Collectanea Philologica, XXVII, 2024: 113–124
https://doi.org/10.18778/1733-0319.27.08

Adriana GRZELAK-KRZYMIANOWSKA ^*

Uniwersytet Łódzki

https://orcid.org/0000-0002-6584-3987

Why Do We Get Sick? Some Remarks by Horace on the Causes of Human Ailments

Quintus Horatius Flaccus, perhaps the most famous Roman poet, vividly portrayed for us in his works both a picture of contemporary society and the world of his thoughts, beliefs and reflections. Among the many well-developed motifs in his work, there are some that have not yet become the subject of in-depth research. These include references of a medical nature. The purpose of this article is to point out places in Horace’s works where he does not so much mention illnesses, but where he gives the causes that make man decline in health. It can therefore be considered that, besides causes beyond human control, the poet’s portrayal of the repertoire of human vices and inappropriate lifestyles is intended to show people that they can improve their existence both physically and spiritually. Horace, by showing the causes of certain diseases and related physical and spiritual afflictions, simultaneously shows man the path to follow in order to be healthy and happy.

Keywords: Horace, medicine, Roman medicine, disease, health, ancient Rome
Słowa klucze: Horacy, medycyna, medycyna rzymska, choroba, zdrowie, starożytny Rzym

Perché ci ammaliamo? Alcune osservazioni di orazio sulle cause dei disturbi umani

Quinto Orazio Flacco, forse il più famoso poeta romano, nelle sue opere ci ha rappresentato in modo vivido sia il quadro della società contemporanea sia il mondo dei suoi pensieri, delle sue convinzioni e delle sue riflessioni. Tra i molti motivi ben sviluppati nella sua opera, ve ne sono alcuni che non sono ancora diventati oggetto di ricerche approfondite. Tra questi vi sono riferimenti di natura medica. Lo scopo di questo articolo è quello di evidenziare i luoghi delle opere di Orazio in cui egli non menziona tanto le malattie, ma fornisce le cause che fanno decadere la salute dell’uomo. Si può quindi ritenere che, oltre alle cause che sfuggono al controllo dell’uomo, la rappresentazione del repertorio dei vizi umani e degli stili di vita inadeguati da parte del poeta abbia lo scopo di mostrare all’uomo che può migliorare la propria esistenza sia fisicamente che spiritualmente. Orazio, mostrando le cause di alcune malattie e le relative afflizioni fisiche e spirituali, indica contemporaneamente all’uomo la strada da seguire per essere sano e felice.

Parole chiave: Orazio, medicina, medicina romana, malattia, salute, Roma antica

Quintus Horatius Flaccus, the most recognised Roman poet, has been a constant source of knowledge as well as inspiration for successive generations of scholars and lovers of antiquity. The literature on this poet is abundant, both in Poland and abroad. It would be difficult to even attempt to collate it here.^[1] Horace was an excellent observer of the world around him, he was involved in the life of the state, he had a large circle of acquaintances and friends, and he possessed extraordinary 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 an atmosphere of melancholy and at other times highlighted by the witty repartee of the 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. Quintus Horatius Flaccus, who lived between 65 BC and 8 BC, partly during the reign of Octavian Augustus, vividly depicted the panorama of his contemporaries in his poems, including the social structure, art, literature, customs, cuisine, travel, social administration, army, 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 causes he indicated for the various health ailments that plagued himself and his contemporaries to such an extent that they were reflected even in poetry. This is not an easy task, since in the vast number of texts written by Horace, none are devoted to medical issues; they often appear in the margins of the problems addressed, are treated metaphorically, or in fragments. 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.^[2]

First of all, the question must be answered as to where Horace could have obtained his information on medical subjects and whether he had such knowledge at all. It is known that the poet, despite his origins,^[3] received a thorough education for the time in which he lived. This education included knowledge of Latin, Greek and literature. After his education in Venusia, he moved with his father to Rome, where, under the guidance of teachers, he studied, among other things, the works of Homer and their translations (Sat. I, 6, 72-75). We know little about the further stages of Horace’s education. He went to Athens around 45, as did representatives of the Roman elite such as Cicero’s son and Marcus Valerius Messala (Od. III, 21, 7-12). The poet studied philosophy, of which he was most interested in ethical problems as well as concepts of cognition. During his two years trip to Greece, Horace also had the opportunity to become acquainted with the rich works of Greek poets, whose works were not readily available in Rome (Harris 1999: 57).^[4] Further turbulent political life forever left its mark on the poet. He did not return to Rome until 42.

