The moral teaching of the Stoics, second only to that of the Christian religion, had an effect in preparing the way for the introduction of humane principles of treatment for the bond and the oppressed. But the Stoics, like many of the Christians, did not always make their actions accord with their principles. Seneca tells of a Stoic who amused himself by feeding his fish with pieces of his mutilated slaves. Juvenal, who wrote when Stoicism was at the height of its influence, asks "how a slave could be a man," and Gaius, the Stoical jurist, in the reign of Marcus Aurelius, classes slaves with animals.

Constantine, in his own character, did not display the beauties of the Christian religion, though his advisers who framed his laws acted under the influence of Christian teaching. This emperor passed laws in reference to slavery. He wrote to an archbishop: "It has pleased me for a long time to establish that, in the Christian Church, masters can give liberty to their slaves, provided they do it in presence of all the assembled people with the assistance of Christian priests, and provided that, in order to preserve the memory of the fact, some written document informs where they sign as parties or as witnesses." In pagan times there was a somewhat similar system of a master being able to redeem a slave and register the redemption in one of the temples.

The laws of Justinian, influenced largely by the teaching of Christianity, did a great deal to relieve the burdens of slavery. "We do not transfer persons from a free condition into a servile—we have so much at heart to raise slaves to liberty." In the words of one of the Early Fathers of the Church, "No Christian is a slave; those born again are all brothers."

Gladiatorial Games were condemned by the Stoics, but these philosophers did not influence the common people. Constantine, in the year before his acceptance of Christianity, gave a multitude of prisoners as prey to the wild beasts of the arena. In A.D. 325 he promulgated this law: "Bloody spectacles, in our present state of tranquillity and domestic peace, do not please us; wherefore we order that all gladiators be prohibited from carrying on their profession." Human sacrifices, which at one time took place in Rome, even in the time of Pliny and Seneca, were abolished under the same influence as checked gladiatorial sports.

Constantine passed laws against the licentious plays and spectacles which flourished in Greece and Rome in pagan times.

Seneca wrote: "Monstrous offspring we destroy; children too, if weak and unnaturally formed from birth, we drown. It is not anger, but reason, thus to separate the useless from the sound."[34] Julius Paulus, a Stoic, in the time of the Emperor Severus (A.D. 222), held that the mother who procured abortion, starved her child, or exposed it to die, was, in each case, equally guilty of murder. The Christian Fathers, in opposing these evils, were acting in accordance with the teaching of their founder, and they incessantly condemned these evil practices, and with greater and more far-reaching power than the Stoics. Although the Stoics anticipated many of the reforms of the Christians, Stoicism never had any penetrating effect on the masses of the people, and differed in this respect from Christianity. The chief obstacle to the prevention of the exposure of children was the great amount of pauperism which prevailed in the Roman Empire, and Christian emperors and councils had no choice but to allow many of these unfortunate children to be taken as slaves, rather than that they should perish from cold and hunger, or be torn by ravenous beasts. The pagan emperors, it is true, had done something to found orphanages, but these institutions were not common until the Middle Ages. Trajan in A.D. 100 supported 5,000 children at the expense of the State, and endowments were created by him for this purpose. Hadrian, Antoninus, and Marcus Aurelius made similar benefactions, and Pliny endowed a charity for poor children.

In the pre-Christian period, social clubs existed for the purpose of people having meals together, helping one another, and providing burial funds. The Emperor Julian condemned the Christians for supporting not only their own poor, but also poor strangers outside their faith. For ages the Church took charge of the poor. Her enemies said that as much pauperism was created as was relieved, and, no doubt, as is usual in the distribution of charity, the good done was not unmixed with evil.

HOSPITALS.

With reference to the important question of the foundation of hospitals, there are two opposing opinions—one, attributing their foundation almost entirely to Christianity,[35] and the other denying to Christianity any pre-eminent influence.[36] The truth lies between these two conflicting views, but nearer to the statement of Mr. Brace than of Mr. McCabe. The truths and influences of Christianity, in the mind of the latter author, are obscured by the many errors of the Church, especially in the Early and Middle Ages; and it is of the utmost importance to distinguish, where necessary, between the teaching of the Founder of Christianity as disclosed in the New Testament, and the teaching of the Church which made many very evident errors, and whose practice soon became different from that inculcated by its Founder, so that at times the Christianity of the Church was as different from Christ's teaching as the vine of Sodom from the grapes of Eshcol. The fact that Christianity emerged from this eclipse points to it as something more than a humanly devised system.

In very early times, the sick were allowed to remain at the temples for the treatment of their diseases, and medical students also attended for instruction. This system was the hospital system of later times, although the temples were not hospitals in the present sense of the word. The system in vogue in the temples of AEsculapius in Greece and Rome has already been described in this book, but the temples of Saturn served the same purpose in Egypt four thousand years before Christ. Professor Ebers of Leipzig, a high authority on the subject, says that Heliopolis undoubtedly had a clinique in connection with the temple. The Emperor Asoka founded many hospitals in Hindustan, and Buddhists and Mohammedans both possessed hospitals ("Encyclopaedia Britannica").

