Quintus Horatius Flaccus, has been a great source of knowledge as well as inspiration for successive generations of scholars and researchers of antiquity. The literature on this poet is less to say abundant, both in Poland and abroad, so that I don’t even attempt to cite it here. Horace was an attentive observer of the world, involved in the life of the state and his friends, and he possessed exquisite literary skills that allow the reader to see the poet’s development and transformation, as well as to learn about the life of the inhabitants of ancient Rome, depicted sometimes in more melancholic and at other times in more witty manner of a satirist. In his works one can find a great many, sometimes not entirely clear, references to the life of the people during the early Roman Empire, including the social structure, art, literature, customs, cuisine, travel, social administration, but also the smoke, din and noise of the imperial capital. In this article, I would like to take a closer look at his works in terms of the medical allusions they contain and, above all, the diseases he indicated as the ones that plagued himself and his contemporaries to such an extent that they were worth being reflected even in poetry. This is not an easy task, as in the impressive number of texts written by Horace, none are devoted to medical issues. I must point out that, for such a legacy, the passages on health and medicine are not very numerous in Horace’s works, but their number and content seem sufficient to make it worthwhile to take a closer look at them.^[1]

Numerous of Horace’s medical references are very detailed and give clues as to what health problems plagued Augustan Rome in particular.^[2] His references and knowledge are not entirely scientific,^[3] but rather deal with such aspects of human health as any intelligent layman living at the time could know and understand. The diseases and the symptoms he mentions can be divided into few general, though modern, categories. Among the various health problems we encounter gastrointestinal, internal, ophthalmological, dermatological, orthopaedical, perinatal or psychological disfunctions. All of them seem an indispensable element of human life, afflicting both the rich and the poor, that not only constitute human vulnerable body, but also affect human state of mind and form the society of an early Imperium Romanum.

Health problems of gastrointestinal origin

Stomach problems were very common in ancient Rome (Harper 2021: 97–103). They also had different origins. Above all, they were caused by poor hygiene and bad eating habits. In Satire I.5, in which Horace makes a reference to a trip to Brundisium (See Musurillo 1955: 159–162; Gowers 2013: 48–66), he writes about health problems (his own or maybe his companion Virgil), that may be a result of drinking dirty water.

Hic ego propter aquam, quod erat deterrima, ventri
indico bellum…
(Ser. I.5.7-8)

The problems with water, especially during trips, which route passed through the swamps,^[4] must have been a cause of a great deal of various inconveniences. Although it is unclear in Horace what specific diseases were caused by the lack of sanitation. Due to the structure and distribution of water, hygiene, and population density, these were probably: deadly dysentery, typhoid and other oral and fecal parasites (nematodes, tapeworms) (Classen, Bastable 2003; Lo Cascio 2001). In the same poem, i.e. during the same journey, the poet mentions also that he suffers from stomach problems, which we might consider to be some kind of indigestion, and this prevents him from taking part in the pastimes he could indulge in were it not for the health problems that plague him, as it might be read from this poem, constantly.

lusum it Maecenas, dormitum ego Vergiliusque;
namque pila lippis inimicum et ludere crudis.
(Ser. I.5.49)

According to Horace, stomach revolutions were also of other origins. They could result from overeating and mixing different types of food. In Satire II.2, in which the poet extols the virtues of a simple and moderate life that gives man health and contentment, he takes the opportunity, in this piece praising simple and moderate living, to hint at the lack of modesty and moderation in eating and drinking, which must have been common among the wealthy and exposed them to various ailments, a fact that did not escape Horace’s attention. Given that he himself was not one of the poor and maybe immoderate in consumption, as evidenced at least by the stature attributed to him,^[5] he may have known this problem from the autopsy, and this satire not only ridicules others but also is likely to contain some autobiographical allusions:

(…) quamquam
putet aper rhombusque recens, mala copia quando
aegrum sollicitat stomachum, cum rapula plenus
atque acidas mavot inulas.
(Ser. II.2.41-44)

Another gastric problem that Horace points out in his works are ulcers of the digestive system, a condition obviously made worse by an unhealthy, fatty and indigestible diet. This must have been an affliction quite common among the ancient Romans, since even the poet is aware not only of their occurrence, but also of the nibbly consequences of neglecting treatment and failing to implement remedial measures. According to the Roman poet, untreated ulcers, as they could lead to more serious conditions, should neither be hidden, nor ashamed of, as it was an unquestionable way to hurt yourself, what is put in such words in one of his Epistles (I.16.24: stultorum incurata pudor malus ulcera celat).

