Celsus’ “De Medicina”: A Latin-English Summary (Part 1)
Learn why Celsus’ textbook of medicine is among the finest classics of science.
Often called the “Cicero of medicine”, everyone has heard of Aulus Cornelius Celsus, but who has read his work? Published in the 1st century AD, De Medicina has served as a standard textbook of medicine for many centuries.
Far from obsolete, De Medicina introduced medical concepts that are still in use, such as the four cardinal signs of inflammation: calor (warmth), dolor (pain), tumor (swelling), and rubor (redness). Whether you have previous knowledge of medicine or not, you will learn a lot from Celsus’ vivid examples and practical advice on living a healthy life.
This summary contains some of the most inspiring parts of De Medicina in Latin and English. Note that I have shortened some of the quotes to make them more accessible to modern readers.
Are We Making Ourselves Sick?
In the iconic preface of De Medicina, Celsus briefly recounts the history of medicine. He starts by arguing that medicine exists everywhere:
Medicina nusquam quidem non est, siquidem etiam inperitissimae gentes herbas aliaque promta in auxilium vulnerum morborumque noverunt.
There is no place without medicine, as even uncivilized people know herbs and other remedies for treating wounds and illnesses.
He goes on to argue that the ancient Greeks did not even need medicine:
… ob bonos mores, quos neque desidia neque luxuria vitiarant.
… due to their impeccable way of life, unspoiled by idleness or intemperance.
Celsus explains:
Siquidem haec duo corpora prius in Graecia, deinde apud nos adflixerunt ideoque multiplex ista medicina, neque olim neque apud alias gentes necessaria, vix aliquos ex nobis ad senectutis principia perducit.
For these two (idleness and intemperance) have afflicted bodies first in Greece, then in our country, and this is why our versatile medicine, which was not even necessary in former times and is still unnecessary in other nations, enables so few of us to reach old age.
While this is a bold statement, it is also timely one, as the WHO warns us that lifestyle factors (e.g. poor nutrition, lack of exercise) are among the leading causes of illness and death.
Offering another daring theory, Celsus explains why philosophers were the first to study medicine:
Primoque medendi scientia sapientiae pars habebatur, scilicet iis hanc maxime requirentibus, qui corporum suorum robora quieta cogitatione nocturnaque vigilia minuerant.
The science of medicine was initially a part of philosophy, that is, it was most eagerly investigated by those who had afflicted their bodies with sedentary contemplation and nocturnal study.
Are you already eyeing the corner where your running shoes are collecting dust? Good — as Celsus mentions later, there is no substitute for a healthy lifestyle:
… utpote cum repugnante natura nihil medicina proficiat.
… since medicine cannot accomplish anything where nature resists.
How Doctors Parted Ways
I used to think that the increasing specialization of medicine was a recent development. Celsus proved me wrong:
Iisdemque temporibus in tres partes medicina diducta est, ut una esset quae victu, altera quae medicamentis, tertia quae manu mederetur. Primam Διαιτητικήν, secundam Φαρμακευτικήν, tertiam Χειρουργίαν Graeci nominarunt.
At that time medicine was divided into three fields, of which the first cures with nutrition, the second with medication, the third with surgery. The Greeks called the first Diaitetiké (nutritional medicine), the second Pharmakeutiké (pharmacology), the third Cheirourgía (surgery).
Until today, there are deep trenches between the three fields. An otolaryngologist in Germany once told me she was not allowed to prescribe as many medications as her colleagues in other fields. When I asked for the reason, she explained that her field was classified by law as surgical, not pharmacological.
Interestingly, nutritional medicine has almost died out and only recently been revived, while in Celsus’ time the field enjoyed the same prestige as the other two. Dieticians were even the first who tried to put medicine on a scientific basis:
Eius autem, quae victu morbos curat, longe clarissimi auctores etiam altius quaedam agitare conati, rerum quoque naturae sibi cognitionem vindicarunt, tamquam sine ea trunca et debilis medicina esset.
The most famous proponents of nutritional medicine, endeavoring to go deeper into things, claimed for themselves also a knowledge of science, believing that without it medicine would be incomplete and weak.
Dieticians’ preoccupation with science led to a schism in medicine, between theorists and more practically minded doctors.
Theory vs. Practice
Medicine soon separated into two rivaling schools, the Rationalists and the Empiricists. Here is what Celsus says about the Rationalists:
Ii, qui rationalem medicinam profitentur, haec necessaria esse proponunt: abditarum et morbos continentium causarum notitiam, deinde evidentium; post haec etiam naturalium actionum, novissime partium interiorum. Neque enim credunt posse eum scire, quomodo morbos curare conveniat, qui unde sint ignoret.
Those who teach Rationalist medicine regard as foundations, first, knowledge of the hidden causes of disease, second, of evident causes, third, of biological processes, and lastly, of the internal organs. In other words, they believe that only he who knows how a disease was caused can cure it.
The Rationalists thus delved deeply into the study of human physiology:
Tum requirunt etiam, quare venae nostrae modo summittant se, modo attollant; quae ratio somni, quae vigiliae sit; sine quorum notitia neminem putant vel occurrere vel mederi morbis inter haec nascentibus posse.
