The Roman adoption of Greek medicine is a significant moment in the history of Western medicine.Reference Cruse¹ In its new Roman environment Greek medicine was turned in Latin, and its practitioners could take advantage of the spread of Roman power around and beyond the Mediterranean both to obtain supplies of non-local drugs, and to seek fame and fortune even in the remoteness of Roman Chester or Hadrian's Wall. Without Latin, which later became the lingua franca of learned medieval Europe, Greek medicine would have languished for centuries unstudied, an exotic, if largely irrelevant, counterpart of Babylonian or Egyptian medicine today. Thanks to Latin, and to the Roman assimilation of Greek medicine, modern doctors appeal to the Oath of Hippocrates, not the lawcode of Hammurabi; when we think of healing gods, we recall Asclepius, not Imhotep or Coventina; and for centuries the epitome of the travelling doctor was Democedes of Croton, physician to the Queen of Persia, rather than his Egyptian contemporary at the same court, Udjeharresnet. Given the significance of this transfer of knowledge, it is not surprising that generations of scholars have set out to explain how this transfer took place. Over the last 30 years, there have been several important studies, not least on the way in which the vocabulary of Greek medicine was adapted for a Latin readership. Indeed, so much has been written on Greek medicine in Rome that it might appear that little new can be said about it.

In this paper, the perspective is reversed in order to concentrate on the experience of the Greeks in Rome, in Italy, and further afield in the West. True, it will not be possible to escape entirely the influence of the most important ancient historical account of Greek medicine in Rome, that of Pliny the Elder in his Natural History, an account resembling a soap opera in its cast of dubious characters – verbose Greek doctors, universally incompetent, eager for sex and money, and more likely to murder their gullible patients than to cure them. One should try to avoid falling into the trap set by Pliny of setting his account of Archagathus the hangman or Asclepiades of Bithynia, the failed schoolmaster turned quack, within the same moralizing context of a battle between good and evil.Reference Beagon² Pliny warns his contemporaries against neglecting traditional virtues, setting his doctors on the same level as see-through dresses and three-legged ornamental tables on the index of moral depravity. Far better to dispense with doctors altogether, and like Pliny's friend, Antonius Castor, grow old with self-medication. It is an interpretation of Greek medicine that went back at least two centuries, to Cato the Elder in the first half of the second century BC. Cato had built his own political career on his hostility to foreigners, like certain British politicians and the EC today; he had been to Greece, and had not liked what he saw. The Hippocratic Oath was, in his eyes, no more than the proof of a conspiracy of doctors to deceive their patients and worse, and he warned his son to have nothing to do with these filthy Greeks. Roman virtue must be preserved from Greek vices.

Few historians today accept this moralising interpretation of Pliny and Cato; we talk instead of hellenisation and urbanisation, about Empire and integration. But in all this we adopt a Roman perspective, and often Roman in the narrow sense of the view from the city of Rome itself.Reference Korpela³ We talk of Greeks coming to Rome, not going to Rome. In attempting to look at the Greeks themselves, and to try and see this development from the point of view of the Greeks, the historian relies mainly on two different sorts of information; inscriptions, set up by or referring to healers, medici or iatroi, who appear to be Greek, and the evidence of the most prolific of all surviving ancient authors, Galen of Pergamum, who lived from 129 AD to perhaps as late as 216 AD. Although born and brought up in Asia Minor, at a time and in an area of the Empire where Greek culture flourished as never before, Galen spent over 50 years of his life in Rome itself, rising to become one of the personal physicians of a series of Roman emperors. He wrote his books in Greek. How far his ideas had penetrated to Latin authors by the end of the third century is uncertain, although at least one such writer, Gargilius Martialis, claims to be citing one of his works.

