THE PUBLIC HEALTH SYSTEM IN ANCIENT GREECE

Dimitrios Katsikis

 

The Greek city-state among other facilitations that provided for the citizens-body included also the benefit of free medical care. The Greek city-state among other facilitations that provided for the citizens-body included also the benefit of free medical care. Public doctors were usually remunerated by the local governments, in an annual basis, so that they offered the required medical treatments to individual patients. The benefit of public medical service was considered as something granted for the legislators. Up to now it does not any proof that this is owed to the legislative work of Solon, a fact that supports the very ancient establishment of this institution.

Doctors are mentioned by the Homer as a special category of people (Homer, Odysseus, xvii, 382-384) while in Plato’s works are classified in the base category of craftsmen (Plato, Gorgias, 445b). Diodorus Siculus preserves a dictum of the legislator Charondas who had ordered that all private individuals, without exception, to receive the services of a doctor supported by public expense. (Diodorus Siculus, xii 13).

In the case of classical Athens, indirect information it is provided in the works of Aristophanes. The Dikaiopolis in the comedy of Aristophanes «Acharneis» prompts the poor and blind farmer to visit the famous surgeon Pittalos (Aristophanes, Acharnians 1027-1032) while in his work «Wasps» it is the half-fainted Lamachos who asks for a public surgeon (Aristophanes, Wasps 1432). Commentators report that the «public surgeon» was elected with public processes and offered medical services without payment (Suidas s. v, Scholiast ad Aristoph. Acharn. 1030).

Reference in this special category of doctors was done using the following terms: The public doctor, the public’s doctor, physician. In their Romans Era they become known with the term «chief doctors». The annual wage of public doctor in the city states of Classical Greece was arround 500 drachmas, but in the following centuries their pay was increased in astronomical ammounts i.e the Asklepiades from the Perge in the 2nd century B.C. received 1000 drachmas from the aegean city of Seleykea at the Pamphylia. In many cases the public doctors created fortunes like the doctor of Delphi Filestos who offered in the 3rd century B.C. as donation to his home-city of Cos the sum of 4.000 drachmas to cover for military expenditures.

Initially the «Surgery» must have been a small room with private equipment, But by the time of Galenos (2nd century A.D.) the simple rooms had been transformed into big buildings equipped from government funds. The doctors, until the institution of big hospitals (mainly military) visited their patients at home. Those who were called to select doctors in the public offices of their city were no other than the residents, via direct vote. The candidate doctor did not have, but to convince the voters for his unique talents and his exceptional abilities. This however did not mean that the elected doctor would be also most qualified or best from the private doctors.

According to the Plato the candidate doctors for the public offices should have justified with the best way their candidature before the elections in order to be elected (Plato, Gorgias, 514d) while in other point of this text, Socrates having point out the potential danger from a such subjective election states that even a lawyer with the suitable speech could be elected in this office (Plato, Gorgias, 456b). In every case however, voters knew that the responsibility of election falls on them, something that Xenofon does not leave without commend (Xenophon Cyropaedia , 6, 15).

In a similar annotation advances also the Cynic Philosopher Teles which in his work «About Escape» charges without hesitation the responsibility of the erroneous election of a public doctor on the voters. The doctors were present in all the public events as in feasts and mainly in athletic contests so that they could immediately treat athletes exiting because of a wound. Also the public doctors had special duties like the medical supervision of the «Adolescents» teams during the period of their military training and service. All the teams of «Adolescents» had public military doctors (Inscription I. G ii / iii, 2237, A. D. 230-235) a diachronic institution that is in effect even today in every organized army. In regard to the importance of military doctors the Greeks already from the Homeric Era had conceived their irreplaceable services and for this reason they had them exempt from daily chores and martial conflicts so that they devote themselves to the work of healing (Diodorus Siculus, iv, 71).

Doctor practices on patient (Attic red-figure kylix, c. 500 BC). Image may be subject to copyright

Doctor practices on patient (Attic red-figure kylix, c. 500 BC). Image may be subject to copyright

Doctors both public and private were organized in associations centered on the cult of Asklepios\’. In Athens the sanctuary of Asklepios was located in the southern side of Acropolis. According to Herodotus the more popular doctor before Hippocrates was the Dimokedes of Croton (Herodotus, iii, 131). Initially he emigrated in Aegina and the second year of his stay in the island he received the rank of public doctor as recognition of his abiliities from the local. In the third year he was hired as government doctor by the Athenians offering him a comparable wage. Then the tyrant of Samos, Polycrates, in the climate of political competition among the Greek cities hired Dimokedes with an annual wage of two talents per year. The brilliant professional career of Dimokedes rendered him the most popular doctor of Greek world and gave his birthplace the fame that makes the best doctors.