Patients were attracted to temples, not only by receiving the services of the priest-physicians, but also in the superstitious belief that special virtue attached to the precincts of sacred buildings. Thus, in the temples of AEsculapius, sick people tried to get as near to the altar as possible. "It may fairly be surmised that the disuse of these temples in Christian times made the necessity of hospitals more apparent, and so led to their institution, in much the same way as in this country the suppression of monasteries, which had largely relieved the indigent poor, made the necessity of poor laws immediately evident."[37] During Hadrian's reign the first notice of a military hospital appears.

The iatria, or tabernae medicae, described by Galen and others, were not for in-patients, but of the nature of dispensaries for the reception of out-patients. Seneca refers to valetudinaria, rooms set aside for the sick in large private houses. The first hospital in Rome in Christian times was founded by Fabiola, a wealthy lady, at the end of the fourth century. Attached to it was a convalescent home in the country. Pulcheria, later, built and endowed several hospitals at Constantinople, and these subsequently increased in number. Pauline abandoned wealth and social position and went to Jerusalem, and there established a hospital and sisterhood under the direction of St. Jerome. St. Augustine founded a hospital at Hippo. McCabe states justly: "In the new religious order a philanthropic heroism was evolved that was certainly new to Europe. In the whole story of Stoicism there is no figure like that of a Catherine of Sienna sucking the sores of a leper, or a Vincent de Paul." It appears evident that Christianity was an important factor in the foundation of hospitals and charitable institutions, not directly, but from its beneficent influence on the character of individuals; and the Roman Church, in this respect, acted in conformity with the teachings of the Christian faith.

Of greater importance is the consideration of the influence of Christianity, and of the Church, on the investigation and elimination of disease. In this matter the Church deserves the severest censure. It is no exaggeration to say that she hindered the scientific progress of the world for centuries. She applied to the explanation of the causation of disease, the demon theories inherited from Egypt, Persia, and the East. The Bible itself reflects the views on demonology current at the time of the events recorded. If demons were the cause of disease, logically the treatment of diseases should have been in the hands of priests, not of physicians. The priests held that they were the proper people to interpret the will of the Almighty; diseases were direct dispensations of Providence.

"It is demons," says Origen, "which produce famine, unfruitfulness, corruptions of the air, and pestilence. They hover concealed in clouds, in the lower atmosphere, and are attracted by the blood and incense which the heathen offer to them as gods."[38] "All diseases of Christians," wrote Augustine, "are to be ascribed to these demons: chiefly do they torment fresh-baptized Christians, yea! even the guiltless new-born infants." Hippocrates, long before the Christian era, wrote with great wisdom in reference to the so-called sacred diseases: "To me it appears that such affections are just as much divine as all others are, and that no one disease is either more divine or more human than another; but all are alike divine, for each has its own nature, and no one arises without a natural cause."[39]

The devil might be driven out in disgust, it was thought, by the use of disgusting materials—ordure, the grease made from executed criminals, the livers of toads, the blood of rats, and so on. The same belief in demoniacal possession led to the most inhuman treatment of lunatics, and the Church in this respect is put to shame when we compare its action with the wiser and more humane practice of the Moors. This belief helped to strangle medical progress for centuries, and is directly attributable to the Church. As late as 1583, the Jesuit fathers at Vienna boasted that they had cast out 12,642 devils. That God dispenses both health and disease is a very different belief from that involved in "demoniacal possession." Travellers in remote parts of the East at the present day tell of alleged cases of demoniacal possession, but investigation does not reveal any difference between these cases and epilepsy or acute mania.

In the first centuries of the Christian era men demanded overt signs of the favour of God, and the objects of veneration kept in the churches and monasteries were held to be capable of curing disease. The Latin Church had either a saint or a relic of a saint to cure nearly every ill that flesh is heir to. St. Apollonia was invoked against toothache; St. Avertin against lunacy; St. Benedict against stone; St. Clara against sore eyes; St. Herbert in hydrophobia; St. John in epilepsy; St. Maur in gout; St. Pernel in ague; St. Genevieve in fever; St. Sebastian in plague; St. Ottila for diseases of the head; St. Blazius for the neck; St. Laurence and St. Erasmus for the body; St. Rochus and St. John for diseases of the legs and feet. St. Margaret was invoked for diseases of children and the dangers of childbirth.

What the influence of Christ's life on earth on the medical art of His time was is a difficult question. It must be remembered that He came to save the souls and not the bodies of men, not to rapidly alter social conditions nor to teach science. The eternal life of man was the subject of transcendent importance, and it is no doubt true that many of the early Christians neglected their bodies for the cure of their souls. As against this, the gospel of love taught that all men are brothers, both bond and free, and this led to mutual help in physical suffering, and to the foundation of charitable institutions. In the times of persecution of the Christians many of them welcomed suffering and death as the portal to eternal bliss.

