FREE ESSAY ON ROLE OF THE HEALER AND "PAYMENT" IN ANCIENT TIMES

ROLE OF THE HEALER AND "PAYMENT" IN ANCIENT TIMES

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.
Bibliography
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.