A physician as "lower middle class" in the Roman world

Galen blood letting by Robert Thom (before 1958)

A history resource article by Mary Harrsch © 2020

I'm working on my article about the House of the Prince of Naples based in part on my translation of Hauser in Pompeji by Professor Volker Michael Strocka.  In the text, he concludes that the less skillful paintings and roughly finished earthquake repairs in the Casa del Principe di Napoli point to the occupants of the house being members of the lower middle class.  However, he seemed to have overlooked the findings of surgical instruments in several locations as well as a Roman version of a mortar and pestle which, to me, points to the last resident being a physician. So I wondered if physicians would be classified as "lower middle class" since they are  definitely more respected and usually much more well compensated in the modern world.  Yesterday, I was researching the issue of the social status of physicians in the ancient world and found a fascinating paper about the topic on JSTOR written by H. Horstmanshoff in 1990, entitled "The Ancient Physician: Craftsman or Scientist?" published in the History of Medicine and Allied Sciences.  In it Horstmanshoff points out that our modern opinion of physicians as a scientifically educated practitioner of a legitimate profession of high social status was not shared by the ancients and only emerged in the second half of the nineteenth century.

"The physicians of antiquity did not belong to a legitimate profession protected by legal and official recognition. For the most part he lacked scholarly academic training and he did not always enjoy a high social status. He had to compete with quacks and miracle workers.  He could not afford to risk his reputation by treating patients who had no chance of recovery...The borderline between rational and irrational medicine was not sharply drawn. There were priests who furnished medicines and dietary regulations and performed bloodletting, just as there were physicians who used amulets and prayers." - Horstmanshoff, "The Ancient Physician: Craftsman or Scientist?"

He points out that physicians, including those who treated emperors like Galen, were actually more respected if they spent time expounding philosophical observations about humoral theory and engaging in rhetorical discussions of prognosis than in actually practicing their craft.

"The Hippocratic physician constantly invested in his reputation, since with a good reputation he would not repeatedly have to demonstrate his competence, especially in the continual competitive battles waged with physicians of quite different alloy." - Horstmanshoff, "The Ancient Physician: Craftsman or Scientist?"

Horstmanshoff notes in Homer's Iliad two types of physicians are described, the "gentleman practitioner" who is more knowledgeable in the treatment of battle wounds than the average warrior (who can treat elemental wounds), and the traveling healers who are equated to manual workmen on par with builders, who do not belong to the noble elite but are not landless laborers.  So, depending on the type of physician, their social standing was somewhere in between the extremes of social hierarchy.

"The most desirable position for a physician was that of city or community physician.  The city physician enjoyed public recognition and, probably, a fixed minimum income by virtue of a contract through which he was obliged to remain in a given city for a number of years.  The advantage for the physician was that he no longer had to contend with other physicians in competitive forays.  The advantage for the city was that it could be assured of medical services." - Horstmanshoff, "The Ancient Physician: Craftsman or Scientist?"

Apparently epigraphic evidence of these arrangements during the Roman Imperial Period have been found.

Horstmanshoff quotes Cicero's De officiis to illustrate the prevailing attitude towards physicians in the late Republic and summarizes it in this way.  "A physician was a craftsman who had to live on what his craft would earn him, but in antiquity work for wages was considered to be of inferior worth, actually a form of slavery, compared with the ideal of the self-sufficient landowner who possessed wealth obtained through long-standing inheritance and who did not need to work for a living. The arts of healing, architecture, and teaching in the honorable disciplines (included are grammar, rhetoric, and philosophy) were respectable only if one exercised them as an amateur, not if one wanted to earn one's daily bread from them."

As for the roughly repaired earthquake damage, I researched the House of the Surgeon, (Reg VI, Ins 1, 10, 23) a site recognized as a probable home of a physician because of surgical instruments found there and also located in Region VI of Pompeii, and learned that it was actually in worse repair than the House of the Prince of Naples. Archaeologists point out they found holes in the floor of the atrium that they think were left by poles holding up its roof after the earthquake of 62 CE or subsequent quakes before Vesuvius' devastating eruption in 79 CE.