It has been asserted that the miraculous cures wrought by Christ for His own purposes were an intimation to His followers to neglect the ordinary means of natural cure, and that this placed a Christian doctor in the position of having to abandon his calling. This is not so. To St. Luke—a Christian physician and the writer of the third Gospel and the Acts of the Apostles—the performance by Christ of miracles of healing presented no difficulties, for he was the travelling medical adviser of St. Paul, and accompanied him on three journeys, from Troas to Philippi, from Philippi to Jerusalem, and from Caesarea to Rome (A.D. 62). St. Paul wrote: "For we would not, brethren, have you ignorant of our trouble which came to us in Asia, that we were pressed out of measure, above strength, insomuch that we despaired even of life, but we had the sentence of death in ourselves, that we should not trust in ourselves, but in God, which raiseth the dead: who delivered us from so great a death, and doth deliver: in whom we trust that He will yet deliver us." St. Paul exercised faith, but also used the means of cure prescribed by "the beloved physician." In a very scholarly book published by the Dublin University Press in 1882, the Rev. W. K. Hobart, LL.D., shows that St. Luke was acquainted with the technical medical terms of the Greek medical writers. St. Luke was an Asiatic Greek. Dr. Hobart writes: "Finally, it should not be left out of account that, in any illness from which he might be suffering, there was no one to whom St. Paul would be likely to apply with such confidence as to St. Luke, for it is probable that, in the whole extent of the Roman Empire, the only Christian physician at this time was St. Luke." In later years the pretence of performing miracles to cure diseases had a great effect in advancing superstition and retarding scientific investigation.

Tacitus and Suetonius record miracles alleged to have been performed by Vespasian. He is said to have anointed the eyes of a blind man at Alexandria with the royal spittle, and to have restored his sight. Another case was that of a man who had lost the use of his hands, and Vespasian touched them with his foot and thus restored their function. It is interesting to follow the career of Proclus, the last rector of the Neoplatonic School, "whose life," says Gibbon, "with that of his scholar Isidore, composed by two of their most learned disciples, exhibits a most deplorable picture of the second childhood of human reason." By long fasting and prayer Proclus pretended to possess the supernatural power of expelling all diseases.

The priests of the Church denounced the practice of Anatomy, and so changed the progress made by the Alexandrian School, and by men like Galen, into the ignorance of a thousand years. The body was the temple of the Holy Ghost, and should not therefore be desecrated by dissection. "Strangers' rests" and hospitals were connected with the monasteries, and were exceedingly useful, notably in the time of the Crusades, but these Church institutions were in a very insanitary condition, for the maxim that cleanliness is next to godliness had little application among the religious orders of the Middle Ages. Dr. Walsh attempts to show that the Reformers blackened the fair fame of the Church they had left, and states that it is to "this unfortunate state of affairs, and not real opposition on the part of the Popes to science," that we owe the belief in "the supposed opposition between the Church and Science."[40] That the Popes did something to foster medical science in a spasmodic kind of way, that papal physicians were appointed and that the Church exercised control over some seats of learning may be freely admitted. That the monasteries preserved some of the Latin classics that they were not all corrupt, and that all monks were not ignorant and idle, are facts beyond dispute. No doubt, too, the enemies of Christianity have overstated their case, but when all is said, the fact remains that the Church enjoyed great opportunities for promoting knowledge and investigating disease, and failed to avail itself of them to such an extent that for ages no real progress was made. This is certainly not an extreme opinion. It would be nearer the truth to say that not only was no progress made, but that the advances made by Hippocrates, by the school of Alexandria, by Celsus, and by Galen, were lost.

In conclusion, in spite of the dreadful blunders and perversions of the Church in the Early and Middle Ages, and the partial eclipse which Christianity suffered, the teaching of its Founder slowly but surely ended the harsh and cruel ways of the pagans, and was the prime factor in promoting the altruism of later times, of which medical knowledge and medical service form a very important part.

FOOTNOTES:

[33] "Gesta Christi; or a History of Human Progress under Christianity," by C. Loring Brace, fourth edition, pp. 33, 34.

[34] "De Ira," i, 15.

[35] Vide "Gesta Christi," Brace.

[36] Vide "The Bible in Europe," Joseph McCabe.

[37] "Smith's Dictionary of Greek and Roman Antiquity."

[38] Origen, "Contra Celsum," lib. vii.

[39] Adams's translation "Hippoc.," vol. i, p. 216.

[40] "The Popes and Science: The History of the Papal Relations to Science during the Middle Ages, and down to our own Time," J. J. Walsh, M.D., 1911.



CHAPTER XII.

GYMNASIA AND BATHS.

Gymnastics—Vitruvius—Opinions of Ancient Physicians on Gymnastics—The Athletes—The Baths—Description of Baths at Pompeii—Thermae—Baths of Caracalla.

GYMNASTICS.

Gymnastics were held in such high repute in ancient Greece that physical training occupied as much time in the education of boys as all their other studies, and was continued through life with modifications to suit the altering requirements of age and occupation. The Greeks fully recognized that mental culture could not reach its highest perfection if the development of the body were neglected. Lucian attributes not only the bodily grace of the Ancient Greeks, but also their mental pre-eminence, to the gymnastic exercises which they practised. They were also an important factor in the excellence of Greek sculpture, and probably the most important part of their medical treatment.

Unfortunately the baths of the Romans and the gymnasia of the Greeks became in time the haunts of the lazy and voluptuous. The gymnastic exercises of the Greeks date from very early times, and at first were of a warlike nature, and not reduced to a system. Each town possessed a gymnasium, and three very important ones were situated at Athens.

