinic of a renowned doctor but he could just as easily have gone to the barber down the street. As their second job, barbers also pull teeth. With methods that are rather less than refined, as you might imagine. But will things really be all that different here? What the patient with the toothache still doesn’t know is that when it’s his turn he’ll have to undergo a real torture. There are lots of instruments used by Roman dentists to pull teeth, and the most feared is certainly the dental pincer, or forfex. Then, as often happens during the operation, if the crown of the tooth snaps and the root remains stuck in the jawbone, the doctor will have to use another pincer, even more awful, whose name says it all,rhizagra, from the Greek, meaning “root grabber”!
All this for what is probably a cavity. And the treatment for cavities truly makes one appreciate how far dentistry has come. In the Roman era it is believed that cavities are caused by a mysterious gnawing worm, capable of boring through enamel as it would through an apple. It is a very ancient theory that goes back at least to the Babylonians and will last well beyond the time of the Romans.
The first step in the cavity cure consists in eliminating irritating foods and applying medicines and mouthwashes composed of opium, incense, pepper, and henbane. A relative of the potato and the tomato, henbane has an anesthetic effect and is also a potent hallucinogen. But it is also a very dangerous plant. Its leaves and especially its tiny black seeds are extremely poisonous. Shakespeare mentions henbane in describing the death of Hamlet’s father. So treating a toothache is no joke, and the patient can only hope that no mistakes were made in preparing the medicine. That explains why people often turn to the great luminaries of the medical profession rather than trusting their fate to the practitioner down the street.
The next step in the treatment is to plug the hole in the tooth with grains of pepper or ivy berries. If—as is certainly more than likely—the remedy doesn’t work, the hole is filled with an infusion of oregano and arsenic in olive oil and closed with wax. But some practitioners don’t stop there. A certain Rufus of Ephesus has the habit of making fillings from a mixture of alum crystals, myrrh, cumin, black pepper, and vinegar. A real high-tech hodge-podge of the ancient world.
How well do these remedies work? We don’t have any scientific records, but it is highly likely that they were not very effective in treating the pain. Toothache suffers could fight it with wine and infusions of catnip (the same herb that domestic cats like to rub against). But in most cases, inevitably, the affected tooth has to be pulled. As a result, Roman-era smiles are quite striking by our standards, and are quite likely to be missing several teeth. But nobody pays much heed. That’s just the way things are in this era.
The surprising thing—but not all that surprising when you think about it—is that cavities and dental problems often affect the wealthy more than the poor. A diet rich in sugars and carbohydrates, typical of those who lead a life of ease, devastates the mouth much more than a low-sugar diet. To be sure, a poor person who doesn’t get enough to eat ends up losing his teeth from malnutrition. Nevertheless, studies of tombs in rural areas near Rome have uncovered this paradox: in many cases the teeth of slaves are more intact than those of their masters.
And what does one do when one loses a tooth? One of the remedies for filling a gap in a smile is to replace the missing tooth with a false one made from an animal’s tooth, usually oxen or calves. The animal teeth are filed so they can be adapted perfectly to the patient’s mouth. Interestingly, as early as the fifth century before Christ the Etruscans were able to make dental bridges from gold leaf. They were hooked onto healthy teeth and contained false teeth to be used as prostheses. But this is a technique that did not go over very well in the Roman era.
One last chilling fact. Reading Celsus one learns about an inhumane (at least in our view) technique for treating an abscess or a gum problem: apply a red-hot piece of iron directly to the affected tissue. This might just be the treatment that the man with the toothache is contemplating right now: he is staring into the void.
Cataract Problems? Here’s the Solution
A woman and her husband are sitting beside him. She has a complex hairdo of braids rolled up behind her head, fixed by a hairpin made of bone inserted horizontally like a bolt lock. Her husband, meanwhile, is staring at the ceiling and chewing on a special kind of gum made from a mixture of juniper berries and portulaca. This chewing gum of antiquity is actually a remedy for halitosis, thanks to the fresh and penetrating aroma of juniper. It’s the ancestor of those herbal lozenges that you often see advertised today, the ones that are so strong that as soon as you put them in your mouth they take your breath away.
