You're Dead to Me - Ancient Greek & Roman Medicine (Radio Edit)

Episode Date: January 14, 2023

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 and water could be dangerous. 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.For the full-length version of this episode, please look further back in the feed.Produced by Cornelius Mendez Script by Greg Jenner and Emma Nagouse Research by Hannah MacKenzieA production by The Athletic for BBC Radio 4.

This is the BBC. This podcast is supported by advertising outside the UK. BBC Sounds. Music, radio, podcasts. Hello and welcome to You're Dead to Me, the comedy podcast that takes history seriously. My name is Greg Jenner. I'm a public historian, author and broadcaster. And 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. And today, we are grabbing our scalpel and forceps to journey back to ancient Greece and Rome to learn all about medicine in the classical world. And to help me diagnose fact from fiction,

I'm joined by two very special guests. In History Corner, she's 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. Hello, Christy. Thank you for coming. Hi, thanks for having me. Lovely to be here.

And in Comedy Corner, he's a stand-up comedian, the host of one of my all-time favourite podcasts, The Comedian's Comedian, as well as other podcasts. And of course, you'll remember him from other episodes of You're Dead to Me, Blackbeard the Pirate, Jack Shepard and fandom. It's 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. This time, 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. Mostly scraping and poking. I'm also kind of on tenterhooks, hoping that there isn't going to be anything quite so visually arresting. 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? 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. 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? 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 orator, 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. People were unwell most of the time and health was a state they only fleetingly experienced. 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 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 sort of stinking. The 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. 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 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. As well as the occupancy problem of dense cities,

we also have the kind of sanitation problem. 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 civilization was so advanced, oh, we have the finest stuff in coming. 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. 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. How do you go to a temple dedicated to him? And what's

the process of getting better? 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. 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. 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 hoped 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. You wake up in the morning and you're not better. Does that mean the gods have

failed you? No, it means you have to go and do some work. So usually 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 exercise was prescribed. I mean, it really was a treatment plan, wasn't it? Yes. So presumably if you're the doctor or the kind of the pharmacist, 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. I love it. Actually, at the Asclepian Temple in Pergamum in modern day Turkey, when you enter into the temple, 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. I may not know much about medicine, but I admire a hustle when I see one. But at the same time as we have those priests and those temples, we also get the rise of professional medicine. And the most

important in the Greek world is probably Hippocrates of Kos, born around two and a half thousand years ago. 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, 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. I can taste what's wrong with you. 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. 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. 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. 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 but Stu I'm going to ask

you about what you think the four humours might have been. Four humours I guess are going to be slapstick, prop gags, one-liners and shaggy dog stories and I want to say bilge, but I think I'm conflating bile and phlegm. Christy, do you want to put him out of his misery? Yeah. So ancient folks thought that the body was made up of four different substances. Blood, phlegm, black bile and yellow bile. So two different kinds of bile. 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. 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? 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. 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. We've mentioned Galen there, 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. 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. Just like, your atoms are too loose. You need to tighten up. 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? Yeah, it does sound like a kind of, yeah, we'll get you there. We'll get you there safely.

Very literally. 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. 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? 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 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. I'm not having the puppy one. That's nonsense. So electric eel for headaches. That could work, isn't it? In a kind of an electroconvulsive kind of... Certainly it'd take your mind off the headache. Epilepsy. Would they have diagnosed epilepsy?

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. Okay. Even the puppy. Puppy is true. It's really fun. 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 the word pharmacon, from where we get the word pharmacy, meant in Greek. Both drug 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. We have a thriving drug trade in the ancient world as well, with pharmacologists setting up shops and stalls in local marketplaces. 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. 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. 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. 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 centres. 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. You could just lie if you wanted to. Patients really had to rely on word of mouth reputation. There presumably would have been some doctors who, Galen, for example, he worked in Rome, right? 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. 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. 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. 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. 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. 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.

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 Tlos, 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. Asclepides, who we were talking about a moment ago, and Galen both cite her remedies. 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. We now have to get on to the somewhat strange concept of the wandering womb. The idea here is that women's bodies are different to men's in very profound ways.

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 medical writers thought that because women were colder than men they didn't possess the heat necessary to digest food. 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. And one of the remedies for menstrual problem or the wandering womb was to have sex. Now, Stu, we have promised you beaver bums. 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? 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? 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. 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 erateus 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 beavers. And fun fact, also used in modern vanilla flavorings. 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 Castoreum in it. 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. So part of the training to be a Roman surgeon was presumably to just ignore the screaming. 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. And we get hospitals. 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. It's now time for my favorite part of the show, which is called the nuance window, which is this is where we, Stu and I have a little have a little, well, I suppose a convalescence perhaps. And we allow our expert, Professor Christie, 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 and 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. Absolutely. And on that note, I'm afraid that is all we have time for today. A huge thank you to our guests in History Corner, the outstanding Professor Christy Upson-Sire from Occidental College in LA, and in Comedy Corner, the stupendous Upson-Sire from Occidental College in LA, and in Comedy Corner, the stupendous Stu Goldsmith. And to you, lovely listener, 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! My name is Jonathan Myerson, and two years ago we produced Nuremberg, a dramatized reconstruction of the trial of the major Nazi war criminals. Their crimes were indisputable, but one mystery remained. How did this group of unremarkable men come to rule all of Germany? Our new podcast, Nazis, The Road to Power, unravels this improbable story in 16 episodes, starring Tom Mothersdale, Derek Jacoby, Alexander Vlahos, Toby Stevens, and Laura Donnelly.

It remains a lesson for us all. Listen wherever you get your podcasts.