You're Dead to Me - Ancient Greek & Roman Medicine

Episode Date: February 5, 2021

Greg Jenner is joined by historian Dr Kristi Upson-Saia and comedian Stu Goldsmith to explore the strange world of Ancient Greek and Roman medicine. Welcome to a world where health was fleeting, water could be dangerous and communal bum sponges are all the rage. The team will take you through a variety of common ailments from tight atoms to wandering wombs and provide startling cures in the form of electric eels and beaver anuses. Produced by Cornelius Mendez Script by Greg Jenner and Emma Nagouse Research by Hannah MacKenzieThe Athletic production for BBC Radio 4

This is the BBC. This podcast is supported by advertising outside the UK. Hi, Greg here. I just wanted to let you know that my other podcast, Homeschool History, is back for a second series. We'll have episodes on the Great Fire of London, William Shakespeare, ancient Egyptian religion and many other things, so if you fancy hearing some short, fun history lessons which are suitable for children and families,

then head over to Homeschool History on BBC Sounds. BBC Sounds, music, radio, podcasts. Hello and welcome to You're Dead to Me, a history podcast for everyone. For people who don't like history, people who do like history and people who forgot to learn any at school. My name is Greg Jenner. I'm a public historian, author and broadcaster, and I'm the chief nerd on the BBC comedy show Horrible Histories. And you might have heard my other podcast, Homeschool History, but that one's mostly for the kids. On this podcast, we treat you with a soothing salve of two parts book learning and one part chuckles, because laughter is the best medicine. Today, we are grabbing our scalpel and forceps to journey back to ancient Greece and Rome to learn all about

medicine and healthcare in the ancient classical world. And to help me diagnose fact from fiction, I'm joined by two very special guests. In History Corner, she's a professor of religious studies at Occidental College in LA and is an expert in religions of the late ancient Mediterranean world. But more importantly, she's co-writing a fascinating new book on ancient medicine. It's Professor Christy Upson-Sire. Hi, Christy, how are you? Thank you for coming. Hi, thanks for having me. Lovely to be here. And in Comedy Corner, he's a stand-up comic and the host of one of my favourite podcasts, The Comedian's Comedian, plus actually several other podcasts, including Child Labour with Sindhu V and The Infinite Sofa. And of course, you'll know him from the Blackbeard episode and the Jack Shepard episode.

It's the returning hero, Stu Goldsmith. Hi, Stu, how are you? I'm fantastic. And that's the only time I've ever been described as a returning hero. And I would like to preserve this moment in amber for the rest of my life. The returning hero suggests

that you have to maintain that standard. I'm mad, there is enormous pressure. There is so much sleep last night. I currently, I believe i have 21 out of 20 points across the two quizzes that i've done at the end of the previous shows and there is no way i can possibly live up to it and i almost started cheating and doing revision before coming this time we're throwing you a uh a tricky one we're taking you back to the ancient world and to ancient medicine and is this something that you know anything about? Have you done anything like this at school?

I don't think so. I did a bit of Latin at school and I seem to remember that their medicine was all about scraping. It's pre-leech, isn't it? I don't think they were into leeches. Mostly scraping and poking. I'm also kind of on tenterhooks hoping that there isn't going to be anything quite so visually arresting these half-remembered images that torment me i'm afraid we might have to disappoint you on that because we do have some pretty arresting things coming up eyes down let's get scraping so what do you know it's time to crack on with the first segment of the pod. It's called the So What Do You Know? This is where I have a go at guessing what you might know about today's subject.

And I'm going to guess you know what medicine is. But would you know what to expect if we dumped you in ancient Rome or ancient Greece and said, eat this? Oh, no, you've got a dodgy tummy. Sorry. And would you know what the four humours are? They sound like a Motown group. Sadly, they weren't.

They were important. We'll get to them later on and find out why. You might know the Hippocratic Oath to do no harm, not least because it appears quite often in TV shows like Grey's Anatomy and Scrubs and Outlander and Star Trek even. But what else is there to know? And more importantly, what do vanilla cupcakes and beaver bums have to do with medicine? Let's find out, shall we? Right, we should start by talking about daily life in the ancient world and how that is feeding into the kind of medicine required. I'm going to turn back to you, Stu, just see where you envisage ancient Roman, ancient Greek life. Do you think it's a time of lovely frolicking in fountains like the opening scenes of Friends? Or do you think it's a world of violence and death? It's 100% beaver bums. I imagine it's nasty, brutish and short, isn't it? I think it probably

wasn't a place you wanted to get poorly. I think that's probably fair. Professor Christie, is it fair to say that this is a world in which illness is the norm? Yeah, absolutely. When we read Greek and Roman sources, we get the picture that at any given time, nearly everyone had some sort of illness, injury, or impairment. And my favorite illustration of this comes from the letters of the Roman order, Fronto, the bulk of which are comprised of his and his friends complaining about their aches and pains. Fronto mentions his own chronic knee pain flaring up all the time, and he talks about bouts of fever and diarrhea, a bite from a scorpion who's hiding in his bed, a stiff neck. He's worried about his mother who's getting sick and his wife who's about to give birth.

So it seems like unlike today, where for most people, health is the default state we experience most of the time, and we occasionally become temporarily sick. In antiquity, the opposite was the case, where people were unwell most of the time, and we occasionally become temporarily sick. In antiquity, the opposite was the case, where people were unwell most of the time, and health was a state they only fleetingly experienced. Fronto even delights in one of his letters to report that he's enjoying a lengthier spell of health than usual. This is already making me realize, like, the idea that the normal state was to be ill means that everybody who created anything that we think about and respect, from your Socrates to your other people with names like that, they were writing that stuff whilst weeping and bleeding and pussy and stinking. gentleman who jumped out of the bath whose name escapes me, Archimedes? But the Eureka guy, he jumped out of the bath and it might well have been a bath of his own pus. This is not a thing that I like to think about. Roman society in particular, enormously urban for the major

cities. But there are also reasons people are ill all the time. These illnesses are caused by things, but presumably we're talking living conditions. We're talking people packed in cheek by jowl, smoke from the cooking, fumes from chamber pots, urban density. I thought for a moment you said urban dentistry and I was going to go. Urban dentistry is also another, that's also going to be a problem, I'm sure. Yeah. So they're living in these really close quarters, which as you can imagine, contagious diseases would have spread quickly in these living conditions. And yeah, air pollution from, as you said, smoke from fires, from cooking, or from oil lamps, and even from faecal matter in chamber pots that people kept in their homes. And so, you know, when we've exhumed human remains

from the time, we find diseases of the lung that are similar to those found in coal miners today. Did anyone have an idea about, was there any kind of movement to go, should I not sleep next to the pot full of faeces? Yeah, I think they had a sense of cleanliness, but they didn't have a sense of germs in the same way that we do. So pathogens were not spread as in the air, except for epidemics. So they did think that if everyone in a city got sick, then it must have been because there was something toxic in the air that everyone breathed.

