Greek Physicians in the Eyes of Roman Elite (from the Republic to the 1st Century AD)

In the 3rd century BC, Greek doctors brought scientific medicine to Rome. The arrival of new therapeutic practices, which were the inheritance of a different mental and cultural framework, provoked a double reaction at Rome. On the one hand, philhellenic circles promoted the presence of physicians in the city and in aristocratic households. On the other hand, the part of the elite that defended the safeguarding of the Roman gravitas condemned both the new medicine and the physicians. The assimilation of Greek medicine in Rome was accomplished in the 1st century BC. However, the attitude of Roman elite towards doctors continued to be ambiguous, since these doctors came usually from the East and practiced a foreign medicine. The aim of this paper is to analyze the attitude of the Roman elite towards those who had to take care of their health. With the help of literary sources like Cato the Elder, Cicero or Pliny, we will evaluate to what extent these physicians who interacted in the life of the aristocracy were perceived as carnifici who killed or amici who healed.

Romans, in the course of their untiring conquest of territories far from Rome, met many other populations with very different lifestyles and languages from theirs. But, doubtlessly, the most important encounter was with Greek people, whose conquest signified intense cultural exchange. The first contacts began with the incorporation of Great Greece and Sicily to the Roman influence area in the 10.17951/f.2018.73.119-137 3 rd century BC, although the links became stronger after the conquest of Greece, a century later. This situation motivated a massive arrival in Rome of well--educated slaves, who brought Greek thought, art and science. All this involved a global Hellenization of Roman culture.
In this context, the incursion of Hippocratic medicine was a very relevant event, since it provided the basis of the later Western medical tradition 1 . The progressive adaptation of Greek allopathy was possible thanks to the intensive arrival of doctors, which aroused the reaction of Roman society, especially among the elite, who transmitted their opinion about the medical collective in different fora.

FIRST GREEK DOCTORS IN ROME AND FIRST REACTIONS OF THE ROMAN ELITE
According to tradition, the arrival of the first Greek doctors in Rome took place in the 3 rd century BC 2 , as seen in the following text: Cassius Hemina ex antiquissimis auctor est primum e medicis venisse Romam Peloponneso Archagathum Lysaniae filium L. Aemilio M. Livio cos. anno Urbis DXXXV, eique ius Quiritium 1 Hippocratic medicine, the first scientific medicine sensu stricto, came to Rome after undergoing great improvement and diffusion in Greece. The writings known as Corpus Hippocraticum form a compendium of the Hippocratic doctrine that, in the words of V. Nutton, "show[s] the gradual creation of a form of medicine that came to dominate Western medical thought and practice for centuries to come, as a source of theories, therapies and ideas on the way in which medicine should be taught, studied and put into practice". Cf. V. Nutton, Ancient Medicine, London-New York 2004, p. 62. In the case of medical diffusion and general acceptance of medici in Roman society, it should be taken into account the Etruscan view of health and medicine. Nowadays, the data to know the actual state of medical practice or the understanding of health conditions in the Etruscan world are scarce, but some finds provide evidence of some medical knowledge. For example, anatomical models of terracotta -given as thank-offerings for fulfilment of vows requesting healing -show highly stylized representations of parts of the human body (heads, limbs, internal organs like uterus, etc.) that testify a good knowledge of anatomy; chirurgical treatments like trepanation are attested or even dental extraction and gold dental appliances that held replacements for missing teeth. It is possible that the medical knowledge of the Etruscans, northern neighbours, influenced Romans as well. For an overview of health in the Etruscan society, see J. MacIntosh Turfa, M.J. Becker, Health and Medicine in Etruria, [in:] The Etruscan World, ed. J. MacIntosh Turfa, London-New York 2013, pp. 855-881. 