Background

The late fourth and early fifth centuries CE were a remarkable period in the history of Roman North Africa. On the one hand there was the Vandal invasion of North Africa and the fall of Carthage in 439, with all that this disaster entailed on the social, economic and agricultural levels. On the other hand, in this very same period, we find an amazing productivity of medical texts, for which Vindicianus, proconsul and physician, his student Theodorus Priscianus, Caelius Aurelianus, the physician Cassius Felix and, somewhat later, Muscio were responsible.

If one were to look for an explanation for this interesting phenomenon, a few reasons come to mind. Rome was, in the first instance, no longer the official capital of the western Roman Empire (since 402 it was Ravenna), nor was it the intellectual and cultural centre that it had been in earlier times. The centre had gradually shifted south to Carthage, which had not been ravished by long drawn-out civil wars and invasions by barbarians during the previous two centuries. North Africa was peaceful and prosperous, at least until the Vandal invasion in 429. The social stability of the country meant that scholars had the opportunity to devote themselves to the study of the ancient Greek manuscripts, and the money to acquire the manuscripts. Travel was also still possible, retaining the possibility of contact with the medical school in Alexandria, which was still flourishing in the third and fourth centuries. A more immediate reason was the fact that, thanks to the good schooling that children received in North Africa, there were still scholars who understood Greek in the late fourth and early fifth centuries, something that was becoming an exception in the rest of the western Roman Empire.

The question arises whether the four medical writers mentioned above had anything in common, anything specifically ‘African’? Was there, for instance, something ‘African’ in the drugs they recommended that caused them to be different from those in the Greek East? That does not seem to be the case. Sabbah points out that the plants from which the materia medica (drug ingredients) recommended by the North African authors derived are basically the same as those in the Mediterranean basin.

Christianity was one of a great many religions in Roman North Africa during the early Empire. Initially the religion of Rome, with its pantheon of gods (especially Jupiter, Juno, Venus and Mars), dominated. Later there was also the emperor's cult, which had to be held in reverence by all. In the coastal cities of North Africa, Punic religious traditions continued to exist, often in Roman garb – Saturn (the local Baal with a Roman name), for instance, was prominent in the religions of North Africa. The native Berber and Libyan cults also still existed, mostly with a Roman overlay. There were also gods of other parts of the empire: the African author Apuleius, for instance, was an adherent of the cult of the Egyptian goddess Isis. Then there were also Jewish communities with their monotheistic religion of Yahweh. Healing was a characteristic of some of these religions; among them the cult of the healing god Asclepius was the most important and widespread.

Each of these religions was part of a culture that had its own management of health care, a wide variety of medical care was thus available to the sick in Roman North Africa. Ferngren refers to the existence of medical, religious, folk and magical traditions. In these traditions, Lloyd points out, the actual healers could be root cutters, drug sellers, midwives, religious healers, or the more rational kind of physicians represented in the Hippocratic texts.

This was the pluralistic religious scene in Roman North Africa during Imperial times. The Christian view of life may have brought about a great change in health care, but much of what is believed to be inherent in Christianity was actually inherited from pagan practices and beliefs and adapted to the new religion.

Greco-Roman medical views

When discussing the medical views of the Greeks or the Romans, the Jews or the Christians, it is important to keep in mind that none of these groups should be regarded as monolithic – they were as diverse in their views within each group as they were in their opposition to the other groups. It should also be pointed out that there was no organized Jewish health care system, nor a coordinated Christian health care system.