As well as the occupancy problem of dense cities, we also have the kind of sanitation problem of where do you put all the crap, water issues. I mean, obviously the Romans are amazing for bringing water into the cities with aqueducts, but there would be some pretty unclean water that people would be bathing in wouldn't they, Christy? Yeah, aqueducts were in fact pretty remarkable. They had settlement ponds and channels that purified the water as it was routed into the cities. But once the water arrived into the cities, it was stored in cisterns so it sat stagnant. And as we know, these are the ideal conditions for waterborne bacteria and for the breeding of insects that transmitted diseases like mosquitoes.

And there also wasn't waste removal. So people just threw their rubbish in the streets and it piled. And as it sat there, it rotted. And this was another place in which insects and vermin that transmitted diseases flourished. The idea that Roman civilizationisation was so advanced, oh, we have the finest stuff incoming, and then when it gets here, it sits around, we throw it out the window. Look, we're only in charge of the first half of the job.

It's like when you go into a department store and there's an escalator up the stairs because they want you to shop, but when you have to go down, you can take the stairs, mate, walk like anyone else. The other place, of course, the disease might spread would be in the toilets and the facilities and stew if you were you know if we put you in a um a delorean and drove you 88 miles an hour and took you back to ancient rome and you needed the loo then you would go to a public facility called a forica i've already been mate right it's one of our rules

before any time travel trip always make sure you've been but in the forica you would sit down and it would be communal and open, no cubicles. You're sitting next to strangers. Once you've done your business, once you've done a number two, someone would hand you something called a zillospongium. Do you know what that is? Oh, is it a sponge or a stick? It is. It's an anal sponge. What I did was I took the word spongium and I took the word xylophone and I did a little bit of jiggery-pokery in my head and I went, that, my friend, is a musical sponge on a stick.

It's a bum wiping sponge, which was passed around communally between strangers. I mean, it was sort of washed in vinegar, we think, Christy, but this is a recipe for disaster, really, isn't it? Is that the beaver bum or have we still got the beaver bum? No, the beaver bum's unrelated. Is that the beaver bum? Or have we still got the beaver bum to come? No, the beaver bum's unrelated. I'm imagining a sponge such as you would buy in a shop now, but of course the sponges they'd have then would be collected from the seabed.

And I think in a way that I've never understood, they are somehow living creatures, which is just an awful end if you're a little sponge and the fisherman comes along. I haven't watched all of SpongeBob SquarePants, but I'd love it if the final episode was him being plucked from the sea and then just wiped across various Roman buttocks. Oh, Spongy and Bobbis SquarePants. Sad times. Let's talk about the religious aspect then. Let's start with ancient Greece.

And we're talking perhaps two and a half thousand years ago. And the god in charge of healthcare is called Asclepius. And he has daughters, the two I'm aware of are Hygieia, where we get the word hygiene, and Panacea, where we get the word panacea, which is handy. Asclepius, how do you go to a temple dedicated to him? And what's the process of getting better? Yeah, so Asclepius was the god you wanted to go to if you were sick. And like you said, his daughter Hygieia and Panacheia were also goddesses at these temples. You would bring them gifts. You would bring prayers and petitions. You would bring anatomical

votives. They were clay or stone objects in the shape of the body part that they wanted the god or goddess to heal. I'm interested in the petitions. I love the idea that I've collected a hundred signatures, a hundred signatures saying that I am deeply unwell, please sort me out. So they would have anatomical things. So if I've got a dodgy knee, I'm going to make a little clay knee and I'm going to take it and place it in the temple as if to sort of highlight the bit of me that there's an issue with. Yeah, we mostly have a lot of eyes and ears and internal organs, wombs. So we can kind of see the things that people most cared about, were most worried about. So injuries, impairments to hearing and to sight, to reproduction.

Because you've done archaeological digs and you've gone, well, in this particular temple, there's a whole bucket of eyeballs. And you're sure that either they were in the habit of making offerings, or there was some chaos god that we don't know about that just demanded a bucket of eyeballs every so often. Cyclops fanfiction. They're just like, you only want one eye! But the signature practice at Asclepian temples was the healing ritual called incubation. So incubation required a sick person to sleep in a special

sanctuary where they hope to have one of two kinds of dreams. Either the God would treat them within the dream and they would wake up healed, or they would receive a dream in which the God prescribed a treatment plan that upon waking, they would follow with the help of the priests. I love your use of the phrase, a treatment plan. I have incubated and I have dreamt a treatment plan, which is six of these four times a day. The other fun thing to throw into the mix also, and Indiana Jones would not have liked this,

but snakes are involved as well. If you go to a temple to Asclepius, they chuck snakes at you. Yeah, and also the snake wrapped around Asclepius, they chuck snakes at you. Yeah. And also the snake wrapped around Asclepius' staff was something he was known for in the depictions of him. The snake was an animal that was in the habit of regularly shedding its skin. And so it served as a symbol of those who shed their illness under the care of the god Asclepius. And it's a symbol that we still see today in a lot of medical associations, the Caduceus symbol with staff with the two snakes wrapped around it. You wake up in the morning and you're not better. Does that mean the gods have failed you? Or does

that mean that you are unsavable? No, it means you have to go and do some work. So usually there, the priests would help you procure the drugs that were prescribed in the dream. So sometimes the treatment plan involved bathing in hot pools or cold pools. Sometimes there were stadiums at these temples. So sometimes exercise was prescribed. So it just meant you had to do your work now. I mean, it really was a treatment plan, wasn't it? Yes.

