The Ancients - How the Romans Treated Eye Infections

Episode Date: May 9, 2021

Traditionally believed to be ‘windows to the soul’, the health of eyes in the Roman Empire could be compromised by lamentable hygiene practices, unclean public baths and dusty roads. But without modern medical remedies, how did the Romans look after their sight? Dr Nick Summerton is a practicing doctor and author of ‘Greco-Roman Medicine and What it Can Teach Us Today’, published by Pen & Sword. He came back on the show to discuss eye care in Ancient Rome: the tools, practitioners and processes.

Hi, I'm Tristan Hughes, and if you would like The Ancients ad-free, get early access and bonus episodes, sign up to History Hit. With a History Hit subscription, you can also watch hundreds of hours of original documentaries, including my recent documentary all about Petra and the Nabataeans, and enjoy a new release every week. Sign up now by visiting historyhit.com slash subscribe. by visiting historyhit.com slash subscribe. It's the Ancients on History Hit. I'm Tristan Hughes, your host, and in today's podcast we're talking about ancient Roman medicine, but in particular we're going to be focusing on ancient Roman eye care. The Romans, as you're about to find out, they had quite a lot of trouble sometimes

with their eyes and the treatments are shall we say interesting to say the least now joining me on the podcast i was delighted to get back on the show dr nick summerton nick he's been on the podcast once before to talk about lessons from the antonine plague but nick as you're about to find out he's also quite an expert on ancient roman eye care on the archaeology and the literature that survives. Now, I must give fair warning about this podcast because in part of it, yes, we do delve into what we know about gory ancient Roman eye surgery. If you're not a fan of that gory detail, then when you hear of it coming, because we do announce it,

you might want to skip over that part. But without further ado, here's Nick. Nick, thank you so much for coming on the show. Thank you very much. I'd like to focus on another area that I know you've done a lot of work on, particularly around ancient medicine. And this is around ancient Roman eye care. Yes, again, an infectious disease like the Antonine Plague, but something that seems to be particularly prevalent in the Roman world. And probably hygiene practices weren't quite as good as we'd like them to be and the water and baths for example was not as clean as Marcus Aurelius comments on this himself you know the

horrible dirty water of bathhouses not being changed as often as perhaps we would like. So crowded bathhouses, communications, poorer hygiene practices, dusty roads all of these would have contributed towards the rise of eye infections. And I think there was also something about the Romans' views about the eye as well. You know, both Pliny, the natural historian, who died, unfortunately, at the time of the eruption of Vesuvius, and Celsus, again, probably a doctor, might have just been a very knowledgeable writer in the first century. They talk about the eyes being privileged body parts, the importance of protecting the eyes,

the window into the soul, I think, that Celsus calls it at one point. So the eyes were really important to the Romans. So they did pay attention to those. And spread across the empire, you do see these what are called votive offerings as well and a votive offering is something that's left in anticipation of a cure as well as a thank you gift and up in Roxeter the couple of the Cornuvai tribe in Shropshire they found a beautiful set of golden eye votives which are in the British Museum they're only small but you can see them if you search in the British Museum. They're only small, but you can see them if you search in the British Museum, as well as some bronze eye votives and a lot of plaster eye votives. So the idea being that at Roxeter there was an interest in eye medicine and eye votives have been found widely across Gaul. And the Temple of Aesculapius at Athens probably was an eye healing centre. Again, a lot of eye votives found there. So representations of eyes, either in gold,

plaster, pottery, bronze. But I say the ones at Roxeter are well worth seeing, actually. That's remarkable in itself, the archaeology that survives. And we must then also have some quite good literary sources talking about eye care in antiquity. Yeah, I mean, we're very lucky with Roman eye care. I mean, one of the reasons it's good to be interested in an area where there's a lot about it. I'm selective which areas of Roman medicine I sometimes pick. Some are tricky, really. But Roman eye care itself, you've got the writings of Scribonius Largus, a physician, military physician, actually attended with Claudius as part of his retinue in invading Britain in AD 43. In fact, he writes in his introduction to his book

that he can't write a very comprehensive catalogue of Roman eye medicine because actually he hasn't got all his equipment with him at the moment because he's abroad, which presumably meant he was in Britain. So he wrote about 22 eye remedies in his book. Galen, as you'd expect from what we know of Galen, he had 200, which he collected from various individuals, including somebody called Axios, who was the doctor in the British fleet. So that's quite a nice link to Britain. And then Celsus, again, the encyclopedias or physician we talked about, had a whole chapter in his books on medical materials on eyes.