It should be admitted from the beginning that this evidence is overwhelmingly from the first three centuries of the Roman Empire, much of it some time after the 70s, when Pliny the Elder was writing his Natural History, and the gap between it and some of the events that Pliny describes is even larger. But that is also an advantage, for it allows us to test whether the situation he describes for his own time and earlier continued to obtain a century or more later. The first question is therefore the extent to which we can still continue to talk of Greek medicine in Rome in the second and third centuries of the Roman Empire. For Pliny, medicine was something imported by Greeks in the second century BC – he even gives a date 219 BC, for the arrival of the first doctor in Rome, Archagathus – and his argument would appear to be borne out by the evidence of inscriptions. The great majority of doctors recorded on inscriptions in the Latin half of the empire bear Greek names: although the percentage declines from 90% in the first to 75% in the second, and 70% in the third century. Only in Roman Africa do non-Greek names outnumber Greek. A similar pattern of Greek names can be found on the so-called oculists’ stamps, found extensively in Western Europe, indicating either a practitioner-owner or the inventor of a particular form of eye ointment.Reference Voinot⁴ A few more Latin names can be found among the inventors of medical recipes recorded by Galen and Scribonius Largus, but the pattern remains generally the same. True, there is an inherent danger in attempting to deduce origin from nomenclature: not every hairdresser with a French name is from Paris, not every spaghetti restaurant is run by Italians, and even if curry houses and Chinese restaurants in Britain still tend to be run by those who originate in India, Pakistan or China, they and their families may have lived in Britain for more than a generation. Not every one of the 130 or so slave or ex-slave doctors who are recorded on first-century tombstones with Greek names will have been born in Greece. But even if they were not, their name is surely indicative of the fact that, well down into the period of the Empire, medicine was imagined as a Greek (or at least a non-Latin) profession. The presence of two major Latin writers on medicine from the first half of the first century AD, Scribonius Largus and Cornelius Celsus, may appear at first sight to contradict the trend, but closer examination reveals otherwise. Scribonius was a bilingual author, perhaps from Southern Italy or Sicily, traces of whose writings can be found in Greek as well as in Latin. Cornelius Celsus, the author of De medicina, the finest Latin work on medicine, has an extremely detailed and sophisticated knowledge of contemporary Greek medicine, and he may well have treated sick patients from time to time, particularly in his own household. But it would be wrong to imagine that doctoring was his occupation (his comments on the income, quaestus, to be made from medicine seem to exclude this), or that he expected his readership to become instant doctors, any more than he expected them to become instant orators, instant generals or instant tillers of the soil, from reading other parts of his encyclopaedia of Artes. He was providing his gentleman readers with the best information at his disposal for them to understand and use as they saw fit. But, leaving Celsus aside, there is little indication of the sort of assimilation of medicine into general Latin culture that we find in the Greek world of Plutarch and Aulus Gellius, 50 years or more later.

It is also significant that 10% or more of the inscriptions of doctors in the West are actually written in Greek – tombstones, dedications, and the like. Evelyne Samama lists 33 such inscriptions from Rome and Latium, the largest number from any occupational group, ranging in date from the first century BC to Late Antiquity.Reference Samama⁵

Although drawing conclusions from such slender material is hazardous, it surely reinforces the notion that the practice of medicine, particularly in Rome, long continued to carry with it a suggestion that this was something particularly associated with non-Romans, with all that that might imply for the status of medicine and its practitioners.

What then draws the Greeks to Rome? For Pliny, the answer was obvious: because one could find there gullible and wealthy patients, only too willing to entrust themselves to the dubious hands of an incompetent foreigner. They came because the Romans welcomed them. A similar complaint about murderous immigrants is uttered a century later by Galen, himself an immigrant to Rome, who accuses his competitors of seeking the anonymity of the imperial capital to escape punishment and obloquy for failure back home.Reference Hankinson⁶ He contrasts the situation of Rome, where innumerable quacks and charlatans prey on an unsuspecting public, with that in his home town, ‘where we all know one another, one's parentage, education, wealth and way of life.’ True, compared with Galen himself, whose medical education is the longest on record, whose family had enjoyed Roman citizenship for at least a generation, and whose considerable wealth allowed him opportunities not available to most of his competitors, almost any immigrant doctor who came to Roman would fail to meet his standards. But the mere label of quack or, Galen's favourite, magician, tells us little in the absence of any agreed criteria for what constituted acceptable practice. Moreover, as studies of charlatans in early modern Europe have shown, even that scornful title is no indication of incompetence, let alone of a lack of acceptability.Reference Gentilcore⁷ Recent research has shown that Galen's most notable opponents among his fellow Greeks, the Methodists, the ‘Thessalian asses’, were far from being the stupid fools he describes, and their ministrations were sought after at least as often as those of Galen and his fellow Hippocratics, if not more so, for Galen in a passing comment bewails the fact that his type of medicine is practised only by a minority.