That they should say, presumably, if you're the doctor or the kind of the pharmacist, and people come along and they're going to dream, and then you're going to sell them the stuff afterwards. As they're falling asleep, do you whisper, oh, go to Salvio's Pharmacy, it's the best one, in the hope that they dream about gold pellets, which, oh, I've got a couple of those I can wrestle up. You're not far off, Stu. Actually, at the Asclepian Temple in Pergamum in modern day

Turkey, when you enter into the temple, it's lined with these shops or stalls. And we know that some of them were pharmacists. And so it's pretty clear that they were in cahoots with the priests in terms of, you interpret the dream to have them give me this drug and I'll provide you the drug. So there seems to have been some cooperation. I may not know much about medicine, but I admire a hustle when I see one. I was about to do a sort of cynical big pharma joke, but maybe I shouldn't because, you know, we all love vaccines now, don't we? The staff you mentioned, Kadoukios? Kadoukios. It sounds like a character in Street Fighter. Sorry. It sounds like what they say. Kadoukios! We shouldn't because, you know, we all love vaccines now, don't we? The staff you mentioned, Caduceus. Caduceus.

It sounds like a character in Street Fighter. Sorry. It sounds like what they say. Caduceus. Caduceus. Yeah, very nice. I wonder how American that pronunciation of it is. I'd have said it was a Caduceus.

This is the fight between Latinists, whether you pronounce the hard Cs, the hard Gs, or the soft Cs and Gs. So Hygieia, Hygieia, right. I prefer the hard pronunciations. But at the same time as we have those priests and those temples, we also get the rise of professional medicine, actual doctors who are like, hang on, no, I think something else is going on here. And the most important in the Greek world is probably Hippocrates of Kos, born around two and a half thousand years ago. What's super interesting about him, he invents the concept of diagnosis and of prognosis of saying, I know what's wrong with you and I know what's coming next.

But what was sort of slightly gross about it is that some of his techniques, Christy, were, well, I mean, I wouldn't want to do them. I mean, he drank people's urine and he tasted their earwax and their mucus and nasal phlegm and all sorts of things. And he was like, I think it might be scurvy. It's kind of a weird gig, but this is a rational approach, isn't it? This is someone saying the body is a system. The system is failing. I can tell you what's wrong and I can tell you what will happen next. I can taste what's wrong with you.

Yeah. We have a ton of writings attributed to Hippocrates and it's unclear if he authored any of them or which of them he authored. He and other medical writers introduced a pretty significant paradigm shift in that he thought that sickness could be explained entirely in terms of changes in the body, not the gods. And medical writers like him set out to diagnose what exactly it was that was going wrong inside of a patient's body by looking at these signs or what we would today call symptoms. So those that are on the surface of the body, temperature, complexion, or the stuff that comes out of the body. And that was really where you had a gold mine of information about what's going wrong in the body. So this is vomit, feces, urine. And yeah,

you're exactly right. They used all of their senses to try to detect the quality of these substances. They looked for changes in color or off colors, bad smells, but also sour tastes or sweet tastes. They were all hands on deck. Imagine coming up with the concept of diagnosis. The sort of diagnosis I do every day is my computer isn't working, which bit that's plugged into that, which is plugged into that, which is plugged into that, and one of those cables must be not working. Imagine coming up with the idea of that. Like before he came along, which is plugged into that, and one of those cables must be not working. Imagine coming up with the idea of that. Before he came along, everyone was just like, oh, my computer's knackered, chuck it in the sea.

Yeah. And as much as we think that ancient medicine is a bit wackadoodle, they really refined observation, devising theories based on patterns of what they saw. And if you read their reasoning, it actually makes a lot of sense of what they were seeing. Right up until the point when you're drinking urine. Despite the rationalism of the sensible thing of it, actually, there was resistance to these new ideas. The Greeks in particular looked at these professional doctors and went, what's that? No, I'm sticking with my gods, thanks very much. So there was a bit of a pushback against this new way of thinking. folks who were sick and injured might have thought it was risky to go to a mortal physician instead of going to the immortal gods, especially because this was exactly the kind of slight that would

piss off the gods. Yes, you don't want to mess with that. That's when you find yourself in the pocket of big Asclepius. How did they overcome that? It took a lot of persuasion. So we have early Hippocratic writings. The Art of Medicine is one of my favorite texts. And it's just a litany of criticisms and skepticism about the new science and responding to them one by one. But the other approach is just to fold medicine and religion together. The doctors would appeal to the gods for help. They would say that the gods were the ones who showed them the remedies.

That's so smart, isn't it? We've got some aspirin. And don't worry, do you want the blessed aspirin or the unblessed aspirin? Great! Although there was stubborn resistance, gradually doctors do sort of gain a bit more prominence. And by 46 BCE, Julius Caesar conferred Roman citizenship automatically on all foreign doctors, which, you know, in the age of brexit sounds like a good idea maybe so but stew i'm going to ask you about what you think the four humors might have been four humors i

guess are going to be uh slapstick prop gags one-liners and shaggy dog stories and i want to say bilge but i think i'm conflating bile and phlegm i want to say like uh like arrogance or something some sort of like it's passion i think you're confusing the seven deadly sins yeah it's gluttony no it's like um spleen or is that i'm confusing that with the bile isn't it i'm thinking splenetic is it something like ardor or kind of like like passion something like that you're just naming romance novels now just like is it lady chatterley's love a trot christy do you want to put him out of his misery because that was a real tour de force yeah so ancient folks thought that the body was made up

of four different substances blood phlegmlegm, black bile and yellow bile. So two different kinds of bile. And so... Oh, so I got bile and I was thinking black bile is a separate thing and blood. Yeah, I really missed that one. That's me kicked right out of pretend medical school. There is this idea that these four humours, if they get out of balance, can tip you towards a certain mood and also, of course, into bad health.