Vitruvius describes the general plan of an ancient gymnasium. It comprised a great stadium capable of accommodating a vast concourse of spectators, many porticoes where athletes exercised and philosophers and sages held discussions and lectured, walks and shady groves, and baths and anointing rooms. The buildings, in true Grecian fashion, were made very beautiful, being adorned with statues and works of art, and situated in pleasant surroundings.

Up to the age of 16 boys were instructed in gymnastics, in music and in grammar, and from 16 to 18 in gymnastics alone. The laws of Solon regulated the use of the gymnasia, and for very many years these laws were strictly enforced. It appears that married women did not attend the gymnasia, and unmarried women only in some parts of Greece, such as Sparta, but this custom was relaxed in later years.

The office of Gymnasiarch (Superintendent of Gymnasia) was one of great honour, but involved also a great deal of expense to the holder of the office. He wore a purple cloak and white shoes. Officers were appointed to supervise the morals and conduct of the boys and youths, and the Gymnasiarch had power to expel people whose teaching or example might be injurious to the young.

Galen relates that the chief teachers of the gymnasia were capable of prescribing suitable exercises, and thus had powers of medical supervision.

Before exercises were commenced, the body was anointed, and fine sand or dust applied. Regulation of the diet was considered of very great importance.

The games of the gymnasia were many and various, including games of ball, tug-of-war, top-spinning, and a game in which five stones were placed on the back of the hand, thrown upwards, and caught in the palm. One kind of game or exercise consisted in throwing a rope over a high post, when two boys took the ends of the rope, one boy on each side, the one trying to pull the other up. The most important exercises, however, were running, walking, throwing the discus, jumping, wrestling, boxing, and dancing.

The first public gymnasium in Rome was built by the Emperor Nero. In the time of the Republic Greek exercises were held in contempt by the Romans, and the first gymnasia in Rome were small, and connected only with private houses or villas.

The gymnasia were dedicated to Apollo, the god of healing, and exercises were considered of greater importance for restoring health than medicinal treatment. The directors of the gymnasia were in reality physicians, and acted as such. Plato states that one of these, Iccus by name, was the inventor of medical gymnastics. As in our own day, many creditable gymnasts, originally weak of body, had perfected their strength by systematic exercise and careful dieting.

Hippocrates had occasion to protest against prolonged and laborious exercises, and excessive massage, and recommended his own system, that of moderation. He applied massage to reduce swellings in suitable cases, and also recognized that the same treatment was capable of increasing nutrition, and of producing increased growth and development. Hippocrates described exercises of the kind now known as Swedish, consisting of free movements without resistance.

Galen generally followed the teaching of Hippocrates on gymnastics, and wrote a whole book on the merits of using the strigil. Oribasius, and Antyllus, too, in their writings, recommend special exercises which appealed to their judgment.

The ancient physicians had great faith in the efficacy of exercises in cases of dropsy, and Asclepiades employed this method of treatment very extensively, using also pleasant medicaments, so that Pliny said "this physician made himself the delight of mankind." Patients suffering from consumption were commonly sent to Alexandria to benefit from the climate, but Celsus considered the sea voyage most beneficial because the patient was exercised bodily by the motion of the ship. Germanicus was cured by riding exercise, and Cicero was strengthened by travelling and massage.

From the writings of Greek and Roman physicians there is no other conclusion to be drawn but that exercises and gymnastics were in great vogue for medical purposes, and were of the utmost benefit. It seems likely that the exercises of the Greeks, and the baths of the Romans, both freed from the abuses which took away in time from their merits, could be adopted at the present day and encouraged by physicians with great advantage to their patients. There is a strong tendency at present in that direction.

Belonging to a different class were the contests of the athletes, who, except in very early times in Greece, were people of the baser sort whose bodies were developed to the neglect of their minds. Those who underwent the severest training ate enormous quantities of meat, and tried to cultivate bulk and weight rather than strength. They did not compete, as a rule, after the age of thirty-five years. Euripides considered these athletes an encumbrance on the State. Plato said they were very subject to disease, without grace of manner, violent, and brutal. Aristotle declared that the athletes had not the active vigour that good citizens ought to possess.

The athletes and gladiators of Rome were mostly Greeks. Both Plutarch and Galen deride them. The former condemned the whole business, and Galen wrote six chapters to warn young men against becoming athletes. He said that man is linked to the divine and also to the lower animals, that the link with animals was developed by athletics, and that athletes were immoderate in eating, sleeping, and exertion, and were therefore unhealthy, and more liable than other people to disease and sudden death. Their brutal strength was of use only on rare occasions and unsuited for war, or for useful work.

In the time of St. Paul, the athletes were evidently abstemious, for he wrote "every man who striveth in the games is temperate in all things," but in Rome, at most periods of their history this class of men was notorious for grossness and brutality.

BATHS (Balneae).

Greek Baths.—In Greece from very early times inability to read and to swim were considered the marks of the ignorant. In Homer's time over-indulgence in warm baths was considered effeminate.[41] The system of bathing was never so complete in Greece as in Rome, but in the former country there were both public and private baths, and ancient Greek vases display pictures of swimming-baths and shower-baths, and also of large basins for men and for women round which they stood to bathe. The Greek baths were near the gymnasia. After the bath, the bathers were anointed with oil and took refreshments. Sometimes a material consisting of a lye made of lime or wood-ashes, of nitrum and of fuller's earth was applied to the body. Towels and strigils were employed for rubbing and scraping after the anointing; the strigil was, as a rule, made of iron.