2 Physicians are mentioned in accounts dated in earlier periods. Dionysius of Halicarnassus says that in 451 BC, physicians were unable to help the sick during a plague epidemic in Rome (Dion. Hal. Ant. Rom. X,53). In turn, Valerius Maximus says that physicians were desperate to save the life of the children of Valesius, the farmer who started the ludi Saeculares according to Roman mythology (Val. Max. II,4,5). However, it is quite likely that both Dionysius of Halicarnassus and Valerius Maximus projected on their narrations the idea of medici in their own times, in the 1 st century BC and 1 st century AD. R. Jackson thinks that the year 219 BC is a late time to date the arrival of the first Greek doctor to Rome, and therefore considers that it is more probable that Archagathus was the first physician employed publically in the city (R. Jackson This text -attributed to Cassius Hemina, a historian in the 2 nd century BC -provides interesting details of the circumstances of the doctor's arrival and the later reaction of Roman society. On the one hand, the concession of citizenship shows that the reception of Archagathus was officially promoted, because such a prerogative could only be the result of a political decision approved by the Roman Senate. On the other hand, the text also reveals the support of members of the Roman aristocracy who were in favor of introducing Greek culture into Rome. The consuls in the year 219 BC (L. Aemilius Paullus and M. Livius Salinator) belonged to the philhellenic faction 4 , like the Acilii, who sponsored the act by offering the doctor a place located in compito Acilio, that is, in a crossroad property belonging to the family 5 . So, most of the philhellenic senators contributed to the establishment of Archagathus in the city.
However, this initial positive attitude turned into rejection, a change which is expressed in the text through the evolution of the appellative to name the doctor, which goes from vulnerarius (the one who heals wounds) to carnifex (the one who kills). But, what was the reason for this change? The spread of the cult of Asclepius -god of medicine -in the year 291 BC had taken place without conflicts: the healing deity was accepted and a temple for it was raised on the 3 Plin. HN XXIX, 12-13: "Cassius Hemina, one of our earliest authorities, asserts that the first physician to come to Rome was Archagathus, son of Lysanias, who migrated from the Peloponnesus in the year of the city 535, when Lucius Aemilius and Marcus Livius were consuls. He adds that citizen rights were given him, and a surgery at the cross-way of Acilius was bought with public money for his own use. They say that he was a wound specialist, and that his arrival at first was wonderfully popular, but presently from his savage use of the knife and cautery he was nicknamed »Executioner«, and his profession, with all physicians, became objects of loathing in general into considerable disrepute" (English translation by W.H.S. Jones, Pliny. Natural History, books 28-32, Cambridge-London 1963 Schrijvers, Amsterdam 1995, p. 37. 5 Several members of the Acilia family are known to have been in favour of the dissemination of Greek culture and medicine in Rome. For example, Caius Acilius translated from Greek to Latin the first speeches made in the Senate by the philosophers Carneades and Diogenes, who came from Athens in a mission in 155 BC (Cic. Off. 32,115). Another example is Manius Acilius Glabrio (PIR 2 A 71), who minted a denary in 54 BC representing the goddess Salus and the word valetudo, the Latin word referring to "recovery from illness" (A.W. Zorgniotti, Medical numismatics: A Denarius commemorating Rome's first doctor, Arcagathus (219 B.C.), "Bulletin of the New York Academy of Medicine" 1970, Vol. 46, No. 6, pp. 448-450). Tiber Island 6 . That was because Greek religious cults and practices possessed the same mental values as Roman ones. And, moreover, from the 4 th century BC, Romans were used to assimilating the gods of the peoples they conquered. However, Hippocratic medicine introduced in Rome surgical and pharmacological practices which had nothing in common with the Roman idea of health 7 . Roman traditional medicine was based on the elaboration of natural remedies which were swallowed or put on the body, and such actions as those mentioned in the text -amputation or cauterization -were incomprehensible within those traditional mental values. The performance of the first doctors must have caused a powerful cultural shock which may have shaken the initial favorable attitude of the Roman elite.
Events in Roman foreign policy in the 2 nd century BC -the beginnings of Roman imperialism -ensured the definitive incorporation of Greece and Asia to the Roman administrative area. This process included the incorporation of territories where the main medical schools were located 8 .