So that then brings us to the theory of opposites, which is also something we get from Hippocrates, but also then later on it's popularised by Galen, who's a very famous doctor in the Roman world. So Hippocrates and Galen are kind of two superstars, I guess. And the theory of opposites, Christy, is that you're kind of trying to tip the other way. If you've gone one way too far, you're like, oh, no, back the other way. So how would that work if Stu had a nasty head cold and a bit of mucus and a bit of

phlegm and he's a bit under the weather? How would you treat him? The ancient physician would say phlegm is the problematic humor and there's an overabundance of that humor. And they thought that all of the humors had certain qualities on the spectrum of being hot or cold or moist and dry. And so they would think the phlegm is overabundant, phlegm is the cold and wet humor. And so in order to restore balance, we need to prescribe treatments that counteract those qualities. And so this could be done in lots of different ways with food that's hot or dry. So spices, garlic, fermented foods and drinks. Or you could send your patient to a hot, dry climate. Or you could prescribe an exercise regimen that would heat and dry them out and so on and so on. The look on my face there was because I was sure you were going

to say it's the opposite. So if he's phlegmy, we've got to make him drink some black bile. But I can sort of see the sense in that. I'm not going to describe myself as phlegmy particularly, but I'm asthmatic and I get chest infections annually. And it's good to be somewhere warm and dry. Yeah, of course. Yeah. And they thought that the humors were susceptible to the things around them. So if, for instance, you're in a climate that is cold and wet, that's going to trigger the production of the cold and wet humor, phlegm. So this makes sense of what they're seeing in terms of seasons and the substances of the bodies. Myself and Greg, resident in Britain, phlegmy.

Coffee, steamy. Christy, resident in Los Angeles, not so phlegmy. Yes. In terms of the four sort of moods that come off the back of these, we have excessive black bile produces melancholia. So you're melancholic. And choleric would come off the back of yellow bile, excessive that. So you'd be fiery tempered and annoyed. Sanguine is a word we use sometimes.

It means an excess of blood, but it would make you quite sociable and cheerful and fun to be around. Is that what sanguine means? I always thought sanguine meant the opposite of that. I've been using that word wrong my whole life. People have been calling you sanguine because you're cheerful and fun and that you thought it was an insult oh there we go oh i've got to make some calls but the interesting one christy that i didn't know until we spoke beforehand is that phlegmatic now when you say people are phlegmatic it's a compliment it means they're deep thinking calm and rational and you want them in a. A phlegmatic person's a good leader.

But in the ancient world, it meant sort of sluggish and horrible and lethargic. We've mentioned Galen there, and Galen is carrying on this way of thinking. And he's a big name in the second century. And he's a huge name because not only does he write a huge amount of stuff, we have so many of his books, but he also treats gladiators and Roman emperors. He is the royal doctor, essentially. Does that mean, therefore, that he is the authority, you cannot argue with him? Or was there still debate about medicine and how best to treat people? There were multiple schools of thought in the ancient world about what caused illness. And a view of another physician who was working in Rome about the same time as

Galen, Asclepias, became very popular. And he believed that the body was made up of atoms, and that illness was caused by the atoms not being able to move freely and regularly throughout the body, especially when the body's pores or channels were too constricted or were too loose. Sounds like an X-Man, like a guy who's just like, your atoms are too loose, you need to tighten up. So what was his thinking there that the atoms in certain bits of you were too loose and the atoms in other bits of you were sufficiently hard that those atoms weren't escaping? So think about what he's seeing.

He's seeing either people who are constipated or have diarrhea. And he's thinking the channels are either too tight, too tense, too constricted, or they're too loose and the atoms are passing too quickly. Is he sort of half right there? Because, you know, it might not be the atoms, but there could be a certain amount of tightness of channel. Whether he's right or not, I want his treatment. So his treatment was massage to loosen the body, exercise, right, move your body.

His motto was swiftly, safely and pleasantly. That's Virgin Trains, isn't it? It does sound like a kind of, yeah, we'll get you there. We'll get you there safely. Very literally. But yeah, massage, walks, a bit of light exercise, some liberal wine, a bit of nice food. It doesn't really sound like medicine. It just sounds like a spa day.

It's great. Yeah, but if the alternative is you get a poking and a scraping and a bunch of bile in your eye, probably a certain amount of success with that. I mean, one of the things I think I know about medicine is it's difficult to work out what works because by the time you've had the stuff, you might have got over the thing already.

Yeah. So if that's happening in both cases, some people are hoovering up a load of phlegm and the others are just chilling out in a spa day and having a massage. This might be like a similar success rate. And that's exactly one of the criticisms that's leveled against the new science of medicine in the art of medicine that I was talking about a minute ago is if some people get better without the help of physicians, or if some people don't get better even with the help of physicians, then how can this science actually be thought to work?

Yeah, and they're not running double blind tests, are they? Also their collection of data was presumably kind of what we would almost call anecdotal now. I mean, are they keeping records? Yeah, they are keeping a lot of records. So they do have histories that detail the progress of a disease, the different symptoms, what the physician did, and then the outcome of the disease. And so they were pretty careful in their record keeping. This is where we get our modern custom of patient charts comes from these case histories. We've heard quite a lot about systemic thinking about the body. Let's hear now about some actual cures. Stu, I'm going to read you four possible cures. Which of the four is the real one?

Oh, so you've made up three of these? That's the game. Number one, if an organ hurts, hold a puppy close to that part of their body and the puppy will suck out the disease and the pain with its mouth. Number two, if you've been bitten or stung by a snake or a scorpion, you need to eat some human earwax, preferably from someone injured. Number three, if you've got epilepsy, then you just need to drink some gladiator blood. Simple. Or number four, if you've got a headache or a migraine, then you need to zap yourself with an electric eel or a torpedo fish. Oh, God, they're all so realistic. I'm not having the puppy one that's nonsense um i so electrogeal for headaches that could work in a kind of an electroconvulsive kind of certainly you'd take your mind off the headache epilepsy would they have diagnosed epilepsy you have a fit

sling a bit of uh of maximus's uh blood on them i don't know about that one and what was the other one bitten by a scorpion or a snake eat human earwax from someone who's been injured. I can't believe I'm saying this, but it has the ring of truth. I think I'm going to go electric eel. I think that one's real. To a certain extent, we've screwed you here because they're all true. Oh, yeah. Even the puppy.