Introduction

Oswald Spengler, in his famous book The decline of the West, postulated that any civilization ‘is a super organism with a limited and predictable lifespan’. Looking at the history of the world in a broad perspective, he rejected the usual linear division of history into ancient, medieval, and modern epochs, and instead believed that meaningful units in history are whole cultures which develop as organisms; the lifespan of such a culture is about a thousand years. Events such as the decline or fall of a culture do not happen fortuitously, he believed, but are a historical change of phase within a greater world picture. One of the eight cultures that he identified is ‘Classical’ (Greek and Roman). If one were to look at this culture, and take as a starting year 480 BCE, the beginning of the Fifty Golden Years of Greek civilization (also known as the Pentekontaetia) and as an end point take 476 CE, the traditional date of the fall of Rome, it does add up to nearly a thousand years. Spengler's cyclic theory could thus apply to this culture. In the first chapter of this book, where the environment, population and cultural life of specifically Roman North Africa were discussed, it was stated, à la Spengler, that the history of Roman North Africa is interesting because it encapsulates, as it were, the rise and fall of a civilization. The period in this case was half a millennium, from c. 146 BCE to 439 CE. But the history of Roman North Africa, although inextricably linked to that of the Roman Empire as a whole, ran its own course, and had its own reasons for its decline, which do not necessarily coincide with the reasons for the decline of Rome.

An account of the preservation and transmission of medical texts is linked to events forming part of the decline of Roman North Africa. Possible reasons for that decline will be discussed, followed by the role of the five important medical authors who form the core of this book. Some repetition in these two sections of information discussed in detail in former chapters is inevitable, the intention being to bring all the strands together in this final chapter to present a complete picture.

In 251 CE a devastating epidemic struck the Roman Empire. A description of the situation in Carthage, capital of North Africa, one of the empire’s most prosperous provinces, has survived:

Some gory details of the symptoms of the disease are mentioned by Cyprian, bishop of Carthage at the time of the epidemic:

It was said that the epidemic, which lasted about fifteen years, carried off 5000 people a day in Rome, and struck everybody, irrespective of age, gender, status (even the emperor Claudius Gothicus died) or nationality – so many of the Goths, against whom the Romans were waging war, died that the emperor did not even bother to continue the hostilities.

Under such circumstances it is understandable that the epidemic was seen as apocalyptic, as a sign of the passing away of the world. At times like this numerous questions would have beset the minds of the panic-stricken victims; the most insistent would have been what the cause of the disease was and where it came from. Horrific as the situation might have been, it was by far neither the first nor the last epidemic to ravage the Greco-Roman world. Although the severity of the disease and the resulting death toll might have differed, the question of the cause of the disease would recur.

The medical texts that were produced in the fourth and fifth centuries CE in North Africa were not original research, but translations/adaptations of the Greek texts of the masters of old. The writers would have been faced by two questions: which of the treasures of the past should be translated, and in how much detail? Fortunately the Romans, being traditionalists to the marrow, had a pattern to follow: Latin medical authors in previous centuries – Cato, Pliny and Celsus – had set a trend that could be be followed by the writers of the fourth and fifth centuries, namely a disregard for theoretical reflection, and a preference for practicality and brevity. This approach determined the choice of the author: rather than the theoretical and polemical approach of Galen (129–c. 210), whose discursive philosophical works dominated the approach taken in the East, the Romans preferred the mild and practical approach of the renowned second century CE physician Soranus of Ephesus. However, in contrast to Galen who left an enormous body of medical and philosophical works, the only work of Soranus of which the complete Greek text has survived is his Gynecology, a guidebook for midwives with remedies/ recipes for the most important female diseases.

The author

We know very little about Theodorus Priscianus, apart from his own statement in Physica c. 3 that he was a student of the famous Carthaginian physician Vindicianus (late fourth century CE), the subject of the preceding chapter. This implies that Theodorus was probably also a native of North Africa and lived in the late fourth and early fifth centuries. We can also deduce that he was a professional doctor. Scarborough believes, in addition, that he was probably ‘a member of the social and economic levels associated with the royal house in the western empire’. The work for which Theodorus is known is the Euporiston, which consists of four books of medical recipes: the Faenomenon, in which he discusses the treatment of external diseases, the Logicus, in which treatments for invisible internal diseases (13 acute and 29 chronic) are discussed, and the Gynecology, which contains treatments for women's diseases. Of the fourth book, the Physica, a collection of magical remedies, we only have a fragment containing a chapter on headaches and part of a chapter on epilepsy.