In this scenario, the presence of Greek doctors in Rome grew intensively, in the same way as critics did among senatorial groups against the incorporation of Greek culture. During the first half of the 2 nd century BC, Cato the Censor set himself up as the leader of this reaction. Cato showed his hostility clearly in some writings. The letter written to his son in his Libri ad Marcum filium might be the most important example of this: The start of the cult of Asclepius in the Urbs is dated 291 BC, when the city had become familiar with the cult of Apollo, the god of healthy qualities to whom a temple was dedicated with the epithet Medicus (Liv. Urb. III,63,7;XL,51,6). Ovid explains that Asclepius' arrival was a consequence of a serious epidemic that spread in Rome in the early 3 rd century BC (Ov. Met. XV, 622-744). According to Plutarch, the Tiber Island was chosen as the abode of Asclepius for health and hygiene reasons (was at a distance from the town) and because the god chose it by swimming to the island in the form of a snake (Plut. First medical schools in Greece were Kos and Knidos, in the ancient region of Caria, in southwestern Turkey. Both centers were led by the family of the Asclepiads and worked before the time of Hippocrates, who received his medical training at Kos (cf. V. Nutton, Ancient…, pp. 69-70;M. Turgut, Ancient medical schools in Knidos and Kos, "Child's Nervous System" 2011, Vol. 27, No. 2, pp. 197-200). In the Hellenistic period, new schools flourished in Asia, like Pergamum, which famous Asclepeion was a medical and therapeutic center, Ephesus or Smyrna (cf. J.-M. André, La médecine à Rome, Paris 2006, pp. 19-20). However, the main medical center in the ancient world was Alexandria, renowned from the 3 rd century BC for the improvement of the studies of anatomy (cf. V. Nutton,Ancient…,. The text specifies three elements that, according to Cato, justified this particular hostility against doctors: a) they had conspired to murder barbarians; b) they worked for money; and c) they deceived patients through confidence. In this case, we must consider that Pliny transmits the words of Cato to justify his own opposition towards doctors in his time (1 st century AD), that is to say, they are second-hand information used for a specific goal. Accordingly, we could doubt about the reliability of the text. Nevertheless, the three features named by Pliny are confirmed by the context of Roman culture and the comparison with other authors. In fact, these three elements have a real base. First of all, the supposed conspiracy was based on a rumor which assured that all doctors had sworn to kill all foreigners since Hippocrates refused to treat the king of Persia. In this way, Plutarch tells us: ὁ δ᾽ οὐ μόνον ἀπηχθάνετο τοῖς φιλοσοφοῦσιν Ἑλλήνων, ἀλλὰ καὶ τοὺς ἰατρεύοντας ἐν Ῥώμῃ δι᾽ ὑποψίας εἶχε. καὶ τὸν Ἱπποκράτους, ὡς ἔοικεν, ἀκηκοώς λόγον, ὃν εἶπε τοῦ μεγάλου βασιλέως καλοῦντος αὐτὸν ἐπὶ πολλοῖς τισι ταλάντοις, οὐκ ἄν ποτε βαρβάροις Ἑλλήνων πολεμίοις ἑαυτὸν παρασχεῖν, ἔλεγε κοινὸν ὅρκον εἶναι τοῦτον ἰατρῶν ἁπάντων 10 .
Secondly, it is true that doctors earned money for their work, an unbelievable thing for any honorable citizen in Rome. Indeed, remunerated work, in which they also had to use their hands, was considered an ars or artificium; that is why the profession of a doctor was similar to an artisan job 11 . Consequently, medicine was 9 Plin. HN XXIX, 14: "I shall speak about those Greek fellows in their proper place, son Marcus.