But it’s his wife who has the serious problem. She can no longer see out of one eye. The eyewashes that she was prescribed and has used over the past few months have accomplished nothing. She’s got one in her hand right now. Roman eye washes are not liquid like ours. They come in the form of a small stick, made of hardened pasty mixtures that have to be diluted, preferably with mother’s milk. One of the stranger ingredients is castoreum, which has soothing effects; it is made from a genital secretion of the European beaver. Would you put something like that in your eye? Probably not. But in Roman times it was thought to be a panacea.
In many cases these eyewash sticks are marked with the seal of the doctor who made them, partly as a form of publicity but mostly as a way of avoiding counterfeiting (even back then, fake medicines were in circulation). Sometimes the seal includes, besides the name of its creator, the name of the active ingredient and the instructions for use.
Roman doctors are able to carry out delicate surgical operations on the eyes: in this case the removal of a cataract. The woman will be made to sit against the light, in a lower position with respect to the surgeon, with an assistant standing behind her to hold her head still. Then, with the utmost care, the doctor will insert a needle between the cornea and the choroid membrane and with a slow movement he will guide the cataract downward.
Yes, perhaps it’s best we stop here.
Also because some strange sounds can be heard coming from another room. They sound like groans, slowly rising in a crescendo to a final strangled shriek. Some of the doctor’s slaves look at each other and smile. The patient in treatment has a decidedly special problem: she’s a woman suffering from hysteria. The word hysteria derives from a Greek term hystéra, meaning “uterus.” So it’s no coincidence that today we use the terms hysteroscopy, hysterectomy, hysterosalpingogram, etc., for examinations or operations on the uterus. In fact, physicians in ancient times believed that hysteria struck those women whose sexual energy, not being liberated, had accumulated to a debilitating overabundance. Women at risk, therefore, included widows, spinsters, and all women who did not have regular sexual activity. As early as the first century CE the prescribed treatment for hysteria was a clitoral orgasm. The affected women went to the doctor, who used his own hands to induce a “paroxysm.” This practice was still widespread up to the end of the nineteenth century.
Here’s the Doctor
It’s finally time for the doctor to see the sick boy and his parents. One of the doctor’s slaves comes to call them. They jump up and quicken their step to keep up with the slave. The door to the doctor’s office opens. They hesitate in the doorway, knowing they must now face one of the most difficult chapters in their lives. It’s the father who goes in first, followed by his wife who is holding the little patient. They get to the center of the room and stop.
The doctor almost seems to be ignoring them. He’s sitting behind his desk writing a prescription for a patient on a wax tablet. The floor is decorated in a beautiful mosaic pattern depicting wild animals on the run—a panther, some birds, a gazelle, and a lion—arranged in a circle around a mythological figure: Orpheus. This is not a coincidence. According to mythology, Orpheus with his scepter could tame wild animals and vanquish death. A good image to inspire trust in the doctor’s patients. On one side of the doctor’s office is a door to another room, a cubiculum, where a bed is illuminated by the dim light of an oil lamp. This room serves as a day hospital for the doctor’s patients. Here too the floor mosaic is truly elegant.
The mother’s eyes scrutinize every corner of the room. The walls are painted with frames and decorations, and they have a long red strip on the bottom that goes all the way around the room. There’s not much furniture. Besides the desk, there’s a chest, a shelf lined with texts and treatises for consultation, in the form of thick scrolls of papyrus. The mother’s eyes pause to examine a long low table: a slave has already laid out the surgical instruments for the operation. They look like instruments of torture.
The father feels the light touch of something wet on his sandal and toes. It’s the caress of a rag soaked with vinegar that a slave is using to clean the floor of the traces of blood left from the last operation …
The doctor stands up. He’s a handsome man in his forties, black hair with just a touch of gray, regular features, and nicely shaped fleshy lips. His big black eyes are striking, as is his gaze, attractive and charming, perhaps because of the crow’s feet at the corners of his eyes. His features and his accent betray the identity of his homeland: Greece.
He knows the master of the slave family very well; he’s been to his farm-villa many times. And he also owes a great debt to the man for once having resolved some problems for the doctor, thanks to a high-level intervention. So the operation will be performed gratis. He listens in silence to the parents’ account of their son’s illness. The little boy observes him, still clinging to his mother. He’s not afraid; instinctively he sees the doctor as a friend. And he’s right. He is the only one who can save him. The doctor observes the boy sympathetically as well. His head is tilted slightly to the side and he’s smiling.