His situation forced him to take up professional work in order to survive a difficult time after the death of his father and the loss of his income and property. Horace managed perfectly well, as we know from his curriculum vitae. He held the post of quaestor (scriba quaestorius), which enabled him not only to support himself, but also to devote himself to the occupation that was to consume the rest of his life, namely writing (Fraenkel 1957: 14–15).^[5] The acquaintance of Maecenas, which most likely occurred around 38 BC (Sat. II, 6, 55-61) and his intimate relationship with Octavian Augustus (Suet. Vita Hor. 10-16) allowed him to lead a quiet life and devote himself to literature.^[6] Let us try, then, to answer the question of where Horace might have acquired his knowledge of medical subjects. He did not acquire it during his many years of education in Italy, nor during his studies in Greece, where he probably explored ethical issues above all (Wójcik 1986: 16). We know nothing about how he came, if he did, into contact with Greek medical texts, although, given that Antiochus of Ascalon, who taught philosophy at the Academy during Horace’s stay there, mentioned one of the Greek doctors who practised in Rome, Asclepiades of Bithynia (II/I BC),^[7] Horace may have had the opportunity to become acquainted with the texts and teachings of this doctor.^[8] This was a period when medicine had lost its religious character in Rome and there were secular medical families in the cities forming something like schools, increasingly accepting students from outside the family.^[9] Education took place through contact with a master, the study of prescribed writings, and the practice of medicine. In addition, there was constantly in the mentality of the Romans a popular medicine, practised by people with more, less or sometimes no training at all. The distrust of the Romans caused them to refer to well-known figures in the healing process, such as Cato the Elder.^[10] Over time, physicians grew in importance and medicine became an extremely important field of knowledge.^[11] This is evidenced, for example, by the interest in it shown by many well-known authors of the imperial period, namely encyclopedists such as Aulus Cornelius Celsus and Pliny the Elder or physicians such as Pedanius Dioscorides. Horace, remaining in contact with Augustus, who was exceptionally attentive to his health, certainly had the opportunity to get a glimpse of how doctors worked. Moreover, being an inhabitant of such a huge city, he saw every day, and perhaps to some extent felt at first hand, the health problems that certainly made people miserable in their daily lives. Moreover, he was among educated people and, as a secretary, he had access to all state documents and, over time, to the resources of the Roman libraries, which meant that he continued to expand his knowledge. Above all, he also possessed a sense of observation and a keen intelligence, which enabled him not only to draw various conclusions from what he saw, to summarise it skillfully, but also to weave elements from the life of the Romans into his works, which were probably very readable to them. You may not find sophisticated illnesses or expert advice in his poems, but you will undoubtedly find descriptions of the most common and characteristic ailments of the time and the causes that triggered them. Chief among these are weather and climate, food and drink, human lifestyle and activity, and emotional disturbances.

To begin with, it is worth looking at how the climate was shaped at the time when Horace lived. Research shows that the poet was fortunate to live in the so-called climatic optimum, that is, at a time when the climate was relatively warm, humid and, above all, stable.^[12] The diseases that were rampant in the Empire were regional or local (Harper 2021: 62–64; Ziegler 2016: 139–155).^[13] The poet therefore did not witness any spectacular epidemics or catastrophes worth mentioning in his opera,^[14] although he was certainly familiar with serious diseases from observation of his surroundings and from descriptions he knew from literature.^[15] The most troublesome issues for a Roman were the flooding of the Tiber and the associated proliferation of disease-bearing insects, and the hot and humid summers, which also led to the emergence of pathogens of all kinds. This seems obvious, as even Hippocrates himself wrote about the impact of climatic phenomena on human health (vide Marek 2013: 63–75). Weather-related issues are frequent in Horace’s works. They do not always result in content related to human health, but they reflect perfectly the prevailing conditions of the time. This allows us to reconstruct the circumstances that the Romans perceived as unfavourable to man’s health and spiritual state. Among the plethora of ‘climatic’ references, several passages tell us about the effect of weather on health. Among them, the poet mentions the seasons and their influence on the life, and perhaps more often the death, of many people.

The worst time to live in the city, according to Horace, was the late summer months. Such a pernicious weather prevailed in Rome itself, which had a population of almost 1 million coming from different parts of the Empire, that it became necessary to flee the capital to other places with better climatic and sanitary conditions in order to stay healthy. This was a typical practice for the wealthier social classes, who went to country or seaside villas away from the cities for these difficult months (Scheidel 2003: 162–163). There are various dangers associated with city life, especially during the summer months. It happened that Maecenas reproached the poet for spending the summer in the countryside, while he himself had to be in the city on business. Horace writes of what life in Rome was like at the time, bringing only febris et testamenta (Epi. I, 7, 9), or fever and death (vide Scheidel 1994: 151–175; Moscetti 1997: 78–85). Malaria spread by mosquitoes also contributed to many premature deaths,^[16] which plagued the Romans especially with heavy summer rainfall and the occasional flooding of the Tiber. He writes, for example, of a ‘daily’ fever mentioned before by Asclepiades of Bithynia, which bore the typical features of a fatal disease caused by a currently known unicellular protozoan parasite of humans Plasmodium falciparum (Sallares 2002: 220–223). A description of similar, albeit milder, symptoms will also appear in Horace (frigida quartana – Sat. II, 3, 290; febris – Sat. II, 3, 294; temptatum frigore corpus – Sat. I, 1, 80).^[17] According to the poet, the peak of mortality in summer was also a sign of intestinal and gastrointestinal diseases, which were contracted through food and water because of the lack of proper hygienic standards.