Another disfunction related to the digestive system that the poet mentions is constipation. This problem appears in Satire II.4, in which the poet writes about Roman cuisine and the pleasures of the palate. He is aware, however, that various diseases are associated with the consumption of fancy food.

Aufidus forti miscebat mella Falerno:
mendose, quoniam vacuis mittere venis
nil nisi lene decet; leni praecordia mulso
prolueris Melius. Si dura morabitur alvus,
mitulus et viles pellentobstantia conchae
et lapati brevis herba, sed albo non sine Coo.
(Ser. II.4.24-29)

Internal medicine issues

People in the time of the Roman Empire also suffered from many internal ailments. Horace mentions that, unfortunately, illnesses can happen to any person and are, as it always was, a challenge to them, but they should be prevented and, when they do happen, dealt with as quickly and effectively as possible. The poet writes about diseases of the kidneys or chest. People suffer from various pulmonary ailments. This is mentioned by Horace in Epistle 7, in which he explains to Maecenas about his poor health, which keeps him away from Rome. Let this one give him strong lungs if he can, for the poet feels too old and sick to return to Rome. The prevalence of diseases of the lungs and kidneys is also confirmed by another passage of Horace’s poetry, in which the well-known physician in Rome, Crater, also tends towards such a diagnosis.

“non est cardiacus” Craterum dixisseputato
“hic aeger”. recte est igitur surgetque? negabit.
[quod atus aut renes morbo temptentur acuto]…
(Ser. II.3.161-163)

Pain in the heart area and pulmonary problems can still be read about in Satire II.3.28-29 (in cor/traiecto lateris miseri capitisve dolore) and in Satire I.9.32 where laterum dolor et tussis are recognized as symptoms of pleuritis or the beginning of tuberculosis.^[6] In one of the Epistles (I.6), in which Horace shows Numicius the secret of happiness, the poet also makes a reference to illness. In lines 28-31, the poet admonishes that, just as in the case of bodily diseases we immediately seek cure and rescue, such a remedy in the case of diseases of the soul is virtue. It is here that he mentions diseases of the kidneys and lungs, which can not only run very rapidly, but can also lead to death.

si latus aut renes morbus temptantur acuto,
quaere fugam morbi.
(Epi. I.6.28-29)

In Epistle I.7, in turn, the poet, explaining to the Maecenas his long absence from Rome, explains this situation by poor health, including lung disease, helped by his prolonged stay in the countryside at Sabinum. Of course, he could have gone to other places known to the Romans of the time for a cure (discedere), but staying at the estate given to him by Maecenas was sufficient for this purpose. He would love to spend time with his friend, but this is not possible because no one has the power to give him back his former health, appearance and joy of life.

quodsi me noles usquam discedere, reddes
forte latus, nigros angusta fronte capillos,
reddes dulce loqui, reddes ridere decorum et
inter vina fugam Cinarae maerere protervae.
(Epi. I.7.25-28)

The problem that Horace’s fellow citizens faced also concerned various illnesses, which manifested themselves by means of fever, chills, pain, or at least a runny nose or cough (tussis; Ser. I.9.30). In the first of his Epistles, Horace explains why he stopped writing lyric poetry at his age. After praising the consolation offered by philosophy, he stresses with a touch of pathos that in his time, as in ours, the philosopher’s peace of mind and equilibrium could be disturbed by the misfortune of a simple respiratory infection.

liber, honoratus, pulcher, rex denique regum
praecipua sanus, nisi cum pituita molesta est.
(Epi. I.1.107-108)

Among the diseases associated with the nose, Horace mentions polyps. It is difficult to determine clearly whether it is of a medical nature or more of an aesthetic problem, which could have been nodule-like growths in the mucous membranes of the nose often caused by chronic inflammation. Horace mentions them twice rather as a cosmetic defect (Ep. 12.5: polypus an gravis); Ser. I.3.40: polypus Hagnae).

