Role Of The Healer And ?Payment? In Ancient Times Essay, Research Paper
The Role of The Healer and “Payment” in Ancient Times
It is evident through ancient writings that forms of healing were present as far back as is recorded. Medicine, healers and forms of payment seem to have played an important role in the past, like they do now. However, over the centuries changes have taken place. From the time of Galen in ancient Rome to the 14th and 15th centuries in England the relationships between doctors and patients have evolved, along with the way medicine is defined and practiced. Specifically I would like to focus on forms of payment and their effect on the doctor-patient relationship and how payment and the practice of medicine have changed over time. These changes led to a healer-patient relationship that was not as personal as it was in the time of Galen. Instead of the healer playing the role of a friend helping his neighbor, we find that being a doctor became a form of trade and the doctor started selling his services for money.
The relationship between a doctor and his patient is a theme that is present in many of the writings we have from ancient times. There was a personal knowledge of the patient and an ongoing relationship with them that most doctors nowadays do not have with their own patients. Patients in our day and age walk in to a doctor’s office and wait for a long period of time, and then see a doctor for a few minutes. In the ancient world the healer would actually come to the house and perform services for the patient there (Prognosis, 170). Healers have always tried to provide an explanation to their patient while treating their illness. However, in the time of antiquity the shared closeness of patient and healer gave the patient an added assurance that their trusted friend or neighbor had their best interests in mind.
There is also evidence of this type of relationship in the Hippocratic society. The writings of Galen describe how he was treated Eudemus, a neighbor of his, and how he came to visit him every night (Galen, 77-79). Galen was with this man through every step of his illness. One interesting thing is the way the man sits and waits for Galen every night. After Galen takes his pulse, Eudemus hangs on Galen’s every word and feels better after he has talked to him. This shows again the close relationship between healer and patient and how Galen’s presence and prognosis gave him peace of mind, which promotes healing. Other writings, such as “Epidemics, Book 1” in which there are day-by-day accounts of each patient’s condition also give us a sense of the doctor’s intimate knowledge of the person they are treating (Epidemics, 44-45). These doctors recorded every detail of sickness and any and all symptoms that the patient reported to them. These doctors wanted to try their hardest to heal their patients or if nothing else try to tell them when they would die. It appears that healers took better care of each individual and focused more of their time on each sick person.
I have mentioned that the relationship between healers and patients in ancient times was different and therefore payment in ancient times was also different. Many times, healers in ancient Rome were not paid at all, or if they were paid, payment was usually not in the form of money. Vivian Nutton says in his article that, “A doctor was a person, male or female, who carried out medical treatment for a fee, or who, like Galen, devoted much of his time to healing, even if he never actually made any monetary charge but merely received presents” (32). This proves that many times doctors did not heal for the money but to learn and to heal for the satisfaction of helping others. Galen himself does not specifically mention payment but there was for him the satisfaction of knowing that he had cured Eudemus and had predicted what happened to him better than all the other doctors. By doing this he became better known in his practice.
Being well known was important because as Vivian Nutton tells us in “Patients and Practitioners”, there were many doctors to compete with. Anyone could declare himself or herself a doctor, “There is (here) no examination, no qualifying-test or oral, only the doctor’s own attestation before a magistrate that he is a doctor” (Nutton, 30). Also, knowledge was easily achieved because of the accessibility of medical ideas and the relative absence of any medical terms and language. This enabled medicine to take a prominent place in the general literary culture (Nutton, 32). Nutton also says that, “participation of all classes throughout the ancient world proves beyond any doubt that medical knowledge was by no means confined to those who called themselves doctors” (Nutton, 33). What Nutton is trying to tell us is that a doctor could be anyone in ancient times and therefore in order to become a paid and prestigious doctor you had to be able to successfully heal the patients.
Even into some of the later centuries this “competition” between doctors seemed to be evident. Carole Rawcliffe talks specifically in her article, “The Profits of Practice: the Wealth and Status of Medical Men in the Later Medieval England”, how physicians in the later Middle Ages came by payment in two ways: either by money, if they were treating nobility, or in exchange for something else like food or a place to live and other types of goods. In order to treat the Royalty and actually earn a decent amount of money, it was necessary to earn the trust of the laymen and then work your way up to wealthier patients (62-65). This was necessary because many times even though, “an agreement…establishing in precise detail when and how a mutually acceptable fee was to be handed over”, that sum was never paid. We know this through the many lawsuits brought on by the doctors (Rawcliffe, 65). So the doctor in the Middle Ages in England really had only one option if they wanted to make a descent living and that was to become one of the best and most well known doctors so that they could treat the wealthier patients.