Natural warm springs used for curative purposes are mentioned by ancient Greek writers.

Roman Baths.—Bathing, which was not much in vogue in Rome in the most ancient times, was more common during the Republic, and became a factor in the decay of the nation in the time of the Empire. Seneca informs us that the ancient Romans washed their arms and legs every day and their whole bodies once a week. The bath-room was near the kitchen in the Roman house, to be convenient for the supply of hot water. Scipio's bath was "small and dark after the manner of the ancients." In the time of Cicero, the use of baths, both public and private, was general, and hot-water and hot-air baths are both mentioned. It has been computed that there were 856 baths in Rome in the time of Constantine.

The public baths were at first used only by the poor, but the mother of Augustus went to the public bath, and in time even the emperors patronized them. The baths were opened at sunrise and closed at sunset except in the time of Alexander Severus, when they were open also at night. The charges for admission were very low. The ringing of a bell announced that the bath was ready. Baths were taken seven or eight times in succession when the people were given to luxury, and some of them wasted almost the whole day there. The voluptuaries of the Empire bathed not only before the principal meal of the day, but also afterwards to promote digestion as they thought. The perspiration induced by the bath took the place of honest sweat induced by work or exercise, and excessive hot-bathing and perspiring in some cases had a fatal ending.

Galen and Celsus differ in their directions to bathers. Galen recommended first the hot-air bath, next the hot-water bath, then the cold bath and finally rubbing; Celsus recommended sweating first in the tepid chamber, then in the hot chamber, and next the pouring of hot, then tepid, and lastly, cold water over the head, followed by the use of the strigil, and anointing and rubbing.

The plan of the baths at Pompeii, which was largely a pleasure resort, is typical of the public baths that were in general use. These baths had several entrances, and the principal one led to a covered portico from which a lavatory opened. The portico ran round three sides of a courtyard (atrium) in which the attendants waited, and it was also the exercise-yard for the young men. Advertisements of the theatres and gladiatorial shows were exhibited on the walls of the atrium. The undressing room was also the reception room and meeting-place. The bathers' garments were handed over for custody to slaves, who were, as a general rule, a very dishonest class. The frigidarium contained a cold bath 13 ft. 8 in. in diameter, and a little less than 4 ft. deep. It had two marble steps, and a seat under water 10 in. from the bottom. Water ran into the bath through a bronze spout, and there was a conduit for the outflow, and an overflow pipe. The frigidarium opened into the tepidarium which was heated with hot air from furnaces, and furnished with a charcoal brazier and benches. The brazier at Pompeii was 7 ft. long and 2-1/2 ft. broad. The tepidarium was commonly a beautifully ornamented apartment, while the anointing-room was conveniently situated off it. Pliny has described the various unguents used by wealthy and luxurious Romans. From the tepidarium the bather might enter the caldarium or sweating room, an apartment constructed with double walls and floor, between which hot air was made to pass. This room contained a labrum, or circular marble basin, containing cold water for pouring over the head before the bather left the caldarium. The method of heating rooms by passing hot air between the "hanging" and the lower floor was in use in the better class of houses, and the device can at present be seen in some of the buildings on the Palatine Hill in Rome, and in the ruins of the great Baths of Caracalla. After a course of sweating the bather had the sweat removed from his body by the strigil, in much the same way as a horse is scraped with a bent piece of hoop-iron by a groom. The guttus was a small vessel with a narrow neck adapted for dropping oil on the strigil to lubricate its working edge. Pliny states that invalids used sponges instead of strigils. Rubbing with towels followed the use of the strigil, and the bather finally lounged in the tepidarium for a varying period before entering the outer air.

The boilers in use at Pompeii were three in number. The lowest one, immediately over the furnace, contained the hottest water. The next above and a short distance to the side held tepid water, and the farthest removed contained cold water. This system was economical because as the very hot water was drawn off from the lowest boiler a supply of tepid water flowed down from the boiler next above, and from the highest to the middle boiler.

A smaller suite of bathing apartments adjoining the men's establishment was for the use of women.

The most important baths formed only a part of the great establishments called thermae. Adjoining the baths of the thermae were a gymnasium for sports and exercises, a library for the studious, lounging places for the idle, halls for poets and philosophers, in which they declaimed and lectured, museums of art, and sometimes shady groves. These complete establishments were first erected by Marcus Agrippa in the time of Augustus. Succeeding emperors vied with each other in providing magnificent thermae, and the ruins of the Baths of Caracalla remain in a wonderful state of preservation to this day. The building of these baths began in A.D. 216. The structure, 1,050 ft. long and 1,390 ft. broad, was on a scale of almost incredible magnificence. Priceless statues and rare objects of art have been unearthed from the ruins. In recent years excavations have revealed a complicated system of subterranean corridors and galleries which existed for the purpose of carrying leaden water-pipes to the baths, and providing a passage-way for the host of slaves who acted as bath-attendants. The great buildings were well lit by windows in the walls of the courtyards, and these openings also allowed for ventilation. A great stadium and beautiful gardens adjoined the Baths of Caracalla. In the north-west section of these baths Alessio Valle has very recently discovered the remains of a great public library. When Caracalla pillaged Alexandria he probably carried off many of the books from the famous library there to enrich his baths. The ruins of the library in the Baths of Caracalla reveal circular tiers of galleries for the display of manuscripts and papyri. There were 500 rooms round these baths. The great hall had a ceiling made in one span, and the roof was an early example of reinforced concrete, for it was made of concrete in which bronze bars were laid. The lead for the water-pipes was probably brought from Cornwall.