They also investigate why our veins sometimes subside, sometimes swell, or what the logic behind sleeping and waking is; they believe that without this knowledge, no one can prevent or cure diseases that pertain to those processes.
Sounds convincing, doesn’t it? Let us now see what Celsus says about the Empiricists:
Contra ii, qui se Empiricos nominant, obscurarum causarum et naturalium actionum quaestionem supervacuam esse contendunt, quoniam non conprehensibilis natura sit.
In contrast, those who call themselves Empiricists contend that researching hidden causes and biological processes is futile, as nature cannot be understood.
As a result of this conviction, the Empiricists focused on practice rather than theory:
A certis potius et exploratis petendum esse praesidium, id est iis, quae experientia in ipsis curationibus docuerit, sicut in ceteris omnibus artibus. Nam ne agricolam quidem aut gubernatorem disputatione sed usu fieri.
(They maintain that) remedies should be sought from the known and certain, that is, from what experience has taught in treating patients, as it happens in all other crafts. A farmer or captain, after all, is made not by disputation, but by practice.
What was there first, theory or practice? For the Empiricists, the answer was clear:
Repertis iam remediis, homines de rationibus eorum disserere coepisse; nec post rationem medicinam esse inventam, sed post inventam medicinam rationem esse quaesitam.
(They hold that) only after remedies were discovered did people begin to discuss the theory behind them. Medicine was not invented after theory, but after medicine was invented, its theory was sought.
The Empiricists even argued that theory had nothing to contribute to practice:
Requirere etiam se, ratio idem doceat quod experientia an aliud: si idem, supervacuam esse; si aliud, etiam contrariam.
They ask if theory teaches the same as experience: if yes, theory is superfluous; if no, it is even harmful, they contend.
Their rationale was that remedies were found through experiments, not through insights into human physiology:
Neque quaerendum esse quomodo spiremus, sed quid gravem et tardum spiritum expediat; neque quid venas moveat, sed quid quaeque motus genera significent. Haec autem cognosci experimentis.
We should not ask how we breathe, but how to alleviate respiratory distress; nor how our veins move, but what to conclude from the different kinds of movement. That is to be found through experiments, they hold.
Having discussed the stances of the Rationalists and Empiricists, Celsus recommends us to take the middle ground. Yes, theory itself does not heal patients, but it can make for better doctors:
Quamquam igitur multa sint ad ipsas artes proprie non pertinentia, tamen eas adiuvant excitando artificis ingenium; itaque ista quoque naturae rerum contemplatio, quamvis non faciat medicum, aptiorem tamen medicinae reddit perfectumque.
There are many things that are not strictly relevant to the crafts, yet contribute to them by inspiring the craftsman. Similarly, scientific theory, although it does not make someone a doctor, will make him a more competent and sophisticated one.
Thinking Out of the Box
According to Celsus, theory is useful because there are no strict laws in medicine (“Treatment A always has the effect B”):
Est enim haec ars coniecturalis. Neque respondet ei plerumque non solum coniectura sed etiam experientia et interdum non febris, non cibus, non somnus subsequitur, sicut adsuevit.
This (medicine) is a conjectural craft. And it very often happens that both conjecture and experience fail us, and sometimes neither fever, nor appetite, nor sleep follows where it should.
In these cases, theory can guide the doctor’s creativity in devising a new treatment. However, Celsus rejects the Rationalists’ notion of “hidden causes”, asking us to stick to more tangible ones:
Petet autem novum quodque consilium non ab rebus latentibus (istae enim dubiae et incertae sunt), sed ab iis, quae explorari possunt, id est evidentibus causis.
The doctor should derive new therapeutic strategies not from covert circumstances (for these are purely speculative), but from observable ones, that is, from evident causes.
Celsus goes on to provide examples of evident causes of disease, including lifestyle factors:
Neque ignorare medicum oportet, quod vitae genus aeger sit secutus, laboriosum an quietum, cum luxu an cum frugalitate; ex his enim similibusque saepe curandi nova ratio ducenda est.
The doctor should not ignore the patient’s lifestyle, whether it is laborious or sedentary, excessive or frugal; it is from these and similar factors that we often have to deduce a novel mode of treatment.
Here Celsus offers insights that are remarkable even by today’s standards:
Potest autem id, dum solum est, non movere (morbum), quod iunctum aliis maxime moveat.
Sometimes a factor is harmless by itself, but can cause disease when combined with other factors.
Modern examples of diseases that are caused by a coincidence of factors (multifactorial diseases, as they are called), are Alzheimer’s, diabetes, and multiple sclerosis.
Celsus summarizes his stance on the relationship between theory and practice as follows:
Igitur rationalem quidem puto medicinam esse debere, instrui vero ab evidentibus causis, obscuris omnibus non ab cogitatione artificis sed ab ipsa arte reiectis.
I therefore believe that medicine should be theory-driven, but informed by evident causes. The so-called hidden causes may have a place in the craftman’s thinking, but not in the craft itself.
This concludes the preface of De Medicina. Head to Part 2 of this series to discover Celsus’ advice on living a healthy life.