In ancient Rome we can also find parasitic and infectious diseases. One of such diseases is malaria, accompanied by chills and high fever. The presentation may include headache, shivering, joint pain, vomiting, jaundice, retinal damage, and convulsions. Horace mentions frigida quartana (Ser. II.3.290) in which attacks of fever occur every 72 hours.^[7] In summer and autumn, malaria, transmitted by the fork-tailed mosquito, very often proved fatal. Unfortunately, it was very deadly. It was a problem of wetlands that spread in central and southern Italy. Malaria had very serious consequences for survivors: stunted growth in children, weakened immunity, it led to rickets, and tuberculosis. Malaria and its symptoms are referred to in another passage of Horace’s Satires. In Satire I.1 the poet writes:

at si condoluit temptatum frigore corpus
aut alius casus lecto te adflixit, habes qui
adsideat, fomenta paret, medicum roget, ut te
suscitet at reddat gnatis carisque propinquis?
(Ser. I.1.80-83)

Fever also appears elsewhere in Horace’s works. In his Satire II.3, the poet’s longest poem of this type, in which he attacks the Stoic philosophers and their attitude to life, he mentions a mother who herself makes her child ill by believing in various superstitions.

(…) mater delira necabit
in gelida fixum ripa febrimque reducet,
quone malo mentem concussa? timore deorum.
(Ser. II.3.293-295)

This passage testifies to Horace’s awareness of the causes that can provoke illness and indicates the beliefs and convictions of the people living in his time. Magical medicine existed in Rome in ancient times and people found it difficult to give up this belief, which had been passed down from generation to generation (Scavino 1998). This is by no means to say that doctors in those days were infallible and proficient in treatment. Hence Horace’s remark about how it may not have been the doctors at all, but chance that made the child well (Ser. II.3.292-293: casus medicusve levarit/aegrum ex praecipiti:).

Another contagious disease that the poet mentions is jaundice. It is clear that at the time when the poet lived, people knew that some diseases were contagious and easily transmitted from person to person, hence they avoided contact with infected people. Horace calls the hepatitis morbus regius (the royal disease^[8]) (Ars 453), because of the enormous cost of its treatment.

In this point it is worth mentioning a disease that appears several times in Horace’s works. It is gout of the joints of the foot, the so-called podagra. In ancient times, this term denoted any spontaneous, very severe pain in the leg and was often confused with rheumatoid arthritis. The term already appears in Hippocrates of Kos, as well as in Aristotle and Galen. In antiquity, gout was also called “Diana’s disease” because hunters in particular suffered from it (a meat diet promoted the accumulation of uric acid), hence the name refers to hunting (podos – foot, agra – hunting; Zieliński 2004; s.v. podagra). In Horace’s time, the term gout was certainly not associated with disorders of urate metabolism. The poet, however, in his poems very correctly identifies the characteristics of gouty arthritism that distinguish it from other inflammatory joint diseases. Horace makes it clear that pain increases rather than decreases when treated with a warm compress. In another place where the poet refers to gout, he notes that it leads to disability, of course, as it is Horace’s custom, attributing the disease to those who live in wealth and drink excessively:

qui cupit aut metuit, iuvat illum sic domus et res
ut lippum pictae tabulae, fomenta podagram,
auriculas citharae collecta sorde dolentis.
(Epi. I.2.51-53)

In another fragment Horace furthermore includes gout in a short catalogue of causes that can lead not only to disability but also to death and writes:

< hunc neque dira venena nec hosticus auferet ensis
ec laterum dolor aut tussis nec tarda podagra:
garrulus hunc quando consumet cumque: loquaces,
si sapiat, vitet, simul atque adoleverit aetas.>
(Ser. I.9.31-34)

Another problem connected with arthritis was cheragra, that is the problem with hands. It appears few times in Horace’s works. In a passage in which the poet writes as follows:

scurra Volanerius, postquam illi iusta cheragra
contudit articulos, qui pro se tolleret atque
mitteret in phimum talos…
(Ser. II.7.15-18)^[9].