The Thermae of Diocletian could accommodate 3,200 bathers. Its tepidarium was 300 ft. long by nearly 100 ft. wide, "vaulted in three bays with simple quadripartite groining, which springs from eight monolithic columns of Egyptian granite about 50 ft. high and 5 ft. in diameter" (Middleton).

From the medical point of view, these great bathing institutions were capable of being used for the treatment of various diseases, and for physical culture. No doubt, they were extensively employed for these purposes and with good results, but their legitimate use became increasingly limited, and abuse of them was a prime factor in promoting national decay. To show to what an extent luxurious bathing was carried in some instances, it is interesting to read that baths were taken sometimes in warm perfumes, in saffron oil, and that the voluptuous Poppaea soothed her skin in baths of milk drawn from a herd of 500 she-asses.

FOOTNOTES:

[41] Od. viii, 249.



CHAPTER XIII.

SANITATION.

Water-supply—Its extent—The Aqueducts—Distribution in city—Drainage—Disposal of the Dead—Cremation and Burial—Catacombs—Public Health Regulations.

THE WATER-SUPPLY.

In ancient Greece, the cities were supplied with water from springs over which beautiful fountains were erected. The Greek aqueducts were not on the same grand scale as the Roman, but were usually rectangular channels cut in the rock, or made of pipes or masonry. Great care was taken in the supervision of these public works.

The first Roman aqueduct, according to Frontinus, dates from 312 B.C.

Pliny wrote of the Claudian aqueduct: "But if anyone will carefully calculate the quantity of the public supply of water, for baths, reservoirs, houses, trenches, gardens and suburban villas, and, along the distance which it traverses, the arches built, the mountains perforated, the valleys levelled, he will confess that there never was anything more wonderful in the whole world."

Frontinus, who was controller of the aqueducts in the time of Nerva and of Trajan, describes nine aqueducts, of which four belonged to the days of the Republic, and five to the reigns of Augustus and Claudius.

"The total water-supply of Rome has been estimated at 332,306,624 gallons a day, or, taking the population at a million, 332 gallons a head. Forty gallons a day is now considered sufficient."[42]

The ancient Aqua Virgo at the present day supplies the magnificent Fontana di Trevi, and the glorious fountains in the Piazzo di Spagna and the Piazzo Navona.

The Romans not only provided great aqueducts for the Imperial City, but also built them throughout various parts of the Empire. In Rome, the aqueducts were built to supply both the low and the high levels of the city. The reason why the Romans did not build underground aqueducts, as is done at the present day, has been variously explained. Perhaps they did not fully understand that water will find its own level over a great distance. They also would have found great difficulty in overcoming the high pressure of the water.

In their conduits they built shafts at frequent intervals designed to relieve the pressure of compressed air in the pipes. The water from the neighbourhood of Rome rapidly encrusted channels and pipes with calcareous deposits. Probably the great advantage of accessibility to leaks and defects gained by building unenclosed aqueducts appealed strongly to the ancient Romans. They did not fully understand the technical difficulties involved in the "hydraulic mean gradient." No machinery was used to pump the water or raise it to an artificial level. A strip of land 15 ft. wide was left on either side of the aqueducts, and this land was defined at intervals by boundary stones. No trees were grown near the aqueduct, to avoid the risk of injuring the foundations, and any breach of the rules for the preservation of the aqueducts was severely punished by fines.

Vitruvius gives rules for testing the water, and points out that water led through earthen pipes is more wholesome than water coming from leaden ones. He states that the "fall" of an aqueduct should be not less than 1 in 200. A circuit was often made to prevent the too rapid flow of the water, and intermediate reservoirs were constructed to avoid a shortage of water in the case of a broken main. Reservoirs were also used for irrigation.

The water from the aqueduct was received at the walls of the city in a great reservoir called castellum aquarum, externally a beautiful building and internally a vast chamber lined with hard cement and covered with a vaulted roof supported on pillars. The water flowed thence into three smaller reservoirs, the middle one filled by the overflow of the two outer ones. The outer reservoirs supplied the public baths and private houses, while the middle one supplied the public ponds and fountains, so that, in the event of a shortage of water, the first supply to fail was the least important. The amount of water provided for private use could be checked, for purposes of revenue, by means of this arrangement.

At first the aqueducts were not connected with private houses, but, later, private persons were allowed to buy the water which escaped from leaks in the aqueducts. Next, private connections were made with the public mains, and, finally, reservoirs were built at the expense of adjoining households, but these reservoirs, although built with private money, were considered part of the public property. Water rights were renewed with each change of occupant. The water-supply to a house was measured by the size of the pipe through which it passed at the in-flow and at the out-flow of the reservoir.