Puppy is true. I love watching you work your way through them and sort of going, well, that sounds like it. Yeah. Okay. Well, a scorpion. Let's go through it. So you're bitten by a scorpion. Get me some earwax. That's not that dissimilar to getting weed on after a jellyfish bite, is it? No. Epilepsy, drink gladiator blood. Well, that's absorbing the power of someone who's powerful and strong. And then, but get a puppy. Get a puppy. I suppose now we get dogs that can be trained to smell cancer and stuff like that, can't we?

So maybe there is a historical root. That remedy comes from Pliny. And we think that it's found alongside other remedies where you would put an amulet or a healthy sheep spleen if your spleen was injured on top of yours. And the idea was that the disease would transfer from your unhealthy organ to the healthy organ. Electric eel slash torpedo fish. That's given by Scribonius Largus. Pedanius, another doctor, he recommended the treatment of a prolapsed anus with the electric eel up the bum. An insertion of an electric eel?

Yes. Well, no, I could see that working, right? Because you're tightening up the muscle, right? It's a convulsive sort of thing. You are absolutely right. I'm astonished to discover this is true, but I found a medical paper published a couple of years ago. Modern scientists have found that actually,

not the eel, obviously, but electricity does actually help. Oh my God, you can reverse a prolapsed bumhole with a sufficiently vigorous electric shock. Please now, everyone, fall silent as I do the official BBC disclaimer. Please do not insert an electric eel into your anus. Thank you very much. Christy, what we're seeing here to a certain extent is available remedies, ingredients, you know, puppies, animals lying around you can get

or you can buy in a marketplace. But the other thing that was more widely available and probably more sensible than electrocuting yourself with an eel would have been pharmacology, plant-based cures, of which we have over 700 in later Roman texts. Right. But there were still problems in this because you've said in your notes that the word pharmacon, from where we get the word pharmacy, meant in Greek… Both drug and poison. Oh, that's handy.

Yeah. Yeah. and poison. Oh, that's handy. Yeah. Yeah. So plants, particularly subspecies of the same plant, one of them could heal you and the other one could kill you. And so you did not want to just take drugs from anyone off the side of the street. You wanted to get your drugs from an expert and pharmacologists. They were called root cutters, literally, were highly valued, sometimes even more than physicians. And sometimes they were even regarded as magicians, which makes sense given the wonder that their seemingly superhuman knowledge inspired. We have a thriving drug trade in the ancient world as well, with pharmacologists setting up shops and stalls in local marketplaces and selling, like you said, Greg, relatively common, cheap plants, pretty reasonably priced. But other plants that were

harder to find or that required more expertise to discriminate between the subspecies, those could be quite expensive. An example of this is medicinal plants and roots that were grown in the island of Crete, which had a reputation for growing rare plants or plants that were especially potent. And so those were the most costly. So pharmacology and of course, also diet was also really important too, wasn't it? We know that professional doctors are giving dietary advice to saying, eat this, don't eat that, exercise. It's all sensible stuff too. But the thing I want to talk a little bit about actually is the move away from traditional Roman medicine, which had often been done by the head of the family. So rather than going to a doctor in the early Roman world,

you would have just sort of gone to grandpa who would have sort of grown up knowing what to give you. My favorite grandpa would have been Cato the Elder, who's a very famous Roman aristocrat. He recommended for pretty much all diseases, cabbages. Just eat cabbages. And he's written a long essay just going, if you've got a stomach problem, cabbages. You need cabbages. Your leg hurts, cabbages. Headache, cabbages. Was he by any chance, he was a cabbage farmer. I love it. Really trying to wrestle back the whole of the concept there. Yeah, funny thing. Yeah. But in terms of the spread of medicine through the Roman world, we do know that eventually, you know, we've heard Julius Caesar in 46 BCE gives natural citizenship to all foreign

doctors, which means presumably doctors are starting to come in. They're starting to replace these traditional ways of thinking. And some of these doctors are enslaved people. They're going to be ancient Greeks who've been conquered by the Romans and enslaved and brought in because they're educated. Yeah. So most physicians would have been trained by being an apprentice. So shadowing, practicing physician as they made house calls and learning how to examine patients, how to read signs and symptoms, how to diagnose, how to bandage. How to get the puppy, yeah. Yeah. And if you could afford it, you might travel to one of the big cities like Athens or Alexandria or Smyrna, where there were medical centers. And there they could hear

lectures from prominent medical thinkers, or they could sharpen their anatomical knowledge by looking at full sets of human bones. There was no centralized medical association that issued medical licenses. So there were a lot of folks running around hanging up shingles, and you wouldn't necessarily know how well educated, how well trained they were. You could just lie if you wanted to. Patients really had to rely on word of mouth reputation. So they wander around the place self-promoting with no real idea of whether they're good. It is not dissimilar from standard comedians.

There presumably would have been some doctors who, Galen, for example, he worked in Rome, right? He was there with all the sort of head honchos, with gladiators, with the emperors, but most other doctors are probably, they may be on the road a bit. Yeah. If you're not doing well in a city, if you're killing a lot of your patients, you're going to want to get out of town as soon as possible, right? Always been my rule. But also doctors, even those who are quite good, they need to find enough clients to make a living. And so they're also on the road most of the time. There's a small subset of physicians

who stayed in place, and these were known as city physicians. These were folks who earned a widespread reputation for success or who had impressed a particularly wealthy, influential client in town. And so these cities, these city councils, would pay city physicians a retainer fee simply to keep them in town so that they were available when needed. The patients would still pay the physician fees for services. So this was the gig you wanted. At Pompeii, which I'm sure you've heard of, there was a surgeon working in the town,

except he was right on the edge of the town next to the exit road. Stu, do you want to guess why? He had intel about the volcano. That would have been very useful. We found half of him perfectly preserved. He was just on the edge. Well, because he wasn't very good and he was ripping people off. Basically, it was the last stop before the cemetery. So you kind of went to him and if he didn't cure you, next stop, Morgsville.