[…] They are a quite worthless people, and an intractable one, and you must consider my words prophetic. When that race gives us its literature it will corrupt all things, and even all the more if it sends hither its physicians. They have conspired together to murder all foreigners with their physic, but this very thing they do for a fee, to gain credit and to destroy us easily. They are also always dubbing us foreigners, and to fling more filth on us than on others they give us the foul nickname of Opici. I have forbidden you to have dealings with physicians" (English translation by W.H.S. Jones, op. cit.). 10 Plut. Cato Maior 23, 3: "It was not only Greek philosophers that he hated, but he was also suspicious of Greeks who practised medicine at Rome. He had heard, it would seem, of Hippocrates' reply when the Great King of Persia consulted him, with the promise of a fee of many talents, namely, that he would never put his skill at the service of Barbarians who were enemies of Greece. He said all Greek physicians had taken a similar oath, and urged his son to beware of them all" (English translation by B. Perrin, Plutarch's Lives, Cambridge-London 1968). 11 From the legal point of view, the assimilation between ars medica and artificium is clear for two reasons. First, medical practice was usually administered through locatio-conductio contracts, which were common between artisans. Second, in Roman legislation, physicians' pay was always called merces or salarium, the characteristic payment of craftsmen, and not honorarium, the pay-not an ars liberalis, so it was not appropriate for members of the highest levels of society. Finally, the loquacity of some physicians aroused suspicion among Romans. When Cato regretted that doctors won patients confidence, actually he disapproved one of the phases on which Hippocratic method was divided: verbal communication 12 . Dialogue with the patient was fundamental as a previous step for diagnosis and the choice of the most adequate therapy. So, the problem was the incomprehension of Hippocratic physicians' modus operandi.
We must contextualize Cato's opinion about doctors in the framework of his general anti-Hellenistic attitude. As Plutarch asserted in Cato's biography, "he was wholly averse to philosophy, and made mock of all Greek culture and training, out of patriotic zeal" 13 . Cato understood that the assumption of new medical practices evidenced a moment of backward and moral decadence which was also reflected in his interest in other branches of Greek knowledge, like poetry or philosophy. The profession of physician exemplified the incompatibility of Greek culture with the gravitas of Roman nature 14 . As he expressed during his censorship candidature in the year 184 BC, his intention was to "chastise the new vices and revive the ancient character" 15 . For Cato, Greek medicine was founded on health conceptions which were not the old Roman ones, and on a kind of relationship between human beings and a world which was not his 16 . The introduction of antagonistic practices in traditional home medicine, the one he practiced and defended, revealed aspects different from Roman culture and way of thinking, in which notions of health and illnesses were not the same. Cato only understood healing through the remedy supplied by the pater familias, and not by a stranger to the family, whom they had to pay 17 . ment associated with ars liberalis. On this topic, cf. K. Visky, La qualifica della medicina e dell'architettura nelle fonti del diritto romano, "Iura" 1959, Vol. 10, pp. 39-44. A ruling of Constantine in 337 in which physicians are equated with artisans shows that the situation had not changed in the 4 th century AD (Cod. Iust. X, 66, 1; CTh XIII, 4, 2). 12 The three phases into which Hippocratic method was divided, allowing the doctor to choose the more appropriate therapy, were verbal communication, sensory examination and conclusive reasoning (cf. D. Gourevitch, Le triangle hippocratique dans le monde gréco-romain. Le  Although the anti-Hippocratic movement was the most extended opinion among aristocracy in the 2 nd century BC, the philhellenic elite accepted the diffusion of Greek medicine 18 . At that time, this acceptance must have mainly consisted of the integration of slave medical staff in the home, but not in social integration. In the 2 nd century BC, medicine did not have its own regulation; this depended on the opinion aroused by medical practice and those who practiced it 19 .

THE SITUATION IN THE 1 ST CENTURY BC
In the 1 st century BC, medicine acquired an intellectual framework, which evolved and developed. New medical characters, who achieved fame with their clinical theories and therapies, started to appear in Rome, such as Asclepiades of Prusa, who dominated medical thinking in the late Roman Republic 20 . His therapy, which gained great popularity, emphasized diets based on the liberal use of wine and the practice of regular physical exercise. Asclepiades' genius consisted in his ability of capturing Roman thinking, by combining, skillfully, his medical conception with a sensible and practical approach, with which Romans identified 21 .