So there's a heck of a lot. And these eye remedies were recipes. And in addition to that, you do have what are called collyrium stamps and these are lovely objects actually and you can understand why people collected them about 320 of them have been assembled and collected and catalogued by an eye doctor actually across gaul he works in lyon so he's collected a whole catalogue of them jacques voyneau and then in britain there's collected a whole catalogue of them, Jacques Voyneau. And then in Britain, there's about a couple of dozen of these. They are beautiful objects. Most of them are about

the size of a matchbox. And they're green and sometimes inscribed on the flat surfaces. But on the edges, they have inscriptions. And normally the name of an oculus, the person who possibly owned this or was using it, the name of the eye condition it was treated, and the name of the remedy they were using as well. It may say, you know, Marcus Julius's eye remedy for sticky eyes or something like that, you know, made with frankincense, or it might say Marcus Julius's eye remedy for sticky eyes, which is better than anybody else's remedy for sticky eyes. So there was a bit of marketing as well as details about the recipes. But they are lovely little objects and they are found widely across Britain. The British Museum, there are examples.

There's examples from Rochester. Chester has some examples. York, London and Litany has them as well and Bath has a couple. So they're widely spread around the countryside, but tell you a lot about the remedies that the doctors were using. Well, let's focus then on one of these places now that I definitely want to focus on, which is that famous settlement just south of Hadrian's Wall, Vindolanda. We have evidence from there about this. Yeah, well, we do. I mean, no stamps from Vindolanda, but a delight for one of the Vindolanda writing tablets, which are little oak documents. It's really a strength report of the first cohort of the Tungrians. So we're talking about the first century. And within there, he talks about there were 296 people at the fort

at Vindolanda at that stage. And they divide them into people who were off from active service, if you like, were classified into three groups. 15 were, they said, agri, in other words, sick. Six were vulnerati, in other words, wounded. And ten had lipientas, in other words, eye problems. So it was one big category. And so Vindolanda, there was this example. We also know from Vindolanda that there was a hospital at Vindolanda from another one of the oak writing tablets. And they've actually found an eye patch at Vindolanda recently as well, which is quite intriguing. So it's quite an interesting find. I think it's interesting, not only in fact of identifying the fact that they did recognize the Lippientis, but actually they were important enough to have it as one of the three categories.

have it as one of the three categories. So there was one big group of sick, but you know, these 10 soldiers with eye problems, so they were obviously important to them. And that reflects very much the finding of these collyrium stamps around the place as well. It is remarkable, isn't it, how common it seemed to be back then, and that 10 or so of their soldiers had it. And in the Yorkshire Museum, you do have one of these collyrium surviving? We do, yeah. Yorkshire. It's quite a thin one. It's got slightly broken up, but Julius Alexander. So it's there in the museum. Hard to find, you have to ask where it is, but I say they are beautiful little objects. The important thing is they are not only inscribed, but they're also green. And the greenness of them,

because they were from green stone, that may be something about their magical property as well. Because Roman medicine was often not just about the medicine itself, but it was about possibly some magical elements associated with it. So they are green stones, most of these stones, and probably locally sourced as well. And people who know Rosemary Sutcliffe's book on the Ninth Legion, The Eagle of the Ninth, will know that being an eye doctor was a way that you could travel around the countryside. And that's very much a way, in that case, to go up in Scotland and not be spotted. But actually, eye doctors would wander around from central locations. So they might have made the medicine centrally, and then they'd wander off around the

countryside to apply their wares to the locals. You see this, and in fact, Ralph Jackson at the British Museum has actually plotted the location of the eye stamps in relation to the road network across Britain. It's quite interesting to see that they do fit quite nicely along it at various points. That's absolutely astonishing. These eye doctors, as you hinted at earlier from the literary sources, they had various remedies, around 20 or so remedies, perhaps more, to deal with the problems that they encountered. Yeah, I mean, there were various different eye problems, lipienters, or we probably call it

