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JAMA 100 Years Ago
September 23/30, 1998


Author Affiliations

Edited by Brian P. Pace, MA

JAMA. 1998;280(12):1034. doi:10.1001/jama.280.12.1034

Ancient Medical Fees.—Bombaugh presents a study on "Medical Fees in Ancient Greece and Rome" in the Johns Hopkins Hospital Bulletin, for August. The first such fee of which he finds specific record was one recorded by Herodotus as given by Darius to Democedes of Crotona, a slave of Oroetes, and consisting of two pairs of fetters of gold. "In his day, in Greece, the usual fee paid to physicians for incidental visits was very small, in fact not more than two groats, sixteen cents, or about one-thirtieth of the customary fee in England in our time, one guinea." It was customary for physicians to be engaged by the year, by the municipality, and paid from public funds. In Aegina, Democedes received one talent a year, about $2000; in Athens his salary for a year was 100 minae, $2400, later receiving a like sum when residing at Samos. According to Pliny, Cleombrotus received 100 talents for the care and recovery of King Antiochus—£24,375, if the Attic talent is meant, $156,000 if the standard of the coin of the Ptolemies." Every Greek city had not only one or more public medical men in the municipal service, whose duty it was to visit the sick in the city and suburbs, but there was also a large dispensary, iatrium, where the practitioner, aided by his pupils, held consultations, performed operations and distributed the needful medicines. Beds were reserved for patients who could not be removed, or for very serious cases. The rich being able to be cared for at home, those who needed the aid of the public dispensary were the poor. Yet in the state of society at that period, the isolated poor, those without patron and without brothers, as the phrase went, meaning those who were not members of a society having a mutual benefit fund, were not numerous. But what poor there were, we are assured by historians, were faithfully attended to in accordance with the precept of Hippocrates. Inscriptions show that it was an obligation that was gracefully and generously fulfilled. In the Roman Empire, "no Roman till Pliny's time had ever vouchsafed to practice physic; that office was only performed by Greeks," says Montaigne, in his Essays, "and medicine, therefore, was in the hands of the slaves. In order to attract the Greek physicians to Rome, Caesar gave them the jus Quiritium, and afterward Augustus exempted them from taxation." Under the superintendence of the archiatri, Romans later became practitioners, the first physician bearing the title being Andromachus the medical adviser of Nero. During the reign of Nero the archiatri were divided into two classes, the physicians of the different quarters of the city, archiatri populares, and the physicians of the palace, archiatri palatini. The former were assigned to the relief of the poor, and each city was provided with five, seven or ten, according to its size. Rome had fourteen, besides one for the vestal virgins and one for the gymnasia. The latter, the sancti palatini, were men of elevated social position, and of high rank, not only in the exercise of their profession, but as counsellors of the government. Both were paid salaries and were allowed special immunities and exemptions. Later on, in the time of Hadrian and Antoninus, such concessions were made still more liberal, and the chief archiater ranked as a vicegerent. While the populares were obliged to attend their poor patients gratis, they were allowed to receive fees from the rich. They were not appointed by the municipal authorities, but were elected by the people, and while their office was less honorable than that of the palatini, it was more lucrative. In the time of Vespasian they had a retiring pension. According to Pliny, at the beginning of the imperial reign eminent physicians made 250,000 sesterces, or about $9750 per annum and Quintus Stertinius, the favorite of the Emperor Claudius, "was content with the honor of serving the Emperor at the rate of 500,000 sesterces ($19,500) per annum, though his fame was such that he might have made 600,000 sesterces, or $25,000 in private practice." Today, in the Vatican, "among the clustered family of the Caesars," may be seen a statue of Musa, the physician of Augustus, placed among "his family group of bronze and marble memorials as one of the highest honors he could bestow."