You mean physically that out of town he was the physically last stop before the cemetery so you'd be heading to the cemetery thinking I'm expecting to die don't worry I'll bury myself and then on your last stop before you get there I will just pop in at Joe's and see if he can sort me out. I mean Christy he was a surgeon presumably he was going to be doing kind of emergency work perhaps? So surgeons were a slightly different class than physicians. were a slightly different class than physicians. Most physicians had some occasion to open up their patients. So whether to cut out gangrene on a wound or to try to dig out a projectile like an arrowhead. But most of the time, physicians tried to avoid cutting open their patients. So surgeons were the professional class, the tradesmen who did

this kind of work. And it was incredibly risky, mostly because of the high rates of infection. And the necropoli, the cemeteries were directly outside of the gates of cities. So he was set up as close as you could be to the cemetery. Yes, ideally up a hill at the foot of which was the cemetery. And then when things went wrong, you could just pull a lever. And then just sort of slide out like Sweeney Todd. We've been talking about men so far, Christy, but actually we do know of women in the ancient world who were not just midwives, not just sort of, you know, folk healers,

were trained physicians who were well-respected. Do you want to tell us about, I mean, I'm going to mispronounce her, but I'm going to go for Antiochus of Telos. Yeah, Antiochus. Antiochus, I was so close. Yeah. So early on in medicine, there was a professional class of women healers, healthcare professionals that were often called midwives or obstetricians, though there's some indication that these women were general practitioners who treated a wider array of illnesses beyond just pregnancy and childbirth. And from the Hellenistic period onward, the titles start to catch up with

the work that they're doing. They start to be called physicians. So iatrine in Greek and medica in Latin, these are the exact same terms that get attributed to men physicians. And we have over 50 attestations of women physicians, many of whom rose to prominence, including Antiochus of Tloss, which is a city in modern day Turkey. She was elected by the city council as the city physician. So she must have had some chops to get that job. And her work gained renown even outside the city. Asclepias, who we were

talking about a moment ago, and Galen both cite her remedies. Heraclides, the Greek philosopher who proposed that the earth rotates on its axis, also dedicated one of his books to her. Wow. Firstly, 50 different female doctors in the ancient world. We're not talking about one woman who bucked the system. We're talking about women in the ancient world. So we're not talking about one woman who bucked the system. We're talking about women in the medical workplace. That's amazing. But also, she rose really high. That's properly legit because that's the double paying gig, isn't it?

So she's going to be loaded. How did that fit into the kind of what I imagine was the sort of rampant sexism of the world at that time? That's a great question. And unfortunately, we don't have many other records about Antiochus. But we do have another inscription about one of these women physicians. It praises her in a sort of backhanded way. So the husband writes this funerary inscription to her and says, she's an amazing physician.

She's even as good as men. There is sexism folded into even the praise. And so Antiochus of Tilos was the Meredith Grey of her time. If you don't know what that means, that's a Grey's Anatomy reference. As well as lots of evidence for women working in healthcare and medicine, we also now should talk really about women's health and in terms of the way in which women were treated as patients. And humoral theory said that men were hot and dry and women were wet and cold.

But that, of course, is to do with the menstrual cycle. But we now have to get on to the somewhat strange concept of the wandering womb. Stu, any guesses what the wandering womb might have been? Is it a beaver bum? I mean, the idea here is that women's bodies are different to men's in very profound ways. There is a Greek physician called Arateus who argues the womb is a separate animal living inside a human and that it is sort of parasitic and it needs moisture. And if things dry up, it will go looking for moisture. So the wandering womb, Christy, is this is a way of conceptualizing women's bodies.

Can you talk us through this? It connects to menstruation, as you alluded to early on, Greg. So medical writers thought that because women were colder than men, they didn't possess the heat necessary to digest food. So to literally cook the food in the stomach to the temperature necessary to evacuate it as refined, easily passable substances like urine, feces, sweat, etc. So women accumulated their partially digested food as thick menstrual blood. And once a month, this is month in Latin is menses, it required this enormous effort to push this thick menstrual blood out of the body. But this overheated the womb. So the womb became dry and hot. It's now parched because it's lost all of its moisture.

And so the reasoning is that it's wandering around the body looking for moisture to soak up from nearby organs. If the womb is glommed onto the lungs, this could cause breathing trouble for women. Or if a woman is having mental distress or depression, they could blame the womb on attaching onto the heart, which is where they thought the mind resided. So this might be an explanation of prolapsed uterus or endometriosis, and people are sort of looking at an unhealthy woman who's struggling with something and thinking, must be a wandering womb. It would keep it in place. It would weigh it down with a baby if you got pregnant. And so we can kind of feel the urgency of a society that is in a demographic crisis at all times to prescribe treatments against women's will. Remember, they're dying in childbirth. They're dying in postpartum infection. So to prescribe treatments to them that will incentivize

them to get pregnant and give birth. God, not to mention the fact it's being prescribed by men. This is more sensible advice from the people who bought you, would you like to buy one of my many cabbages? Now, Stu, we have promised you beaver bums and you have referenced the beaver bums already. So now it's time for beaver bum update. Oh God, is it finally time? Come on then. I would like you to guess how else apart from recommending that a woman have sex how else might the wandering womb be lured back into place think about smells is the uh the advice i'd give you and this is something to do with beaver bums i have got i feel like i'm having a breakdown are we going to introduce

something into the lady in order that the womb be charmed back down to its correct place? Yeah. Bang on. Oh, Christ. Why did you do this to me? There's another method as well, which is not just lure down with charming, but also scare down with something nasty from the top. Oh, it's shouting at the top of the head. Get back down there, you womb. Oh, even more disgusting. Oh, it's shouting at the top of the head. Get back down there, you womb! Oh, even more disgusting. Oh, God. Can we now have our beaver bum update

and also just a sort of general guide to how was this done? What nice smelling things are we talking? As you mentioned, Greg, medical writers like Arateas thought about the womb as a little animal that was receptive to pleasant things and repulsed from unpleasant things. And so you would put sweet smelling fumigations underneath the vagina, like cardamom, cumin, anise, fennel.