Many are the doctors that in the context of their profession did not hesitate to travel in all the corners of the Greek world in order to offer their services, many times under adverse conditio to which they responded in with great spirit of selflessness. Doctor Damiadas from Sparta, served as a public doctor in the town of Gytheo for two years showing an exemplary personal and professional attitude. When the city of Gytheo due to its bad finances could not pay his annual salary Damiadas refused to be paid for this year.

For this sacrifice the city honored him with the titles of “consul” and “benefactor”.Menokritos the Samian served the city of Carpathos for 20 years (?nscription ,?.G . xii ,i ,1032, second century B .C .). Before that he offered his services for free in the city of Rhodes. Great was also his benvolance to his native Cos. Among his other great deeds during the siege of the city from Philip V (Polybius , iii , 2, 8;Appian ,Macedonica ,4) Menokritos selflessly and at his own expence treated his wounded compatriots from dawn to dusk.

Achilles tending the wounded Patroclus (Attic red-figure kylix, c. 500 BC). Image may be subject to copyright

Achilles tending the wounded Patroclus
(Attic red-figure kylix, c. 500 BC). Image may be subject to copyright

In Lamia, the Mitrodoros son of Andromenes helped all who they asked for his help without receiving payment (Inscription IG. ix , ii ,69, second century B .C, ). Apollonios the Meletian even though he was not apublic doctor offered to serve as such in the island Tinos in a period difficult for the city and he agreed not accept payment for the first six months. But when a new disaster (plague) broke on the island he did not abandoned it but continued with the same self-sacrifice and unselfishness curing and relieving the new calamity (Inscription.I.G.XII,V,824,189-167 B.C.). The doctor Ermeias from the Cos would astonish everyone with his self-sacrifice to treat wounded soldiers and from both sides on the war that broke out between the Gortyna and the Knossos in the end of 3rd century B.C. The cities recognized their services and them honored them accordingly. The gifts they gave them were both material i.e. a crown from gold, oil and gifts of honor i.e offer of citizenship and titles like «consul» and «benefactor».

The city of Elatea in Phocis, as a sign of gratitude to the person of the doctor Asklipodoros from the Cos, gave privileges to all doctors that their name began with initial “Askl”- Asklepiodoros not only had helped the patients of Elatea but also had given a series of public lectures about the rules of public health ( Supplementum Epigraphicum Graecum, III, 416, second century B.C.). The Delphians in 235 B.C. will exempt the doctor Philistos and in his descendants from all taxes between including also the tax for the Health Service (Association Inscriptionum Graecarum, ed. W.Dittenberger, 437, c 263 B.C). This exemption was judged necessary as a sign of gratitude for the valuable services of the doctor of Delphi who offered them without exception both to locals and pilgrims (inscription. S. I.G, 538, C 216-215 B.C).

At Isthmus the municipal authority of the city will honor the public doctor Satyros (Inscriptions of Cos 409, second century B.C.) The Greek doctors because the spirit of unselfishness and the high sense of duty offerd their services to everyone in need, helped without exception all the social and economic classes of people. The slaves also were incorporated in the program of medical assistance. For them their master should pay a special tax, «Hiatrika».

A stele in the municipality of Gythion in honor of Damiades praises his offer which was directed to all indiscriminatetly, as he treated both poor and rich, slaves and free people (inscription. IG. b, 1145, c 70 B.C).Plato simply left the responsibility for the slaves on their masters without commenting further (Plato,Laws,720 b-e).Their action exceeded the needs of human race and extended also to the animals, mainly the domesticated ones. Mitrodoros, is referred by the residents of Lamia as «Horse-doctor”. From papyruses of Hellenistic Egypt becomes known a special tax that aiming to payment «horse medication», (Pap.Hideh,45, 257-256 B.C.) a tax that his existence was continued at least up to the 4th century (Pap.Oxyrhynchus,92,A .D. 335). Particularly interesting and worthy of report is the case of Hellenistic Ptolemaic Egypt.

Because the bloated bureaucracy of the state each movement of public doctors was specified in details based on protocol. The public doctor was supposed initially to act according to written directions of his colleagues who functioned as leaders in the treatment of illnesses. In case that despite the following of the directives and the application of suitable treatment, the patient died, the doctor was exempted from further investigation for malpractice. In the opposite case the doctor was prosecuted with the applying, per case sanctions (Diodorus Siculus, i,82 12).

Aristotle reports that the doctor could act at will only after three days had passed with treatment conforming to the existing written directives. Afterwards this time period if the treatment had brought no visible result he could follow his own personal treatment (Aristotle, Politics, 128?). In Egypt the minister who was responsible for the smooth operation of public health services brought the title «doctors oversee» as for example Chrysermos from Alexandria, son of Herakletos and blood relative of King Ptolemy VI [Inscription. Orientis Graeci Inscriptiones Selectae (O.G .I.S), 104, reing of Ptolemy VI (I81-146) B.C. from Delos]

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