conjunctivitis nowadays. But there were lots of things. There was dim sight, there would be gritty eyes, sticky eyes. There were lots of different terms that were on these eye stamps, obviously in Latin or Greek, but lots of remedies and lots of recipes to choose from. And I think that's one of the challenges. I mean, as I said, Scribonius had 20, Galen managed to assemble 200, and there's the 320 eye stamps, and some of them have got several remedies on different sides, because they might not just have the inscription on one side, they might have it on all four sides, and they do in some situations. So lots of remedies. But when you look at the remedies, they often can be divided into two broad groups. A lot of them have got metallic salts in them. So things like zinc compounds,

lead compounds, copper, antimony, zinc, and then other organic things like frankincense, myrrh, opium poppy, quite common things. One of the interesting things that some people think is that these stamps were there as a sort of a quality marker. So what the doctors would be doing, probably in somewhere like York, is they would make up one of the recipes into small little batons. The French doctor who's assembled this list

calls them sort of tiny French loaves, really. And they are probably only about an inch long, tiny little batons. And then they would stamp them with the stamp. And they are probably only about an inch long, tiny little batons. And then they would stamp them with the stamp. And then there would be a mark so the person then could be confident what was in that, you know, that was the medicine that was inside it. But interestingly, in Lyon, back in the 1990s, they found a doctor's grave and it contained not only some eye stamps, but also some actual cleria, the medicines themselves, which they analysed. And one of them was stamped as being a collyria full of saffron, and it contained no saffron at

all, actually. So even when it was stamped, you had to be a bit careful as to what was actually in it. So as I say, the collyria themselves were made centrally, probably places like York or Colchester, stamped, and then they would have been put in a box, and then they would have been transported around to be used outside. So what do we know about the medicine boxes that these oculists would be carrying around with them? Well, the medicine boxes are intriguing and beautiful items of equipment. Again, they probably had some magical properties associated with them because they were golden in colour, made of brass, and they were inscribed a lot of the time. But they were beautiful boxes. And in fact, I had a friend who's a retired design technology teacher, Martin Jones,

kindly made me one. And he's a very skilled metal worker, and it took him about 50 hours to make one with a lot of work, because they are complicated. They were made of brass, a lot of small compartments inside with little lidded compartments, a sliding lid. So the boxes themselves, a brass lidded box, you pull the lid open, inside a number of compartments contain the caleria and underneath on the bottom side there would be an indentation, like a cut marked indentation, because the idea being that the doctors would have the caleria in this box, they'd stop when they found somebody who needed the treatment they'd slide open the lid take out a bit of the hardened cholera one of these small batons cut a little tiny bit off so we're talking about perhaps half a centimeter of this baton

that would then be ground up on a grounding pallet the lid of the box would be put on the box would be turned over and then the indentation on the underside would then be used for mixing that ground up baton with possibly egg, milk or water. I mean, they do talk about using breast milk as well, so I'm not quite sure where they would have got that from. But that was seen as the best recipe. But you mix it with that and then with a spatula, you would then pop it into the person's eye. And then with a spatula, you then popped it into the person's eye. So a really intriguing piece of equipment, the box, because it's got these magical properties probably from its appearance, but also not only contains the clearia,

but actually is then can be turned over and be used as a mixing place as well to mix it with the egg, the milk or the water before you pop it in the person's eye. So that was the way they worked. Now, we actually made up some of these clear air as well. And I tested them out with somebody called Sally Pointer down in Wales. Not, I might add, on real patients quickly before I get struck off, just on Petra dishes. We used a recipe called phyllo, which was lead, acetate, zinc, gum arabic, and a bit of opium. We couldn't actually put the opium in, unfortunately, again, because of GMCmc general medical council reasons but we tested it out against a common antibiotic i would use as

a gp and it worked as well in killing the common bugs that you would get in an eye on a plate not as i say in reality because of course the problem with all these metals are you don't really want to put lead in people's eyes or mercury in people's eyes. I mean, they will kill the bug, but they're probably not tremendously healthy for your eye. So they were using effective recipes, is what we know. And in fact, in a number of other areas of Roman pharmacology, we are beginning to find things that were remarkably effective. catastrophic warfare bloody revolutions and violent ideological battles i'm james rogers and over on the warfare podcast we're exploring the vast history of ferocious global conflict. We've got the classics. Understandably, when we see it from hindsight,