And here's the less exciting part. You would either have the woman inhale foul-smelling things, like smoke from a burning goat, or force her to ingest disgusting drinks like castoreum, which is a substance extracted from the anuses of beavers and, fun fact, also used in modern vanilla flavourings. Oh my God! Castoreum! This is shellac and beetles all over again. Castoreum is disgusting beaver bum gland produce and it's made in vanilla.

It's added to vanilla products, I think. Yeah. If it's not beaver bummy enough, chuck a bit of castorium in it for that authentic beaver bum vanilla flavour. Also, just while we're on the subject, the smoke of a burning goat. Were they off their heads when they came up with this? Like that to me sounds like something that you can sort of envisage a doctor improvising for his life against all the odds. Have you tried looks in the river beaver anus? Okay, let's do this. So there we go. We're talking here about V-steams pre-Gwyneth Paltrow, 2000 years before goop. They were already sticking fruit and various things up a lady's foof. I don't think you can say that on the BBC, Greg Jenner.

So that's the saucy part of the show over. Spungium seems like a pleasant memory now by comparison, doesn't it? Christy, can we talk now quickly about something that people might recognise, which is the medical ethics and, of course, the Hippocratic Oath. Doctors supposedly took this oath. Hippocrates is said to have created it. Is that true? Yeah, likely not. It seems to date to a few centuries after Hippocrates, though there are some similar principles found in the oath and in earlier Hippocratic writings, like the ever-famous do no harm.

We know the Hippocratic Oath was amended more recently in the 20th century by a guy called Louis Lasagna. What a name! And he took out the references to payment and also to the gods, because of course we don't really need them anymore. What was the origin then of the Hippocratic Oath? Was it that you had to, in a time when you suspect your doctor's credentials, they've wandered in off the street with a variety of aquatic mammals slung over their back and some sort of bum scraper. And they go, which would you prefer? The idea of an oath or a promise that they had all taken would be pretty important, right?

That's exactly right. Holding oneself accountable to doing your very best in these conditions in which, as we've talked about, it would be pretty easy for a quack to pass themselves off as a physician. And so it was to reassure patients. There were lots of oaths in the ancient world, not just the Hippocratic oath. Scribonius Largus, who we've mentioned already, his guiding principle is compassion, empathy,

and kindness toward the patient. So that was another guiding principle besides do no harm. Yeah, but he also electrocuted people with eels. Let's talk a little bit about dissections and vivisection just quickly. Do we know about how doctors learn of the body in terms of, you know, getting hold of corpses? Yeah, so most anatomical study happened actually through dissection, but dissection of animals. But the dissection of human bodies seems to have been in practice only for a short period of time in Egypt and Alexandria. And Kelsis, a medical writer, even talks about vivisection, which is the dissection of living bodies. It was incredibly controversial, eventually phased out. And physicians in training were advised rather to seek out what they call accidental anatomy.

So that was occasions in which you happen to see the insides of bodies. So when criminals are flayed in the arena or when soldiers' bodies are ripped apart on the battlefield. And we do know of a couple of people who are claimed to have done vivisection. We have Erasistratus. I mean, he's called the father of neuroscience. So I'm going to have a big swing here and say that he had a poke around a brain. Is that fair? Yeah, he experimented on brains and nerves. And he was really pretty advanced in terms of mapping how damage to particular parts of the body affected motor function. So he was experimenting on live patients, we think?

Correct. Yeah. That's scary, isn't it? And it reminds us that our friend Fronto was living a pretty good life because he wasn't a criminal or a prisoner of war who was having his brain cut open and experimented on. Right. No, he just had knee pain, but that's fine. I mean, I've got knee pain. I'm all right. I mean, actually, that brings up another question, Christy. We've got no real mention here of painkillers or anesthetics. Do we think they had any? Yeah, they certainly knew about painkillers. So they knew about Mandrake, Henbane, and especially opium.

But it doesn't seem like pain relievers were always available or that they managed to dull all of the pain. Our medical sources talk about using apprentices and even pulling in family and friends to hold down a patient who's writhing and wriggling in pain. I would prefer strangers. And they even mention physicians and surgeons ought to be stalwart in their purpose and be unmoved by their patients' cries and pleased to stop.

So it seems that pain was a part of medical treatment. Right. So part of the training to be a Roman surgeon was presumably to just ignore the screaming. That is quite sobering. So just a final thought, really, when we get the rise of Christianity, which of course starts as a Jewish faith, this is where we start to see a slight change in healthcare because it becomes charitable and we get hospitals. Right, exactly. For most of antiquity, healthcare was a private issue. It was left to families to treat themselves or to find money to hire physicians.

But with the rise of Christianity, we start to see this shift and rooted largely in Jewish traditions, Jewish values of hospitality for the vulnerable and the needy. And Christians adopt these values and create charities like food doles, alms for the poor, and eventually by the fourth century CE, full-blown hospitality

complexes. This is where we get our term hospital. These hospitals that were connected to monasteries were places where all sorts of vulnerable people could get help, including the sick. And this was revolutionary because it was the first time that the masses had access to free inpatient health care under the supervision of medical professionals. And the consequences can't be overstated. It seems that those who had access to even basic nursing care lived longer. They had a higher quality of life. And most importantly, they survived epidemics that devastated communities. So people flocked to Christianity

and healthcare contributed in no small part to the Christianization of the empire. The Nuance Window! It's now time for my favorite part of the show, which is called The Nuance Window, which is called the nuance window, which is where we, Stu and I, have a little, well, I suppose a convalescence perhaps. And we allow our expert, Professor Christy, to tell us what we need to know about this subject. So without much further ado, the nuance window.