Among the general diseases we must mention dropsy – hydrops. This is a historical medical term for a symptom involving the accumulation of excessive fluid in the tissues and natural cavities of the body. It does not appear in modern medical terminology. It can probably be regarded as a synonym for generalised oedema (Latin: anasarca). Horace compares precisely greed to dropsy, which makes a man drown in so much superfluity and wealth that he is unable to use.

crescit indulgens sibi dirus hydrops
nec sitim pellit, nisi causa morbi
fugerit venis et aquosus albo
corpore languor.
(Od. II.2.13-16)^[10]

Ophthalmological problems

Horace pays a lot of attention to problems related to vision. This is not just a matter of problems relating to visual impairment, but also ailments indicative of infection. The frequent references to this subject should remind us that a high rate of inflammatory eye diseases was typical of the Mediterranean countries, before the era of antibiotics. Horace refers to problems associated with inflammation of the eyes as lippus. This type of disease did not spare Horace himself, who writes about it in Satire I.5. It may have been caused by arthropods.

hic oculis ego nigra meis collyria lippus
inlinere…
(Ser. I.5.30-31).

In Satire I.2 Horace mentions Plotius Crispinus who lived during the 1^st century BC and was derided by him as a ‘mediocre poet’ and also reported that the philosopher suffered from conjunctivitis (Sat. I.2.120: ne me Crispini scrinia lippi/conpilasse putes). The problem of diseased eyes also appears in Satire I.3. In this work, Horace mocks the Stoics, who treated even small weaknesses as the greatest crime. He metaphorically uses a common affliction to mock the tendency, characteristic of humans, to see others’ faults and not necessarily their own.

Maenius absentem Novicum cum carperet, “heus tu”
quidam ait “ignores te an ut ignotum dare nobis
verba putas?” “egomet mi ignosco” Maenius inquit.
stultus et inprobus hic amor est dignusque notari.
cum tua pervideas oculis mala lippus inunctis,
cur in amicorum vitiis tam cernis acutum
quam aut aquila aut serpens Epidaurius? at tibi contra
evenit, inquirant vitia ut tua rursus et illi.
(Ser. I.3.21-28)

Horace still mentions the lubrication of diseased eyes in the Epistle I.1.28-29.

Another problem the ancients had to deal with was strabismus. Horace mentions it in Satire I.3, where he lists it among human aesthetic defects, rather than in medical terms (Ser. I.3.44-45: strabonem appelat paetum pater).

Dermatological problems

A number of dermatological problems were also among those that plagued the ancient Romans as well as modern man. Skin problems, due to the fact that they were easily noticeable and often appeared, also found their place in literature. In Satire I.3 Horace mentions various defects (vitium), such as the aforementioned polyps (Ser. I.3.40), or warts appearing on the skin (Ser. I.3.74: verruca).

An interesting reference to warts appears in a hilarious passage in which one wag ridicules another by saying: It is a good thing they took that horn off your head. What a holly terror you’d be if you still had that, considering how wild you act without it. (As a matter of fact, he did have quite an ugly scar on the left side of his shaggy brow). After making some further cracks about his ugly mug and his “Campanian disease”, Messius told him he should take the role of the Cyclops in the dance the shepherds do, for which he wouldn’t even need to put on a mask:

(…) caput et movet. ‘o tua cornu
ni foret exsecto frons,’ inquit, ‘quid faceres, cum
sic mutilus minitaris?’ at illi foeda cicatrix
saetosam laevi frontem turpaverat oris.
Campanum in morbum, in faciem permulta iocatus,
pastorem saltaret uti Cyclopa rogabat:
nil illi larva aut tragicis opus esse cothurnis.
(Ser. I.5.58-64)

In this fragment Horace mentions the so-called Campanian disease, which involved the appearance of warts on the face. Their radical removal, cauterisation or both may explain the appearance of scars on the face of Messius.^[11]

