Physicians and the Roman Imperial Aristocracy: The Patronage of Therapeutics

The question of the status of the physician in the Roman world is one of profound complexity that has generated a great deal of study and debate. ¹ The complexity arises from the fact that physicians can be found at every level of ancient society and in a great variety of status situations. There were itinerant rural physicians and semiprofessional village physicians, quacks working street-corners, public physicians in cities, slave-physicians in aristocratic or imperial households—and at the top, there were individuals like Galen, personal physician of emperors and member of the imperial entourage. It was not unheard-of to move between some of these extremes. Many physicians were freedmen; many were foreigners who acquired Roman citizenship; some achieved the rank of eques or knight; some were counted among the emperor’s friends or companions. This much we know, often from very brief funerary inscriptions that survive in great numbers. ² Sometimes, but much less frequently, we are informed about how a physician achieved such elevations in status.

In this paper I examine some of the mechanisms available to physicians for moving up the hierarchy of their own society; in particular, I investigate how medicine worked within the traditional Roman-Hellenistic system of patronage that pervaded the Mediterranean world in antiquity. ³ I shall focus on the role of the spectacular prognosis, diagnosis, or cure in this system. These were dramatic and very public performances, resulting, if successful, in fame and social status for the performer. In several ways, they parallel the phenomenon of forensic oratory in the Roman aristocracy: both types of performance were used to prove intellectual prowess, harm enemies, and advance reputation, and were intensely agonistic in nature. Thus the theatrical elements of medicine that Heinrich von Staden and others have emphasized in relation to Galen’s anatomical demonstrations also characterized diagnosis, prognosis, and therapy. ⁴ This study also illustrates that medicine in Greco-Roman elite society could be a highly competitive, zero-sum struggle for status and reputation that involved aggressive self-promotion and the ruthless humiliation of rivals.

We might begin with a single, and simple, example of social advancement through therapy. In a.d. 97, at the age of thirty-six, a Roman senator of praetorian rank made an unexpected recovery from a grave illness. Shortly afterward he wrote a letter to the emperor Trajan asking for Roman citizenship for his therapist, a freedman from Alexandria: “Last year, lord, I was sick with a grave illness to the point of danger of death, and I employed a therapist [iatroliptes]; for whose solicitude and devotion I can repay my gratitude only by the favor of your indulgence. Therefore I ask that you give him Roman citizenship.” ⁵

Pliny the Younger makes this request as if it were an ordinary thing. The language is formulaic. He uses very similar terminology (which I have indicated in italics below) in a subsequent letter on behalf of another physician, one Postumius Marinus. This time, he does not ask for citizenship for Marinus himself, who already has it, but for five of Postumius’s relatives: “My recent illness, my lord, indebted me to Postumius Marinus, my physician; to whom I can repay my gratitude with your favor, if you indulge my prayers with your customary goodness. Therefore I ask that you give citizenship to his relatives.” ⁶

At the end of each letter Pliny appends requests for citizenship for a number of freedmen on behalf of their patrons, or former owners. This detail, like the formulaic language already noted, suggests that his requests are routine in nature. It was a striking feature of Roman government that even such an apparently mundane bureaucratic matter as an individual grant of citizenship had to be handled by the emperor himself. ⁷ Often an intermediary such as Pliny was involved; that is, someone with a personal relationship to the emperor. ⁸ Pliny himself served on Trajan’s advisory council, was elevated to the consulship by him, and certainly could have counted himself the emperor’s “friend,” amicus. ⁹

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