A high mortality rate in Rome was also recorded in autumn, from August to October, what did not escape the poet’s attention. With the phrase autumnusque gravis, Libitinae quaestus acerbae (Sat. II, 6, 21), Horace suggests that early autumn not only makes people fearful because it brings cold, but it is also the period when death takes its greatest toll. This is when man’s greatest enemy is the Auster (nocentem corporibus Austrum; Od. II, 14, 15-16), now known as the sirocco, which blows from the south from Africa or the Arabian Peninsula bringing clouds of sand dust from the Sahara and other deserts and the characteristic ‘bloody’ rains especially in southern Italy. Hence this wind is described by the poet as plumbeus (Sat. II, 6, 20), meaning heavy and oppressive, as it blew huge heavy clouds. With the oncoming cold and rain in late autumn and winter, colds and lung infections began to appear among the Romans, causing increased mortality among all age groups (Harper 2021: 100–102).

Related to climate and weather are the aforementioned issues of food and drink, which were spoiled or contaminated most often due to high temperatures and improper preservation and storage methods.^[18] The poet elaborates on the issues related to unhealthy eating, as it was obvious to both doctors and ordinary citizens that improper eating habits could contribute to the development of many diseases and ailments.^[19] Horace included among harmful and unhealthy foods products imported from distant regions such as Lucrian oysters (Lucrina conchylia), overseas fish such as flounder or parrotfish (rhombus aut scari), guinea fowl (Aphra avis), Ionian hawks (attagen Ionicus) (Ep. II, 49-60). Living in the first century BC, the author very sensibly draws the attention of readers and listeners to the fact that much healthier products are those from one’s own native or local production, from one’s own fields or prepared from one’s own animals, such as, for the Romans, olives from trees (oliva), sorrel leaves (herba lapathi), common mallow (malvae salubres), which helped with indigestion, roast lamb or goat (agna vel haedus).

It is not only unhealthy to eat exotic foods brought from afar, the poet warns, but also to mix certain foods together (Sat. I, 4, 126-127). This provokes indigestion, stomach problems, diarrhoea, physical and spiritual heaviness. Horace writes:

(…) nam variae res
ut noceant homini credas, memor illius escae,
quae simplex olim tibi sederit. at simul assis
miscueris elixa, simul conchylia turdis,
dulcia se in bilem vertent stomachoque tumultum
lenta feret pitvita (Sat. II, 2, 71-76).

In the same work, the poet points out that the consumption of food in excess also contributes to the development of gastric problems. In Satire 2 of Book II, in which the poet extols the virtues of a simple and moderate life that gives man health,^[20] he mentions the harmfulness of excessive eating to the stomach when he writes:

mala copia quando
aegrum sollicitat stomachum (Sat. II, 2, 42-43).

Overeating and its consequences were probably quite common in wealthy social circles, and at the same time became a grateful subject to be portrayed in works such as satires.

Access to clean water was another significant problem for the Roman Empire. Although clean water was supplied by aqueducts, in the summer water could be contaminated and excess water in heavy rainfall and flooding caused serious problems with mosquitoes. During the expeditions and journeys undertaken by the Romans, access to clean water was also a huge problem, as the roads ran through damp areas and marshes. Horace is aware of the possible harmful effects of drinking contaminated water. Drinking unhealthy, unpalatable water, the poet writes – can have similar effects to unhygienic eating. Horace, in his most famous and personal Satire 1.5, recalls his journey to Brundisium with Mecaenas and the poet Virgil. The route of their expedition included crossing the Pontine marshes by boat. There, suffering from stomach problems, he admonishes them to be careful with what they drink and eat:

hic ego propter aquam, quod erat deterrima, ventri
indico bellum, cenantis haud animo aequo
exspectans comites (Sat. I, 5, 7-9).

Although it is unclear what specific diseases were caused by the lack of sanitation. Due to the structure and distribution of the population, hygiene, and population density, these were probably: deadly dysentery, typhoid and other oral and fecal parasites (nematodes, tapeworms) (Harper 2021: 102).