The doctor’s warmly reassuring and plainly Mediterranean countenance communicate a very interesting context for this scene. At the beginning of Rome’s history, the figure of the physician did not exist. It was the paterfamilias who took care of his loved ones and his slaves with prescriptions and wisdom handed down from father to son. It wasn’t until the conquest of Greece that Rome came to know the figure of the professional physician. Greek physicians came from the most famous medical schools of the time: Ephesus, Smyrna, Antioch. The eastern Mediterranean of those days was the equivalent of the United States today, with its research centers, universities, and great institutions of knowledge, such as the celebrated library of Alexandria, Egypt.
And so, initially at least, the physicians circulating in Rome were essentially slaves of Greek origin (evidently much appreciated because their market price was considerably higher than the average). In a very short time these slaves were freed and in their new status as liberti they were permitted to start their own private practices.
Interestingly, Romans were not well suited for the medical profession in part because, according to the Roman code of values, a citizen could not profit from saving his neighbor, at least not through manual labor per se. In his De Officiis, Cicero declared that a cultivated Roman could know medicine but not practice it. A Roman would view this as we today would view a priest presenting the faithful with a bill after every Mass or confession.
It was Julius Caesar who really understood the value of these professional practitioners. In 46 BCE he granted free physicians the right to Roman citizenship, thus legitimizing their role in society. Under Trajan, doctors are by now well-known figures. Yet, despite the passing of generations, the medical profession continues to remain in Greek hands. In fact, based on the inscriptions discovered by archaeologists on tombstones and the like, 90 percent of physicians are still of Greek or Middle Eastern origin. And a hundred years later, in the third century CE, this would still be true of three-quarters of physicians.
In the era of Trajan there is a new trend among wealthy Romans, one that we might compare to the modern idea of the personal trainer. This is the figure of the medicus amicus, a sort of listener and adviser regarding the physical and psychological ailments of the Roman patrician class. For the less well-off there is a sort of local public health service, with the number of doctors (called archiatri) varying from five to ten, depending on the size of the city. Appointments to the office, salaries, and certain benefits were established through imperial approval.
Naturally, there is also criminal liability for doctors in cases of egregious malpractice, as set forth in the Lex Aquilia of 286 BCE and the Lex Cornelia de Sicaris et Veneficis, which punished poisoning but also the prescription, sale, and purchase of poisonous substances.
The Operation Begins
The doctor asks the parents to sit down and speaks to them in reassuring tones. He imagines their pain and anguish and tries to comfort them, without, however, letting them perceive the difficulty of the operation. While he is explaining to them how the operation will proceed, the boy is given a glass of a very sweet liquid containing some ingredients that will numb his senses almost to the point of making him lose consciousness—an early form of anesthesia.
The mother, meanwhile, can’t take her eyes off the instruments lined up on the table. There must be thirty, maybe more. Actually, they are only a part of a vaster arsenal of instruments, at least a hundred and fifty or so, scattered about the doctor’s office, some in their cylindrical metal cases (identical to the cases in which we keep our glass-and-mercury thermometers), others placed in wooden boxes or rolls of leather. She doesn’t know it, but those instruments are suitable for almost all the operations described in the ancient texts and allow us to gauge the surgeon’s ability in many fields, from dentistry to ophthalmology, from urology to orthopedics.
Which instruments will he be using? He has a vast array to choose from. There are a lot of bistouries, or surgical knives, with a common handle in the form of an elongated leaf. We count no less than ten types of interchangeable blades, differing in shape and size, from one made for precise incisions to broader ones for cutting through muscles.
The Romans’ knowledge of anatomy and their surgical techniques are surprisingly well developed, and we can see just how modern they are by some of the doctor’s tools. There is, for example, a surgical knife used for opening the spinal column. There’s a selection of pliers for extracting teeth, which we imagine will be used on the man with the toothache. They’re shiny, made of bronze or steel, each one a little masterpiece produced by specialized artisans under the guidance of the doctor.
Some of the pliers are used for another type of extraction, for removing splinters or arrows from bodies. We notice some peculiar-looking pliers that remind us of the tongs that bakers use to take pies and cakes from their display windows but they obviously have another use. They have two serrated valves on the ends similar to the jaws of a crocodile. They are used to grab onto the tonsils at the bottom of the oral cavity. They clamp shut and with a quick twist and a yank the tonsils are stripped clean. Still others are used for closing blood vessels or for sewing a wound. There is no lack of instruments for risky operations, such as an S-shaped tube for the removal of calculi from the bladder through the urethra, and even a ceramic hot-water bottle, in the shape of a foot, to be filled with hot or cold liquids, for the treatment of arthrosis, arthritis, and inflammations. A surgeon today would have no difficulty recognizing instruments almost identical to his own.