This subject is brought up again in Rawcliffe’s article along with a few other issues. One is the fact that because doctors were trying to work their way up on the social ladder to treat wealthier patients it is a good assumption that by this time in the world doctors were starting to lose the closeness of the doctor-patient relationship found in a small community. I make this assumption based on the fact that in ancient times when there was a close doctor patient relationship it was because the doctor knew his patients. When communities started growing it became more difficult to know everyone in it and keep that same kind of close relationship. Also, when doctors started to earn a living their pursuit of the wealthiest patients probably limited their chances of a close relationship with them. There is also evidence of this when it tells us that there were many lawsuits brought on by doctors because people did not pay their bills (Rawcliffe, 65). I would say as a general rule in most societies usually a person does not sue a close friend or neighbor for not paying so this indicates to me that by this time doctors had started practicing on more than just the locals around them.
The doctors that I just mentioned who were the personal physicians to kings and queens may not have had the high status in society that one may imagine they would. If you were to read the writings of Galen you would probably get the impression that doctors were respected and high on the social ladder because of the way Galen makes it sound like he is well respected in society. But, according to Vivian Nutton even the wealthiest and most well known physicians were not always thought of as coming from the right social bracket. “In a society such as the Roman Empire, where landed wealth and the ability to enjoy a life of ease and honour…were the marks of a true aristocrat, any connection with medicine was to some extent demeaning” (Nutton, 39). This statement tells us that the physician was not of incredibly high status in the ancient society. Some may have become very rich but medicine was not as respected a subject as it became in later centuries.
In these later centuries “payment” was starting to become more of a set sum for doctors (Rawcliffe 65). Yet with many lower class patients “payment” still could be a variety of items. In a sense healing was becoming more of a trade than a service. The doctors in this later medieval time period traded their services for food, shelter and perhaps other services. But before this time in the writings of Galen and Hippocrates “payment” was not always received and those who were doctors were not in it just for the money. Doctors in ancient times seemed to care more about their patients and their relationship with them, it was not all about how much money they could get or what they would receive for healing each person. This is what it had become in 14th and 15th centuries. Even in the 12th century we find healing as a free service, first to the poor and then to anyone who was in need (Miller, 719). It is also evident that becoming a doctor in ancient times was not a way to make a lot of money; it was at best a “minimum wage” job.
So, the methods of payment have changed from the time of ancient Rome through the 14th and 15th centuries. At first ancient people were willing to heal their friends and neighbors for very small fees in various forms, then as we move through time people started paying for services of healing. As the relationship between the patient and doctor got weaker, the role of a doctor changed too. In the middle ages we start to see the development of doctors as being specific people with more knowledge of medicine that the average man. Not just anyone was a doctor. The people started making rules for who could practice medicine, and only those who succeeded got to advance as trusted doctors. As the link between doctors and patients became more separated, the forms of payment became more defined. It was no longer two men trading services as neighbors; it was a professional that a patient had to pay in order to receive treatment. Doctors started to practice medicine for the money and not just for the satisfaction of healing patients (Rawcliffe, 65-70).
As you can see the role of patient and healer used to be of one neighbor helping another or of a doctor healing for the satisfaction of healing and for his own learning and understanding of disease. But over time that has changed into a form of trade, a doctor selling a service for money. The healer of the ancient times had so much more personal knowledge of their patients that they would be able to not only heal their physical aliments but also give them hope and set them at ease. Therefore, forms of payment have changed from ancient Rome through the 14th and 15th centuries along with the relationship of healer and patient.
1. Carole Rawcliffe, “The Profits of Practice: the Wealth and Status of Medical Men in Later Medieval England.” Social History of Medicine 1988, 1: 61-78.
2. Galen, On Prognosis. Edited and translated with an introduction by Vivian Nutton (Berlin: Akademie Verlag, 1979), pp. 69-101.
3. G.E.R. Lloyd (ed), “Epidemics, Book 1.” Hippocratic Writings (New York: Penguin, 1978), pp. 29-47.
4. Timothy Miller, “The Knights of St. John and the Hospitals of the Latin West.” Speculum 1978, 53: 709-33.
5. Vivian Nutton, “Murders and Miracles: Lay Attitudes Towards Medicine in Classical Antiquity.” In Roy Porter (ed), Patients and Practitioners: Lay Perceptions of Medicine in Pre-Industrial Society (Cambridge: Cambridge Univ. Pr., 1985), pp. 23-53.
6. G.E.R. Lloyd (ed), “Prognosis” Hippocratic Writings (New York: Penguin, 1978), pp. 170-3.