The curatores aquarum had very responsible duties. Under their orders, in the time of Trajan, were 460 slaves who were subdivided into various classes, each of which had its own particular duties to perform in connection with the maintenance and control of the water-supply. A supply of pure water and proper drainage are of first importance in sanitation, and it is evident that the Romans understood these matters well.

DRAINAGE.

The drains of Athens, built of brick and stone and provided with air-shafts, ran into a basin from which pipes carried the sewage beneath the surrounding plain which it helped to fertilize.

The chief drain of Rome was the Cloaca Maxima, and there was a great network of smaller drains. The privy in private houses was usually situated near the kitchen, and a common drain from the kitchen and the privy discharged into the public cloaca. A pipe opened just above the floor of the closet to supply water for flushing. Ruins of very small rooms have been discovered in the Via Sacra of the Roman Forum, and it has puzzled archaeologists to discover their use, but they are thought to have been sanitary closets. The sewers of Rome drained into the Tiber.

DISPOSAL OF THE DEAD.

Both in Greece and Rome earth-burial and cremation were employed for the disposal of the dead. Near the Temple of Faustina in the Roman Forum, under the Via Sacra, have been found the graves of some of the dwellers of the hills before Romulus founded the city. In Rome, burial within the city was forbidden from the time of the Twelve Tables. Exceptions were made in the case of emperors, vestal virgins, and famous men, such as those who had been honoured with triumphs. The large cemetery for the poor lay on the east side of the city and the tombs of the rich were along the roadsides. The remains of some of these can now be seen along the Appian Way. One of these tombs is the Tomb of the Scipios, which, as Byron wrote, "contains no ashes now." Near the Tomb of the Scipios can be seen a door with high steps which leads to the columbaria. These are little rooms provided with pigeon-holes for the reception of the ashes of the freedmen of notabilities. Inscriptions show that some of these freedmen were physicians, and others musicians and silversmiths. The shops of the perfumers stood in a part of the Forum on the Via Sacra. Perfumes were much used at incinerations to disguise the smell of decomposition before the fires were kindled. The Christians opposed cremation and favoured earth burial, and in time the business of the perfume-sellers failed, and Constantine bought their shops.

The Catacombs were used almost entirely by the Christians. If all the passages of the Catacombs could be placed in line, it is said that they would extend the whole length of Italy. They were hewn out of volcanic soil very well suited for the purpose, and were probably extensions, in the first place, of quarries made for the purpose of obtaining building cement. They were used by the Christians, not only for the religious rite of burial, but also as secluded meeting places. The bodies were laid in loculi, sometimes in two or three tiers, the loculi being filled in with earth and stone.

Many of our public health regulations had their counterpart in ancient times, for instance, any factory or workshop in Rome which created a public nuisance had to be removed outside the city. The spoliarium of the Coliseum was an ancient morgue.

A detached building or room, valetudinarium, was provided in large houses for sick slaves. This was for the purpose of preventing infection as well as for convenient attendance on the sick.

FOOTNOTES:

[42] "Dict. of Gr. and Rom. Antiq.," Smith, vol. i, p. 150, to which the author is indebted for much of the information herein supplied.



APPENDIX.

FEES IN ANCIENT TIMES.

The professional incomes of doctors in ancient Greece and Rome varied greatly as at the present day. A few were paid very large fees, but the rank and file did not make more money than was equal to keeping them in decency.

Seleucus paid Erasistratus about L20,000 for curing his son Antiochus. Herodotus mentions that the AEginetans (532 B.C.) paid Democedes, from the public treasury, L304 a year; the Athenians afterwards paid him L406 a year, and at Samos he received L422 yearly. Pliny says that Albutius, Arruntius, Calpetanus, Cassius and Rubrius each made close upon L2,000 a year, and that Quintus Stertinius favoured the Emperor by accepting about L4,000 a year when he could have made more in private practice. The surgeon Alcon made a fortune of nearly L100,000 by a few years' practice in Gaul. Pliny states that Manlius Cornutus paid his doctor L2,000 for curing him of a skin disease, and Galen's fee for curing the wife of a consul was about L400 of our money.



INDEX.