In another place, Horace mentions that moles sometimes appear on people’s skin (Ser. I.6.67: inspersos reprendas corpore naevos) and another cosmetic-medical defect connected with the scalp, i.e. dandruff (Ser. II.3.125-126: caputque/coeperis inpexa foedum porrigine). The next, more medical than cosmetic inconvenience, caused by parasites, was namely scabies, which most common symptoms are severe itchiness and a pimple-like rash. According to Horace, people avoid the infected because they are aware of the risk of infection.

ut mala quem scabies aut morbus regius urget
aut fanaticus error et iracunda Diana,
vesanum tetigisse timent fugiuntque poetam
qui sapiunt, agitant pueri incautique sequuntur.
(Ars 453-456)

Orthopaedic/genetic diseases and birth defects

It is difficult to speak of any specific orthopedic and traumatological diseases. However, we can find references in Horace that suggest the existence of certain symptoms. In Satire I.3 there are, of course, mocking descriptions of human defects, among which the poet also mentions some infirmities, such as crooked feet (varum) (Ser. I.3.47), legs bent inwards (distortis cruribus) (Ser. I.3.47), a deformed foot (scaurum) (Ser. I.3.48), bow-legged, on bowed ankles (pravis fultum male talis) (Ser. I.3.48). Varus, Pullus, Scaurus were names of important Roman families, which most probably came from similar defects, congenital or acquired, in one or several ancestors. Diseases may also include dwarfism (Ser. I.3.45: male parvos).

Mental/neurological diseases

It is difficult to distinguish between real pathologies and the poet’s opinions about various people, their believes and convictions. Horace repeatedly finds insanity in human behaviour and recognises it as a disease.

si male rem gerere insani est, contra bene, sani:
putidius multo cerebrum est. mihi crede, Perelli
dictantis, quod tu numquam rescribere possis.
audire atque togam iubeo conponere, quisquis
ambitione mala aut argenti pallet amore,
quisquis luxuria tristive superstitione
aut alio mentis morbo calet: huc propius me
dum doceo insanire omnis vos, ordine adite.
(Ser. II.3.74-81)

Another mental problem could have also been depression, described by doctors such as Hippocrates, Galen and mentioned also by Celsus. Horace portrays himself as a difficult patient, a victim of depression who resists all attempts at therapy:

sed quia mente minus ualidus quam corpore toto
nil audire uelim, nil discere, quod leuet aegrum,
fidis offendar medicis, irascar amicis,
(Epi. I.8.7-10)

As I have shown above, we can find quite a few references to medical issues in Horace, both in earlier and later works. The older the poet was, the more such remarks were made, which is simply due to the fact that he had more knowledge and experience, and to the fact that he probably had more and more ailments himself, as well as witnessed the various illnesses that plagued his contemporaries, both his friends and those he criticised so passionately. Hence, diseases related to the gastrointestinal tract, heart, lungs, skin, eyes or genetic and mental illnesses occur. Obviously, we cannot read the medical references in isolation from the context of the whole work, as they often constitute a metaphor or are intended to have a stronger impact on the reader. This means, no more and no less, that Horace had to refer to diseases that were common and well-known at the time in order for the allusions and comparisons to achieve their intended literary and moralising effect, since some of the suggestions constitute a criticism of the common behaviour of ancient Romans in the face of illness. Horace gives us some insight into his contemporary society, including medical views, causes of illness or cures, which were not the subject of this article and are themselves an interesting material for research.

^* Dr Adriana Grzelak-Krzymianowska is a researcher at the Department of Classical Philology at the University of Lodz. In 2002 graduated from the Faculty of Classical Studies at the University of Lodz on the basis of thesis on Lucretian anthropology. In 2012 obtained her Ph.D. with her dissertation on Lucretian ethics. Author of articles in Polish, English, Latin and Italian. Organiser of the conference: Rome and Iberia. Diversity of Relations from Antiquity to Modernity. Scientific interests: Epicurean philosophy in Rome, travel and resorts of ancient Rome, medical issues in Latin literature.

e-mail: adriana.grzelak-krzymianowska@uni.lodz.pl

© by the author, licensee University of Lodz – Lodz University Press, Lodz, Poland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution license CC-BY-NC-ND 4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Received: 03.04.2023. Verified: 04.05.2023. Accepted: 14.05.2023.