In this context we have, for the first time, testimonies of elite members, who refer to intimate and familiar situations shared with doctors. The prolix Cicero's work is, doubtlessly, the best information source 22 . On some occasions, he describes physicians as intellectual colleagues, such as Sextus Fadius, from whom he says to have borrowed a book about gluttony and whom he defines as a nice doctor (medicum suavem) 23  However, was Cicero's opinion about doctors always positive? In a letter to Tiro, he says: "For I fear our friend Lyso is somewhat careless: first, because all Greeks are so..." 28 . It is clear he had doubts about Greeks. In another letter, he implies that if his salary is increased, a doctor will do his job better. In this way, Cicero recalls one of the biggest stigmas on this group, that is, Greek physicians carried out remunerated work, suggesting that their professionalism may depend 25 Cic. Ad. Brut. I, 6, 2: "To you I most earnestly recommend Glyco, the physician of Pansa, who has the sister of our man Achilles for his wife. I hear he has fallen under Torquatus' suspiction in connexion with the death of Pansa, and is being kept in custody as a parricide. Nothing could deserve less credence, for to whom has Pansa's death dealt a worse disaster? Besides, he is steady and a worthy fellow who, you would think, could not even be driven to crime by the prospect of gain. I beg you, yes, I beg you insistently (for our man Achilles is as much perturbed as the occasion demands), rescue him from detention and keep him safe" (English translation by M. Cary, Cicero in Twenty-Eight Volumes. XXVIII, Cambridge 1989 The doctor is not an equal, he is mostly a Greek -all the doctors mentioned have Hellenic names 30 -and, for Cicero, that will make him feel superior. A physician is a person who sells his work for a salary -something unbelievable for a senator like him -a person whose origins are humble, as they are usually slaves or freed slaves. A person who is inferior and with whom there is no possible comparison. Nevertheless, we should mention the affectionate words he wrote to his personal doctor, Alexio, whose death he lamented with enormous sorrow: The praise of Alexio emphasizes an important aspect to evaluate the consideration Greek physicians enjoyed among the Roman elite: emotional blossoming. Medical procedures meant the establishment of close relationships, because during his work the doctor had to examine the patient, question him, and share the same space. At the same time, the patient was aware of the benefit he received. The senatorial elite knew doctors' subordinate position, but they appreciated their profession, their knowledge and their personal attitude because of the positive effects all this had. 29 Cic. Fam. XVI, 4, 2: "I do beg you, dear Tiro, not to spare expense in anything whatever necessary for your health. I have written to Curius to honour your draft to any amount: something, I think, ought to be paid to the doctor himself to make him more zealous" (English translation by Perseus under…). 30 Although it is true that physicians were Greeks in a high percentage, overall at the 1 st century BC, to have a Hellenic name was not a sure evidence for a Greek origin. It is known, for example, that Roman aristocracy had the custom of assigning fictitious names of Greek etymology to his slaves no matter what were their mother country (cf. I. Kajanto Rom, Helsinki 1971, pp. 156-157). 31 Cic. Ad Att. XV, 1, 1: "What a misfortune about Alexio! It has upset me more that you can believe, and not, I assure you, particularly on the score which most people seem to think it has, asking to what doctor I shall turn now. What do I want with a doctor now? And if I do want one, is there such a dearth of them? It is his love for me, his kindness and charming manner that I miss. There is another thing, too. What have we not to fear, when so temperate a person and so skillful a physician can be overcome suddenly by such a disease? But for all these things there is one consolation: we are born under this condition, that we may not refuse anything that fate has in store for mortals" (English translation by E.O. Winstedt, Cicero. Letters to Atticus, Cambridge-London 1987).
Greek doctors' assimilation became official thanks to one of Julius Caesar's measures in the year 46 BC, which provided all those who practiced medicine in Rome with Roman citizenship 32 . The aim of the regulation was to make attractive their stay in the city and to attract the presence of these professionals. In this way, not only the arrival and establishment of new physicians was motivated, but also medicine and its practitioners found a place in the judicial and administrative spheres of the city.

