by his general Ptolemy, the seat of medical research moved
to this new city on the Mediterranean coast, which attracted
scholars and physicians from all over the Greek world. Fa-
mous Alexandrian medical scholars include Herophilus, who
lived in the early third century b.c.e. Herophilus investigated
the eye and brain and deduced the usefulness of the pulse
in the diagnosis of disease. His written work on the topic of
dissection (which has not survived) described his study of
human anatomy. A contemporary of Herophilus, Erasistra-
tus, made a famous study of the brain, nerves, arteries, and
veins and went further than Herophilus in understanding the
structure of the brain and the nervous system.
Th e theory of the humors was further advanced by Ga-
len, a physician of Pergamum (129–200 c.e.) in Asia Minor,
who was renowned for his public dissection of pigs, apes,
dogs, and goats. His works include On the Elements according
to Hippocrates and a work in 17 volumes, On the Usefulness of
the Parts of the Body. Galen explored the nervous system and
the spinal cord, demonstrated the function of the veins and
arteries, and showed that urine originated in the kidneys. Ga-
len’s works circulated widely in the Arab-speaking and Per-
sian-speaking world as well as in Europe, where physicians
relied on his theories and practices for the next 1,500 years.ROME
BY BROOKE HOLMES
Th e Romans considered health to be both a private and a
public aff air. Th e majority of responsibility for maintaining
health rested with the individual and the family, and patients
had access to a range of options in their pursuit of health, de-
pending on their location and their resources. Th e health of
the populace also benefi ted from the construction and main-
tenance of public aqueducts, sewers, latrines, and baths. Of-
fi cial interest in public health, however, was largely restricted
to the army.
Life was precarious in the ancient Roman world. Th e av-
erage life expectancy at birth was about 25 years of age, and
infant mortality rates were high. Th e risk of death remained
serious during the child’s fi rst year, although those who sur-
vived had better odds thereaft er, with a life expectancy ex-
tended into their thirties and forties. Th e analysis of skeletal
remains has shown that environmental and demographic
factors determined the unique disease profi les of individual
settlements. Dental health, for example, could be aff ected by
fl uoride levels in the water, and low-lying areas were prone
to malaria. Poor sanitation, particularly in the overcrowded
areas of Rome, fostered the spread of ailments such as diar-
rhea, pneumonia, jaundice, parasites (such as tapeworm), and
infections of the liver, bladder, and kidney.
Malnutrition, caused by an irregular food supply, posed
a serious threat everywhere, aff ecting poor women and chil-
dren particularly hard. Childbirth, too, exacted a heavy toll
on women. For Romans who survived past their twenties, de-
generative diseases such as arthritis would have made later
life diffi cult and painful, and chronic pain was a problem at
any age, especially for slaves and free laborers. Roman rem-
edies are considered largely ineff ective by modern standards,
though they may have had a placebo eff ect. Patients may have
improved because of their positive expectations rather than
as a result of the remedies themselves.
In the early Roman Republic, the health of the house-
hold, both free persons and slaves, was overseen by the
paterfamilias, the male head of the family. Th e remedies rec-
ommended by Cato the Elder (234–149 b.c.e.), who wrote in
this tradition, are primarily herbal and magical, drawn from
Italic folk medicine. Cato saw medicine as an internal aff air
that did not require professional expertise. He was writing,
however, at a time when Romans were becoming Hellenized,
that is, more Greek, following their military conquests across
the Mediterranean and the infl ux of Greek ideas, goods, andIvory fi gure of a hunchback thought to show signs of Pott’s disease,
Hellenistic, about fi rst century b.c.e. (© Th e Trustees of the British
Museum)
health and disease: Rome 553