Other doctors we know did not come on their own initiative or of their own free will. Roughly three quarters of all doctors recorded on inscriptions in the West in the first century AD were slaves or ex-slaves, some of them born into slavery, others captured in war or by unscrupulous traders. One would like to know how the wine-prescribing doctor Menecrates of Tralles, son of Demetrius, came to live in the Ager Atinas in Southern Italy, where his name was changed to Lucius Manneius – he is likely to have been the ex-slave of Quintus Manneius.Reference Cristofori⁸ The percentage of slaves and ex-slave diminishes noticeably after AD 100, but this is in part a fault of our evidence, which has preserved many inscriptions from the burial-places of the great slave and freedman households from the first half of the first century. Nor should one forget also that, from a Greek perspective, the allure of Rome may not have been as great as the Romans themselves imagined. Soranus of Ephesus, a Greek city with its own extremely flourishing medical community, seems to have visited Rome, but his views on the mistakes made by the Romans in teaching young children to walk on hard marble pavements hardly suggest a desire to stay long. Another Ephesian, Rufus, seems never to have visited the city and, even if Simon Swain is right to posit that he was one of Trajan's palace doctors, he never thought any of his Roman experiences worth recording in the works that survive to us.Reference Swain⁹ Major cities such as Athens, Alexandria, Ephesus or Smyrna had their own attractions, and from the perspective of a lad from the island of Cythera, making good in Sparta was achievement enough.

Indeed, Pliny's interpretation of the career of Archagathus, the first doctor in Rome, can be turned on its head. For Pliny, this incompetent Laconian was welcomed with open arms and civic privileges in 219 BC, but within a few months returned home with the jeers of the crowd ringing in his ears. From the perspective of Archagathus, a renowned surgeon, the rewards of his official contract as a civic doctor may not have encouraged him to say any longer in this hick frontier town, and – like Democedes of Croton in his travels in earlier Greece and Persia – he may simply have moved on to better things when his contract came to an end or other opportunities presented themselves.

In general, however, the standard explanation must surely be right. What brought doctors from Nicaea, Thebes, Ephesus, Smyrna, Tyana and so on to come to Rome must have been the prospects of advancement, the hope of making money or of establishing one's family in respectability. The agrarian community imagined by the Elder Cato two centuries earlier had long since disappeared, replaced by tenement blocks, where, at best, one might have a window-box in which to grow a few kitchen herbs. Here was a ready market, and one, where as Galen himself noted, the size of the city allowed doctors to specialise and make a living as an ear-doctor, a specialist in anal fistulae, or as one doctor proudly recorded on his tombstone, as a clinician, surgeon and ophthalmologist. The fact that this man, a freedman, lived in Assisi, making a substantial amount of money that he then expended lavishly on public benefactions, also suggests that such riches could be found outside the city of Rome itself. The very Greekness of medicine may also in itself have proved an attraction, for not only were there other Greeks already in imperial Rome, but the fact that one could point to an origin and training in the Greek world of the Eastern Mediterranean may also have been a selling point by showing that Sosicrates, son of Sosicrates of Nicaea, was the genuine article.Reference Nutton¹⁰

For others, status for themselves and their families was a major attraction. One can sense the pride of Calpurnius Asclepiades of Prusa, whose learning and morals, according to his tombstone, had gained the approval of some very distinguished men, and brought Roman citizenship for himself and his family, as well as a sinecure as assistant to one of the magistrates in Rome. And we have letters of Pliny the Younger asking the emperor Trajan for citizenship for his masseur and for relatives of his Greek doctor, Marinus.

Why Galen himself came to Rome in 162 is a matter for speculation. Although usually voluble about himself and his family, he does not say, except to hint that there was some sort of trouble back in Pergamum, he uses the word stasis, which made it uncomfortable to remain there for long. Readers of Galen may also imagine that his departure was in part due to his own abrasive and self-righteous personality – Galen blames his departure from Rome in 166 on the hatred he had engendered in his competitors, envious of his successes and his learning – and reading his egotistical outbursts, one can appreciate the reasons for their dislike. His return from Pergamum in 168–169, he proudly proclaims, was at the behest of the emperors, who summoned him to join them in a military campaign in Northern Italy. From then on, once back in Rome, he seems to have treated a succession of emperors well into the third century, although he may have left court in 191 or so to avoid the murderous Commodus.