The little boy is now lying on the operating table, dazed by the effect of the mixture he was given to drink. Total anesthesia doesn’t exist in this era, only analgesic substances that lower the body’s capacity to feel pain. Those derived from opium, already known to the Romans, are the most effective, along with beverages with a high alcohol content.
Now the doctor examines the boy’s head. The area where the incision will be made has been totally shaved. With the utmost solemnity, the surgeon takes a scalpel in hand. It has a lance-shaped handle and an extremely sharp blade. He holds it as though it were a pen and presses it delicately against the boy’s soft skin. The boy’s father closes his eyes. The mother squeezes hers shut in a grimace of pain. Because of the special nature of the operation they have been given permission to remain in the doctor’s office, but they are standing off to the side. Around the table, in addition to the surgeon, are two slave assistants, one of whom is holding the boy’s head still. The blade cuts; almost immediately a rivulet of blood comes streaming out. The boy tries to move but the hands that are holding him (and the liquid he has drunk) do not allow him to defend himself. With remarkable quickness, the scalpel outlines a window of flesh. Rapid cutting movements separate it from the underlying bone. When it is completely detached from the bone, the skin is folded to the side, like the page of a book. The blood is abundant because the scalp contains a lot of blood vessels. A dab with a cloth and a water rinse clean the area, leaving the skull in plain view. Now it’s time to cut through the bone.
Among the many instruments spread out on the table ready for use are some drills with very sophisticated serrated bits, to be put in motion with a rotating brace. But as we’re not dealing with the thicker skull of an adult, the surgeon must proceed with even more caution.
His hand glides slowly over the instruments on the table and stops on a chisel. This one will do fine. He picks it up and with the utmost care he holds it against the bone, above the temple. He starts to dig a small groove, as though he were creasing the bone, with a technique known as “progressive abrasion.” He proceeds delicately, putting into practice a principle that Galen will expound on several decades from now in his treatise De metodo medendi, namely that when a surgeon operates on very thin skulls, a simple section is much safer than drilling. The father is dumbstruck.
The surgeon’s manual dexterity is truly amazing. In almost no time at all he has managed to open a “hatch” about two inches in diameter in the little boy’s skull. He drops the chisel and hammer into a small bucket of water that one of his assistants promptly takes away. (This is how surgical instruments are cleaned and “sterilized” in the Roman era.)
Now, with another instrument, the surgeon pries up the disk of bone to be removed. Gradually, the disk is lifted away and we can see the first of the meninges that protect the brain. We can also glimpse the almost imperceptible throbbing of the outermost blood vessels. Holding an oil lamp up close, the surgeon’s assistant makes it possible for him to smooth and clean the edge of the hole so it will not damage the meninges. This window will become a safety valve to relieve the pressure that has been exerted on the brain by the growing tumor. If the boy survives, the bone will gradually grow back until it recovers the hole. But will he survive?
In his heart the surgeon knows that he has not resolved the problem; he’s only relieved the pain. In this era, a tumor has no cure.
The incision is closed by folding over the flap of skin and sewing it back into place. Some historical documents point to the use of bone splints to hold pieces of skin together. For suturing, Galen advised using thin threads of animal intestines. Another material that was sometimes used was Celtic linen. The growth of scar tissue was fostered by the application of compresses and poultices made from medicinal herbs.
The surgeon picks up a clay bottle labeled with the Greek word chamaedrys and tips it until a dense liquid comes oozing out. He rubs it on the incision. It is an extract of the germander plant, used in ancient times to treat traumatic lesions and heal abscesses and ulcers. Even today it is used as a cleansing wash for the mouth and nostrils and to counteract the spread of gangrene.
The operation ends with a strange ritual. This doctor is indeed one of the best, but he’s not able to save everyone. Many deaths are not explainable. It’s no coincidence, then, that this doctor surrounds himself in his office with amulets, good-luck charms, and objects that invoke the protection of the gods. In particular, there is a small bronze hand associated with the cult of Jupiter Dolichenus, the divinity that presided over the success of military organization. A serpent wraps around its wrist and thumb, and a pine cone covers the index finger. This hand is fixed to the end of a wooden rod as though it were a sort of scepter, and the doctor, reciting sacred incantations in Greek, waves it over the boy’s wound. Then he looks over at the father, smiles, and half closes his eyes, letting him know that everything has gone well.