Academics, 56

Adamantius, 116

Adams of Banchory, 31, 32, 124

AEsculapius, 3, 13, 14 ——, College of, 6 ——, temple of, 4, 14, 17

AEtius, 118

Agathinus, 87

Agrippa, 63

Alexander of Tralles, 119

Alexander the Great, 38, 40, 41

Alexandria, 42

Alexandrian School, 42

Anatomy, 27, 44, 46, 76, 101, 140

Andromachus, 68, 82

Antonius Musa, 65

Antyllus, 112

Apollo, 3, 13

Apollonius, 80 ——, alleged miracles of, 81

Aqueducts, 9, 155

Archagathus, 5

Archiater, 6, 68

Archigenes, 88

Aretaeus, 87

Aristotle, 25, 40

Asclepiadae, 18, 40, 44

Asclepiades of Prusa, 23, 51, 146

Asklepieion of Cos, 19

Astrology, 68

Athenaeus, 86

Athletes, 147

Augustus, 63

Aurelianus, 91

Baths, Greek, 148 ——, Roman, 149

Baths of Caracalla, 44, 153 —— at Pompeii, 152

Byzantine Period, 111

Cabalists, 128

Caelius Aurelianus, 91

Caesar, Julius, 44, 54, 55

Caligula, 67

Caracalla, 44, 153

Cassius Felix, 89

Catacombs, 160

Cato the Elder, 7, 8

Celsus, 48, 72 ——, works of, 73

Christ, miracles of, 138

Christianity, 128 —— and hospitals, 133

Chrysippos, 46

Claudius, 67

Cleombrotus, 46

Cloaca Maxima, 8, 159

Cnidos, 17, 44, 50

Constantine, 130

Cornelius Agrippa, 1

Cos, 17, 44

Cremation, 159

Decline of Healing Art, 111 —— of Rome, 111

Democedes, 22

Democritus, 23, 25

Demon Theories of Disease, 136

Dietetics, 32, 103

Dioscorides, 88

Disposal of the dead, 159

Dogmatic School, 23

Drainage, 159

Drug-sellers, 59

Eclectics, 87

Elements, the four, 39

Empirics, 23

Empiricism, 23, 48

Epicureans, 56

Erasistratus, 45, 47

Essenes, 45, 127

Euclid, 43

Eudemus, 79

Fabiola, 135

Fees, 162

Galen, 96, 146 ——, influence of, 110 ——, works of, 99

Gibbon, 10, 56, 120, 140

Gladiatorial games, 130

Gladiators, 147

Gnostics, 128

Gods of disease, 3 ——, of healing, 3, 15

Gorgias, 25

Gymnasia, 19, 145

Gymnastics, 143 ——, inventor of medical, 146 ——, opinions of physicians on, 146

Gymnasiarch, 20, 144

Gynaecology, 31, 93, 107

Heliodorus, 91

Herodicus, 25

Herodotus, 22, 91

Herophilus, 45, 46

Hippocrates, 7, 25, 146 ——, sons of, 37 ——, works of, 26

Hippocratic Law, 33 ——, Oath, 35

Homer, 15, 16, 148

Horatillavus, 61

Hospitals, 133 ——, founders of, 135

Hygeia, 15

Iccus, 146

Jacobus Psychristus, 116

Justinian, 130

Lectisternium, 3

Leucippus, 23

Library of Alexandria, 43

Livy, 2, 4

Machaon, 16, 17

Maecenas, 66

Magnus, 116

Marinus, 95

Meges of Sidon, 79

Melampus, 15

Meletius, 116

Methodism, 23, 51, 54

Miracles of Apollonius, 80 ——, of Christ, 138 ——, of Vespasian, 140

Mithridates, 45

Mithridaticum, 45

Monastic medicine, 137

Moschion, 123

Nemesius, 116

Neoplatonism, 112

Nero, 67, 69, 70

Nerva, 81

Numa Pompilius, 2

Obstetrics, 31, 93

Octavianus, 55

Oculists, 70

Operations, 29, 30, 78, 113 ——, dental, 2

Oribasius, 87, 93, 114

Orphanages, 132

Ovid, 24

Pathology, 104

Paulus AEgineta, 94, 113, 124

Period, anatomic, 21, 45 ——, philosophic, 21 ——, primitive, 20 ——, sacred, 21

Pestilence in Rome, 89

Philinus of Cos, 48

Philosophy, 56

Plague, 4, 120

Plato, 25, 39

Platonists, 56

Pliny, 3, 52, 65, 72, 84, 146

Plutarch, 5, 7

Pneumatism, 86

Podalarius, 16

Poisoners, women, 70

Priest-physicians, 1, 134

Priests, 18

Proclus, 140

Ptolemy, 43

Public health regulations, 161

Pythagoras, 21

Pythagoreans, 22

Quacks, 58, 61

Quintus, 95

Rhodes, 17

Roman quacks, 58, 61

Rome, 56 ——, medical practice in, 58

Rufus of Ephesus, 94

Saints, 138

St. Luke, 139

St. Paul, 139, 148

Sanitation, 8, 155

Sceptics, 24

Scribonius largus, 82

Seneca, 67, 131

Serapion, 50

Serpents, 14

Sewers, 8, 9, 159

Slave-physicians, 60

Slaves, 60

Soranus, 92

Stoics, 56, 129

Suetonius, 140

Surgery, 30, 73, 107

Surgical instruments, 90

Tacitus, 140

Temple of AEsculapius, 4, 14, 17

Temples, 3, 4, 17

Themison of Laodicea, 23, 53, 54

Theophrastus, 42

Theriaca, 98

Thermae, 152

Thessalus of Tralles, 83

Thrasyllus, 66

Tiberius, 66

Vettius Valleus, 82

Vitruvius, 144, 157

Water supply, 63, 155

Women poisoners, 70

Wounds of Julius Caesar, 55

Transcriber's Notes & Errata All SmallCaps text has been changed to ALLCAPS. Scanning errors One missing footnote label has been inserted One instance of 'o' has been changed to 'of'. Typographical errors One extra ending double quote has been removed. One instance of 'he' has been changed to 'He'. Hyphenation 'out-flow' and 'outflow' have been used once each in the text.

THE END