But Galen was an extremely wealthy man, even before coming to Rome, and one should be cautious about generalising from his life. But how did others make that move from the Greek world to Rome? Patronage helped. Cicero talks of contemporaries visiting the Greek world and employing a Greek physician, who might return to Italy with them as a sort of trophy medic. In the appeal of Dr Lucius to the goddess of the shrine at Hierapolis Castabala to protect the consul designate Dexter Rutilianus on his journey from Syria back to Rome, one can detect the hopes of a doctor awaiting the call from a former patient to come to Rome. Service in the army, even if brief, like Galen's, will have brought doctors, such as Dr Hermogenes at Chester, and perhaps even Pedanius Dioscorides, the famous pharmacologist, into contact with leading senators serving as governors, generals, or officers. Other Greeks may already have been important men in their local communities, who could use their provincial connections to establish contacts with the imperial centre. Some doctors, such as the Andromachi under Nero and Trajan, or the Statilii of Heraclea Ulpia, formed medical dynasties linking their homes in Greece or Asia Minor with the imperial court for two or more generations, to the advantage of both court and local community. Patronage, as so often in the Roman world, mattered.

But not everyone had a consul or an emperor as a patron, or was as independently wealthy as Galen. He likes to portray himself as the boy from the provinces risking all to make his way in the world. The reality was that, once in Rome, he could immediately meet with old friends and connections from Pergamum, such as Teuthras, or Eudemus, his old philosophy teacher, who would help him along. Teuthras provided him with a large collection of unusual recipes that he had inherited from another Pergamene doctor, while his treatment of Eudemus, early in his first Roman stay, gained him access to patients from the highest social strata.¹¹

Others managed somehow to find someone with whom to study. The unknown author of a pharmacological tract on the properties of the lesser centaury, himself a Greek from the age of Galen, tells how he attached himself to a distinguished doctor in Rome, accompanying him on his rounds and learning the tricks of the trade from him. Another contemporary Greek author, this time of a tract on theriac, studied with several teachers in Rome, the most important being the otherwise unknown Maecius Aelianus.¹² It would be interesting to know who were Galen's hetairoi, friends or pupils, who came with him to visit the sick or attended his public lectures – we have a few names, but most are clearly of senators and such like, whose attendance gave Galen a social cachet, rather than junior colleagues. Certainly, association with the great Galen could serve as a calling card, if we may believe Galen's story of the quack he met in Rome, who was claiming to cure toothache with a remedy he had gained from Galen himself. It is not clear whether it was the conjuring trick or the use of his name that so annoyed Galen that he had the man hauled off to be punished.

Others relied on different strategies to become noticed. Galen himself carried out anatomical dissections in public, challenging others to do likewise. Thessalus the Methodist went around with a large crowd of followers. Others brandished flashy instruments or poured out streams of high-falutin’ language. Still others emphasised their Greek culture, such as Heraclitus of Rhodiapolis, ‘the Homer of medical poetry’, or Tiberius Claudius Menecrates, who wrote 156 books and established his own clear and logical medical sect at Rome in the time of Nero. Most of the Greek inscriptions of doctors in the West assert the cultural claims of the doctor and his family through the elegant sculptures that accompany them or through long verse inscriptions and high-flown language, very different from what we find in typical inscriptions of Latin medici.

All this also presupposes a community that could appreciate and respond to those appeals, and recent studies have only emphasised the bilinguality, if not multilinguality, of the Roman Empire.Reference Goldhill¹³ Rome itself was, like modern London or New York, a city of foreigners: the Orontes flowed into the Tiber, in Juvenal's words, and it would easily have been possible for an immigrant Greek to gain a toehold in that milieu. But what did it mean in the first two imperial centuries to be a Greek in Rome. We have long moved away from a simple opposition between Greek and Latin, in which writing in Greek or referring to the Greek past signalled at least detachment from the Roman or the Latin world. Galen's father, we know, was a Roman citizen, but it is only inscriptions, not Galen's writings, that have revealed that fact. On only one occasion does the prolific Galen use the word ‘we’ to refer unequivocally to the inhabitants of Rome alone, and this at the end of his long life. Save for that exception, ‘we’ always refers either to humanity in general, to Galen himself and his friends, or to the Greek world – ‘with us’ usually means at Pergamum, not Rome. But this is not to be seen as suggesting an opposition to things Roman, but pointing to the ways in which Romans could choose to frame their identity from a range of choices. The tombstone of Calpurnius Asclepiades mentioned earlier, by contrast, emphasises his Romanitas: written in Latin, it stresses the Roman public positions gained by him and his family. Besides, as already indicated, most tomb inscriptions of doctors of Greek origin, or at least Greek nomenclature, are in Latin, which suggests that, in this respect at least, the families of doctors themselves adapted to their Roman environment.