He gestures that the boy can be taken off the table. The father and one of the surgeon’s assistants carefully lift the body of the little patient and carry him into the other room, his legs dangling like those of a marionette.
Discovering the Sea
Will the boy live? We hope so, but we’ll never know for sure. Our journey is about to start up again, following our coin.
Archaeologists did actually find the skeleton of a five- or six-year-old boy, who lived at the beginning of the second century CE, the son of slaves (or freed slaves) who worked in the country. He had a brain tumor that deformed his skull, and on that side of his head there was an opening made by a surgeon. The boy survived the operation and must not have suffered anymore from the painful headaches that required the operation. But he didn’t live long. Unfortunately, the tumor brought his short life to an end a month and a half later. Now his skull and his little remains are conserved in the Museum of the History of Medicine at the Universitá La Sapienza in Rome. This little boy found by the archaeologists lived in Fidene, on the outskirts of Rome.
After the operation the family needs some time before they can start their journey home. Mother, father, and son have found hospitality at the home of one of their master’s clients, who has given them a room in his house just two blocks away from the doctor’s office. The boy has to remain totally at rest for a few days before getting on the wagon to go back home. The Greek doctor has come to see him several times, bringing compresses and medicines, changing his bandages, checking the wound. Even though he’s used to seeing the pain and suffering of his patients every day, he has developed a sincere affection for this little boy, so hard hit by the misfortunes of life, who smiles at him every time, especially when he brings him a present.
During this rest period, Lusius has had the chance to realize two of his dreams: discovering the sea and falling into the embrace of Venus. The young girl who led them to the doctor’s house took him down to the beach, right to where the waves come lapping over the sand. The slave smiled, hesitated, and then, smiling again, touched the water and waded in. He looked out at the vast expanse of the sea, its color gradually changing as the eye moves away from shore, and the power of the waves. He had never seen so much water and didn’t think it was even possible. And he couldn’t resist. He took off his tunic and dove in, shouting with joy, being careful to stay where his feet could touch bottom because obviously he didn’t know how to swim.
The beach in Rimini in Roman times is radically different from the beach we know today: the coast is farther back, but above all it’s uninhabited. There’s no tourism so there are no beach umbrellas, no cabins, no bars, no entertainers, and, obviously, no lifeguards or Nordic vacationers. The beach is a simple border, a no-man’s-land between two worlds, as arid and inhospitable as a desert. And that’s the way it’s treated: nobody even thinks of spreading out a beach towel, lying in the sun, going for a swim, or spending their holidays here. The only people you see are some occasional fishermen taking a walk or kids playing in the waves. The sea and the beach have no part in Roman amusements.
Later that evening, when the stars had filled the sky, Lusius and the girl stretched out behind an abandoned boat, far away from everything and everyone. The sand and the stars caressed their bodies locked in a long embrace. On the morning of their departure, Lusius paid his bill at the modest inn where he had stayed. And that’s where our sestertius changed hands again. It ended up in the locked wooden drawer of the innkeeper, mixing in with lots of other sesterces.
But it wasn’t long before its journey started up again. From the same inn, two rooms away from the slave’s room, a well-dressed, well-built man with a severe look on his face came striding out onto the street. His head held rigidly straight, his movements measured and brusque, he walked with a military mien, his sandals making short metallic bursts with every step. There’s no doubt he’s wearing caligae, replete with metal cleats on the soles. Indeed this man is a soldier, a Batavian who’s part of an escort detail for Caius Nonius Cepanius, a famous military commander under Trajan and later under Hadrian. He has been with him for years, following him throughout the entire military campaign in Dacia. And he is still following him now that he’s in command of a select cavalry unit.
When he paid his bill he was given the coin as change. He looked at it for a second, smiling at the image of the emperor, then stuck it in the purse hidden under his belt, mounted his horse, and headed for the south gate of the city of Rimini. Riding under the big Arch of Augustus he passed by two lovers embraced in a fond farewell. He didn’t recognize Lusius and he kept right on going, leaving as he has always done: at a gallop. He turned into a dot on the horizon on the Via Flaminia, heading south.