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Subscribe to Warfare from History Hit wherever you get your podcasts. Join us on the front line of military history. Well, let's keep on the topic of putting stuff in ancient Roman eyes. I never thought I'd ever say that on the Ancients podcast. Let's go a bit gory because let's talk about cataract surgery in the ancient Roman world. What do we know about it, Nick? Well, we know quite a lot, actually, because Celsus gave us a really nice, well, he gave us a description. I won't say it's necessarily a nice description about how to do cataract surgery. They called it couching. And what we've also found, both across Britain and in Gaul, is cataract needles. They are quite magnificent bits of equipment.

They consist really of a bronze object. At one end, there's a needle. At the other end, there's the blob. And a few of them found in France, it looks like they've got a syringe type mechanism inside them as well so you could actually pull the object apart and it could act as a syringe which again might have been relevant to the cataract operation but the way Kelsus described they were used is essentially first of all you had to have a well-lit room that was important to him you then had to have an assistant that was probably even more important

because the role of the assistant was to hold the head of the person having their cataract dealt with because as he said if the head moves then that's the end of the eye so you can't afford to have the head moved and then you have to go in he said not gingerly you have to go in quite clear what you're going to do you get the cataract needle and you effectively stick it from the top of the eye and right into the lens. So in the anatomy of the eye, the lens is where the cataract is behind your pupil. So in fact, what you're wanting to do is to go from probably taking the needle from your forehead and putting it down behind the eye. And then you get the lens and essentially push it back behind the eye and then you get the lens and essentially you push it back into the eye because what you're trying to do is to get the cataract is if you like a blurred lens so what

you're trying to do is to move the lens out of the way so the light can flow through so once you've done that you then withdraw the needle turn the object around and probably warm the blob at the end of the cataract needle and you could use that just to cauterize the hole that you made at the top of the eye so a pretty gory but the important thing is a well-lit room sitting opposite the patient and having a good assistant to really clamp the patient's head because there's no anesthetic and you don't want them to move and you don't want to move the eye either now interesting the ones that were found in france which were like syringes the idea on those is that you actually put the needle inside and you suck and try to suck the lens out rather than pushing it down so it's a

gory operation but a successful operation and certainly was copied well into the middle ages and even in some third world countries nowadays they still do cataract couching in this way admittedly they would not be using an assistant to hold the head and not having any anesthetic but cataract couching is it is a way of allowing the light to pass through into the eye again some people would have not wanted to have that operation done and various of the clarium eye stamps talk about remedies to clarify the vision and they might have helped a bit by drying out the front of the eye and altering the front of the eye's curvature so that might have helped the light to go in a bit but yeah i can't say i would particularly want to go and have a roman

cataract operation no matter how successful it was it was quite gory no no absolutely not i'm definitely not even going to get onto dentistry as another area which definitely do not want to talk about for ancient roman treatments with all that i mean nick and you've said it just then but i just want to emphasize no anesthetic back then when they were doing this surgery as you say the assistant seems just as important as the doctor himself to hold the head of the person in place when this, apologies for the gravity of detail, when the syringe goes behind the eye. Exactly, yes. It's a very delicate surgery, so if the patient moves their eyes or moves their head, you're in a bit of a pickle actually,

to be quite honest. So you tended to cover up the other eye while you were doing the operation as well. So Kelsus, you know, for people who want to try this at home, I say Kelsus does quite a nice description in detail as to how you can actually do it. But no, I wouldn't try to do it. Do not try it at home. Let's just get that clarified right now. And just before we leave on this, I mean, there was one other bit of archaeological discovery, unsurprisingly, from Vindolanda, which is the Roman eye patch. That's extraordinary as well. Yeah, it's the only one I'm aware of. And I guess in terms of once you've put a medicine into somebody's eye, it's always good to keep it