THE EMPIRE AND THE ASSIMILATION OF GREEK PHYSICIANS IN THE ROMAN ELITE
The Empire brought about an important change by approaching physicians to the elite and, indeed, some of them were included in it. That was mainly possible due to their proximity to the imperial family. From Augustus' reign, the custom of having a personal doctor spread among emperors 33 . Antonius Musa was the first one to achieve such great fame and prestige, as Dion Cassius describes: When Augustus was consul for the eleventh time, with Calpurnius Piso, he fell so ill once more as to have no hope of recovery; at any rate, he arranged everything as if he were about to die. […] And although he lost the power of attending even to the most urgent matters, yet a certain Antonius Musa restored him to health by means of cold baths and cold potions. For this, Musa received a great deal of money from both Augustus and the senate, as well as the right to wear gold rings (for he was a freedman), and he was granted exemption from taxes, both for himself and for the members of his profession, not only those living at the time but also those of future generations 34 . 32 Suet. Caes. 42. It is not known whether the measured survived Caesar. It may have been, as the acta Caesaris were ratified by Mark Antony and the Senate after the dictator's death. Additionally, Augustus confirmed some of the personal immunities awarded by Caesar, especially the concession of citizenship rights. For this matter cf. M. Hirt Raj, Médecins et malades de l'Égypte romaine. Étude socio-légale de la profession médicale et de ses praticiens du Ier au IVe siècle ap. J.-C., Leiden-Boston 2006, p. 221. 33 First testimonies of court doctors go back to the 18 th century BC and come from the ancient Near East. Some letters written on clay from the royal palace of Mari, the capital of a kingdom that dominated northern Syria, refer to physicians who treated patients in the royal circle. In the Neo-Assyrian Empire, we even know the name and treatments given by court doctors, like Urad-Nanaya, chief physician to King Esarhaddon ( Antonius Musa was one of Mark Antony's former freed slaves, who became part of Augustus' personal service in the year 23 BC, after curing the emperor with a treatment based on cold hydrotherapy and a diet of lettuce 35 . As a regard for his good praxis, he obtained rich benefits from the emperor himself and the Senate, as Dion Cassius tells. A statue of the doctor was erected next to the one of Asclepius 36 , he received great financial compensation and was exempted from paying taxes. But the most important privilege was to wear a gold ring, which implied his incorporation into the Roman elite. During Claudius' reign, about sixty years later, another medical character stood out in the core of the imperial family: C. Stertinius Xenophon. As the emperor's personal doctor (medicus Augusti), his life was very different from the rest. He occupied military and civil positions typical of the equites cursus: he was military tribune during the Britannia campaign in the year 43 AD, and praefectus fabrum and ab epistulis graecis in Rome 37 . However, his fame and status did not prevent Tacitus from involving him in the emperor's death, incited by the emperor's wife. After narrating the first, and unsuccessful, murder attempt by Agrippina with a poisonous mushroom, Tacitus tells: It is well known that Tacitus is somewhat an unreliable source because of the rumors he accustomed to invent to make his narrations more attractive. Then, we must read this report with caution. Indeed, neither Flavius Josephus nor Pliny the Elder suggest anything about this when they refer to Claudius' death 39 , so Tacitus' information is believed to be an invention. However, it is noteworthy that he wants to tarnish the doctor's memory, making him part of the plans to end the emperor's life, although accusations of being conspirer and poisoner were common 35 For Antonius Musa cf. PIR 2 A 853. 36 This information is given by Suetonius (Suet. Aug. 59). 37 For C. Stertinius Xenophon, cf. PIR 2 S 913. 