Yet, in all this, one troubling question remains. What was the language of everyday medicine in Rome? How did these newly arrived healers communicate with their patients? How did Sosicrates of Nicaea become friends with the freedman Munatius Plancus and his wife? We have some excellent studies on how Greek medical terms, and indeed treatises, were turned into Latin, but writing is only one form of communication.Reference Langslow¹⁴ Few doctors had the good fortune to come from Southern Italy or Sicily, where bilinguality could extend to tombstones or boundary stones, or a doctor such as Scribonius Largus could be sufficiently adept to write medical treatises in both Greek and Latin. After perhaps half a century in Rome, Galen must have been fluent in Latin, although his own treatises show little indication of this – interestingly, the newly discovered tract, On the avoidance of grief, 40, has Galen describe a purse with a Greek word derived from Latin, fascolion. But for a substantial percentage of the population crucial decisions about health and illness were made in the course of discussions with foreigners of doubtful linguistic competence.

Of course, one might argue that Greek doctors came to Rome precisely because they could find there many Greek-speaking patients, and that Hermogenes and Antiochus in distant Chester, for all their Greekness, would have had to learn Latin because of their army connection. But how many Greek speakers were there in fourth century Milan to greet the poetic Dr Dioscorus, let alone in first-century Falerii, the small-town home of Dr Asclepiades of Pergamum? Historians of education only complicate the problem, by asserting that few Greeks learned Latin, unless they were among the small elite with imperial ambitions, and that the teaching of Greek declined in Rome after the first century BC, or was confined to the upper classes. Any bafflement over this essential question of linguistic communication may be unwarranted, but at least it should remind us of the potential difficulties of communication during the face-to-face encounter of ancient doctor and ancient patient. One may wonder whether it is coincidence that the one medical sect that rejected the painstaking Hippocratic search for the nature of the individual patient was that of the Methodists, the most successful form of Greek medicine in Rome.Reference Tecusan¹⁵ The Hippocratics demanded a detailed understanding of the patient, gained by observation and, if we follow Rufus of Ephesus’ guide to clinical diagnosis, Medical Questions, from talking. The Methodists, on the other hand, saw a simple and immediate correlation between what could be observed and the actual therapy; their classification, unlike that of Galen or Rufus, had little need of words. It was an ideal practical medicine for a mega-city and for the linguistically challenged.

What answer, then, can be given to the question posed in the title of this article? Can a Greek become a Latin? The obvious answer is yes, for the great majority of inscriptions are written in Latin, not Greek, and by Late Antiquity several Greek texts had become fully assimilated into Latin, and Latin doctors, with Latin names like Cassius Felix, could write their own medical treatises that develop the ideas of Hippocrates and Galen. Indeed, even Galen becomes a Latin doctor, if we are to believe the only surviving direct reminiscence of an encounter with him. In 1501, Hieronymus Surianus was planning a re-edition of the complete works of Galen in Latin, when he received a visit from the ghost of Father Galen.Reference Surianus¹⁶ This Galen writes in Latin, and instructs his future editor about his original Latin words and phrases. There is no suggestion that Surianus’ Galen is a Greek. But this change of identity took centuries to come about, and the passage from Greek to Latin required an important intermediary: Romanitas, being Roman. It is the Roman Empire, particularly in the first two centuries of the Christian era, that provides the point of fusion between the Greek and Latin worlds. Galen the Greek is also Galen the Roman, living, working, and writing at the very heart of the city of Rome. Pergamum may remain home, yet even Galen at the end of his life can change his perspective to see himself as a Roman and to praise the benevolence of the Roman emperors. And that, we can be sure, while something different from being a Latin, was an essential step along that path.