closed for a while to allow the medicine to circulate properly. So again, probably a bit of padding with an eye patch would make a lot of sense. And certainly after cataract surgery, you'd probably want to just cover it up so nobody can see what's been done really, because I think it would put most other patients off, I would think. Absolutely. Absolutely. Okay, just to wrap it all up, then, this has been an amazing eye-opening chat. Literally eye-opening. Nick, are there any aspects of ancient Roman eye care that we still follow, albeit loosely, today? Well, I think there are. Interestingly, when I've been doing a bit of work on looking at some other aspects of Roman medicine at the moment and trying to understand what we can learn from

the ancients, and I think eyes obviously still remain very important to us, and operations like dealing with interned eyelashes and eyelashes that turn out, we call them ectropion and entropion in medical terms, they were important operations to the Romans. And I don't think as a GP, I would probably deal with them particularly differently today. I'd still pull out the eyelashes without anaesthetic, I suppose. But because the eyelashes irritate the eye when they're turned in, that would be the first step before going off for some proper surgery. So again, we still do things. And what I've talked earlier on about some of the medicines they would use were in effective antimicrobials, the phylocalirium, equivalent to my antibiotic I use today. And Euphrasia eye drops, which are a homeopathic

eye drop, they're not mentioned in any of the Roman texts. But actually, when we, again, going back to the analysis of a Roman calirrium from that collection found at Lyon, I mentioned earlier on, one of those was absolutely crammed full of Euphrasia pollen. So it's interesting that an eyedrop you can buy over the counter was actually what was being used, albeit probably more for soothing the eyes in a homeopathic way by the Romans. And that's still available. And it was available in Lyon to the doctors. I think there is one broader thing which I think you can learn as well is that if we look in terms of anti-infectives more generally and it's quite difficult with ancient medicines to be clear exactly what they were and exactly what they were being used for and sometimes identifying the plants in them is

difficult but a group at Nottingham they got an eye remedy for a stye. It was an ancient Roman remedy, Greek remedy, which was actually in what's called Bold's Leech Book, which is an Anglo-Saxon medicine book. And they made that up, assessed it much more rigorously than the work I did, and found it not only an effective treatment against styes, but also broadly a useful antimicrobial against MRSA, which people have heard of that nasty hospital superbug. So to me, there is something about the Roman eye recipes, perhaps indicating there may be things there about treatments for infections more generally, which we can learn from. And certainly the Ancient Biotics Consortium at

Nottingham, now moved to Warwick, are actually now scanning ancient texts to look at recipes to see not necessarily whether they can be used precisely for Roman eye care, but can they be used as replacements for antibiotics when our antibiotics are all run out because we've developed resistance to them. So a lot of possibilities, I think, in the future, which will be quite intriguing. That is really intriguing, really interesting. I mean, it sounds like ancient Rome medicine epitomised by eye care, just another reason why we are very fortunate to be living in the world we are today, particularly in regards to medicine. I think so. But I think we also have forgotten some valuable lessons from the past. And I think we've talked about that in terms of the Antonine Plague and eyes as well. But there are other aspects of ancient medicine as well, where we can look back at the past and think actually doctors and the idea that we're being given

a license to practice, which some people call is a license to deceive, really, rather than actually a license to practice, because the regulatory systems don't really assess us in a way that perhaps would ensure that we are safe doctors. And the Romans had a different approach. And again, in a book I'm just coming out next year on Gracken-Rome Medicine and what it can teach us today, I look at some of these other areas as well. Regulation, the importance of prognosis, the importance of trust. There are lots of other things. And Scribonius Largus, who we talked about, was very committed to the idea of humanity in terms of his writings and the way you deal with patients. And certainly some modern philosophers are looking back at Scribonius Largus, not just because of his eye remedies, but also because of his views

about humanity and the way medicine could, should be in the sort of modern world. So there's an awful lot in the past that I think we can draw on in different areas. So eyes and Antonine Plague is just a small part of it, I think, really. Absolutely. That's a great point to leave it on, Nick. And finally, you mentioned it just there. You've got a book coming out and it is called? It's called Greco-Roman Medicine and What It Can Teach Us Today, covering things like the Antonine Plague, eye remedies, psychological well-being, but also things like architecture and health and medical personnel as well.

So it will be out by pen and sword book sometime in this year. Brilliant. Nick, thank you so much for coming on the show. Thank you.