So as we've seen today, it's really fun to talk about ancient medicine. But my students who are aspiring healthcare professionals always ask me, is there anything useful to studying the past? Ancient theories are outdated. Many of these ancient treatments are downright horrific. So is there anything they can take to make them better physicians? And I have a few responses for them. So first, I think it's important just to get a sense of where medical ideas and values and institutions came from. So we've talked about the oath, hospitals, also just basic scientific method. Second, studying medicine from other time periods and contexts can unstick us from routine ways of thinking and attune us to aspects of medicine that we tend to pay less attention to. So, for example, today medical students are laser-focused on science classes.

That seems to be the only thing they care about. But when we read ancient sources together, it reveals far more humanistic perspectives, including patients' fears, anxieties, reluctance to follow instructions, as well as physicians struggling with particularly thorny diagnoses. And these are issues that have not gone away. So studying medicine in another context can broaden our perspective to a wider array of issues and resensitize us to neglected aspects of healthcare. And third and finally, studying history generally puts us in contact with a plurality of people, many of whom seem quite strange to us. And our goal as historians

is to try to understand unfamiliar views and practices and to see them as reasonable given their context. So studying the past is an occasion to practice becoming comfortable with diversity and difference. And this is a skill that is directly transferable to the clinical context, where physicians encounter people with many different worldviews, priorities, values. And the best physicians are those who meet their patients where they're at and work with them as partners, what experts now call culturally competent healthcare. Amazing. Thank you so much. I love the idea of, did you say culturally competent? Meeting people where they're at. I mean, I suppose that must be harder and harder with things like the anti-vax movement, that people are going to need vaccinated. And if you meet them where they're at,

they're not going to get vaccinated. So I suppose that's going to be increasingly important, isn't it? And it's a problem that ancient physicians dealt with too. You had to convince them, you had to persuade them. And so those kinds of rhetorical strategies might come in handy today too. As long as anything is said by Morgan Freeman, people just do whatever that man wants. So what do you know now? and people will just do whatever that man wants. So what do you know now?

This is where we have our 60-second quickfire quiz for our comedian, Stu. So far, you are averaging better than perfect across two episodes because you've somehow managed to sneak bonus points. It's unsustainable. Let's not kid ourselves. You maybe peaked too soon, but you're up against Cariad Lloyd

in the Ultimate Series Champion here at the moment. So this is big stakes. Here we go. Question one. The Caduceus symbol used by some modern pharmacies is two snakes wrapped around a staff. But why snakes? Because they shed their skin

and that's like when you recover from an illness. Yes, it is. Very good. Question two. If I handed you a xylospungium in a Roman public toilet, what would you be doing with it? I would be watching other people wipe their bums and refusing to on the grounds of hygiene. Very sensible. Question three. Asclepius, whose name means to cut open,

was the Greek god of medicine. Name one of his two daughters. Hygieia or Hygieia or Panacea or Panacea goddess of medicine. Oh, look at you with your Greek alternatives. Goodness me, that's probably another bonus point. I think you might have snuck one in there. Question four. Which Greek physician is called the father of medicine and gave his name to an oath? Hippocrates.

It is Hippocrates. Question five. Which ancient physician tended to emperors and gladiators and popularised the humoral theory of opposites? Oh, Galen. Galen is correct. Question six. Medical writers thought that the imbalance of the four humours

could change people's moods. Name one of the four different temperaments. Oh, phlegmatic. Yes, that's right. You could have melancholic, choleric or sanguine as well. Question seven. Antiochus of Tlos was a skilled doctor in a city in Turkey. Why was her gig so cushy?

Can I pass and come back to it? Yes, okay. Question eight. How did Erasostratus, known as the father of neuroscience, learn about the nervous system? He stuck things in people's brains. He did. Yes, live people's brains.

Question nine. Asclepiodes had a motto of swiftly, safely, pleasantly. Give me a couple of his lovely remedies. Oh, electrochial up the bum. No, no, no. For rectal prolapse. No, he was a nice one. He was a massage, exercise, baths and wine. Question 10. According to Scribonius Largus, what was the shocking remedy for a headache?

Is that the, for a headache? Yeah, the electrochial. Electrochial, yep. Okay. And then I going to let you go back to your past from early on. Antaikos of Talos was a female physician in the city of Talos. Why was her job so financially lucrative? Because she was really good at it and everyone respected her. I can't remember. I don't know.

It's true, but no. It's because she was paid once as a sort of upkeep and then paid every time she treated someone. So she was paid twice, basically. So you got two questions wrong. Oh, mate. Two questions wrong, but you got a bonus point for Greek pronunciation options. So you got nine out of ten. Oh, thank you very much.

Thank you. You still did very well. What we've learned there, I think, is that Professor Upson-Sire is a very excellent teacher, but the Romans were too complicated in their naming and we should probably write them a strongly word letter. Do you have a lovely time learning about this stuff? I've had a wonderful time it's been as graphic as I was expecting. And listeners if you're in the mood to crack on with more classical civilizations why not check out our episode on the ancient olympics with Professor Michael Scott and Shappi Korsandi or if you want more of Stu Goldsmith

where you know where you can find that with the Jack Shepard and of course the lovely piracy episode the old black beard and remember if you've had a laugh, if you've learned some stuff, please do share the podcast with your friends or leave a review online and make sure to subscribe to You're Dead to Me on BBC Sounds so you never miss an episode. All that's left for me to say is a huge thank you to our guests. In History Corner, we've had the wonderful Professor Christy Upson-Sire from Occidental College. Thank you, Christy. Thanks so much for having me. It was great fun.

It was great fun. I learned a lot, but I also got to say anus quite a lot, actually, more than I thought I would. And of course, in Comedy Corner, we've had the stupendous Stu Goldsmith. Thank you, Stu. Anus for having me. Well, lovely listeners, join me next time as we promenade through the past with a brand new double act. But for now, I've got a bit of a headache, so I'm off to go and lick a torpedo fish. Bye! You're Dead to Me was a production by The Athletic for BBC Radio 4. The research was by Hannah McKenzie, the script was by Emma Naguse and me, the project manager was Isla Matthews, and the

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