Poor nutrition has sometimes made the ancient Romans also suffer from ulcers of the digestive system, a condition made worse by an unhealthy, fatty and indigestible diet. Untreated ulcers, in turn, could lead to more serious conditions and one should neither be ashamed of nor hide them. In this way the sick person harms himself. Horace notices:

Stultorum incurata pudor malus ulcera celat (Epi. I, 16, 24).

It is also most likely that constipation caused by the consumption of foods low in fibre and low in vegetables plagued the inhabitants of the Roman Empire (dura alvus: Sat. II, 4, 27).

Interestingly, Horace also links two other diseases, namely gout and dropsy, to a poor diet. In this point it is worth mentioning that gout appears several times in Horace’s works (Epi. I, 2, 52; Sat. I, 9, 32; Sat. II, 7, 15-16). 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 later will appear in Galen’s works. In antiquity, gout was also called ‘Diana’s disease’ because it touched upon hunters in particular, as a meat diet promoted the accumulation of uric acid, hence the name itself (podagra) refers to hunting (podos – foot, agra – hunting) (Zieliński 2004: 455). In Horace’s times, the term gout (chiragra/podagra) 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 (fomenta: Sat. I, 1, 80). In another place where the poet refers to gout, he notes that it may lead to disability, of course, as it is Horace’s custom, attributing the disease to those who live in wealth and drink excessively (Sat. II, 7, 15-18).^[21] Horace furthermore includes gout in a short catalogue of causes that can lead not only to disability but also to death (Sat. I, 9, 31-34). The other mentioned disease is 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 (anasarca). Horace compares metaphorically greed to dropsy, which makes a man drown in so much superfluity and wealth that he is unable to use (Od. II, 2, 13-16).

Further causes leading to various diseases of body and soul are those related to lifestyle and the various activities undertaken, or not undertaken, by man. We can lose our health if we live in filth and sloppiness (sordes; Sat. I, 6, 68) or frequent brothels or indulge in debauchery (mala lustra; Sat. I, 6, 68). Lack of exercise (Epi. I, 2, 34), refraining from the necessary strengthening of the body (Sat. II, 3, 153-154) or insufficient and poor sleep (Ars 7) may also contribute to the deterioration of people’s health.^[22]

The reasons for contracting various illnesses may also be spiritual or emotional in nature. According to Horace, who must have been familiar with the basic medical concepts of his times, which were dominated by belief in Hippocrates’ concept that physical illnesses and mood and personality disorders are related to an imbalance between the four humours (blood, phlegm, yellow bile and black bile), health problems can be triggered by strong feelings. Among these, the poet mentions rage, jealousy or greed (avaritia; Sat. I, 6, 68; Epi. I, 2, 52-58), which can disturb these very humour ratios. The poet explicitly links these feelings to bodily symptoms.

Cum tu, Lydia, Telephi
cervicem roseam, cerea Telephi
laudas bracchia, vae, meum
fervens difficili bile tumet iecur (Od. I, 13, 1-4).

Also noteworthy is the poet’s mention of the relationship between bodily and spiritual illnesses and their interaction with each other. In Letter 8 of Book I, 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).

The aforementioned causes that effect health in a negative manner are influenced by humans. Unfortunately, there are numerous diseases beyond their control. Such a condition, according to the poet, is for example the late old age (tarda senectus). It is true that people also die in their youth (Od. I, 28, 19), but since the mortality rate in Rome is very high,^[23] those who live to a ripe old age must reckon with deteriorating health. The poet himself is afraid of getting old and mentions that he would like to preserve his strength and sound mind even in old age (Od. I, 31, 17-20).

In conclusion, Horace, who had no medical training, as many of practicing doctors of those times, alluded in his poems to the various physical ailments that plagued his contemporaries, and perhaps at times himself, given his stature and habits. As I have already mentioned, he was an excellent observer and, by citing the examples given above of the causes of diseases and ailments, both independent and man-made, he took the opportunity to say something more about Roman society. In addition to illnesses and ailments mentioned in this article, the poet indicates other diseases in his works that give us even broader picture of the society of the time, although they are mostly superficial and desultory. Not all the remarks point to the rational nature of the causes of illnesses, as the Romans were also familiar with a magical way of thinking and, being forced on and off to cope with the hopeless situation, they happened to refer to a supreme being or deity.^[24] For the most part, however, the medical references used by the poet, whether related to lifestyle, diet, external conditions or old age, fit in with the didacticism and moralising commonly present in Horace’s works, with a hint of reflection and thoughtfulness about human life, beliefs and choices.

^* 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 PhD 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, ancient medicine and medical Latin.
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: 24.04.2024. Verified: 28.04.2024. Revised: 18.06.2024. Accepted: 28.06.2024.