38 Tac. Ann. XII, 67: "Agrippina was in consternation: as the last consequences were to be apprehended, immediate infamy would have to be braved; and she fell back on the complicity -which she had already assured -of the doctor Xenophon. He, it is believed, under cover of assisting the emperor's struggles to vomit, plunged a feather, dipped in a quick poison, down his throat: for he was well aware that crimes of the first magnitude are begun with peril and consummated with profit" (English translation by J. Jackson For Seneca, the debt to the doctor cannot be paid since he provides health and gives life. The value of the salary they receive is much less than the service given, because his personal dedication is priceless. In his references about medici there is always a halo of gratitude towards their personal dedication to the sick: the philosopher is aware that there is concern for the patient that goes beyond what is professionally necessary. For this reason, Seneca considered the good physician as a friend who does not sell his art, but generates gratitude for his personal disposition, and his kind and familiar will brings friendship 43 .  40 In this respect, the phrase of the orator Quintilianus is revealing, when he said: "Does medicine cease to be of use just because there are some physicians who poison people?" (Quint. Inst. II, 16, 5). Other cases of poisoning by physicians in the imperial court are known, like that of Eudemus, who helped Livia kill her husband Drusus Caesar in 23 BC (Tac. Ann. IV, 3, 8, 10-11). 41 Suet. Nero 34, 5. Regarding the reliability of this report, Suetonius poses the same problem as Tacitus. 42 Sen. De benef. VI, 15, 1-2: " The answer to this is that the price paid for some things does not represent their value. You pay a physician for what is invaluable, life and good health, a teacher of the liberal sciences for the training of a gentleman and cultivation of the mind. Consequently the money paid to these is the price, not of their gift, but of their devotion in serving us, in putting aside their own interests and giving their time to us; they get paid, not for their worth, but for their trouble" (English translation by J.W. Basore, Seneca. Moral Essays, Vol. 3, Cambridge-London 2006). 43 In the case of Seneca, the figure of the medicus-amicus was personified in Statius Annaeus, whom Tacitus describes as a loyal friend of the philosopher and skilfull doctor who provided the poison he requested shortly before his death (Tac. Ann. XV, 64). extimuit; non fuit contentus remedia monstrare: et admovit; inter sollicitos adsedit, ad suspecta tempora occurrit; nullum ministerium illi oneri, nullum fastidio fuit; gemitus meos non securus audivit; in turba multorum invocantium ego illi potissima curatio fui; tantum aliis vacavit, quantum mea valetudo permiserat: huic ego non tamquam medico sed tamquam amico obligatus sum 44 .
As well as good doctors, Seneca also recalls the physicians who only worked in their own interests in order to make their name and become more famous, worsening the patient's symptoms in order to gain greater credit when healing them, or failing in their mission and causing tremendous suffering in the patient 45 . In the mid-first century AD, medical literature in Latin had been distributed in Rome, such as Celsus' De Medicina and Scribonius Largus' De Compositione medicamentorum, and the elite had access to it. In this way, Roman aristocracy formed an idea about how a physician should operate according to the medical deontology in effect, and therefore the opinion that doctors created would depend on whether their practices corresponded with that idea or not.
During the Flavian dynasty, the integration of Greek doctors in Roman society was a fact. Indeed, at this time, their presence in the imperial administration, in which they had taken part since Claudius' reign, was strengthened 46 . However, they continued inspiring hate among some members of the elite, as for example Pliny the Elder, who made a thorough attack on doctors in Book XXIX of his Natural History. His criticism can be summarized in two concerns. Firstly, according to Pliny, physicians were merchants, led by ambition and desire of money, who dealt with a patient's life.
Non deseram Catonem tam ambitiosae artis invidiae a me obiectum aut senatum illum qui ita censebat, idque non criminibus artis arreptis, ut aliquis exspectaverit. Quid enim venenorum fertilius aut unde plures testamentorum insidiae? 47 44 Sen. De benef. VI, 16, 1-5: "My task would be endless if I tried to collect more instances to prove that valuable things are sold at a low price. What then? Why is it that I owe something more to my physician and my teacher, and yet do not complete the payment of what is due to them? Because from being physician and teacher they pass into friends, and we are under obligation to them, not because of their skill, which they sell, but because their kindly and friendly goodwill.
[…] Suppose a physician gave me more attention than was professionally necessary; that it was, not for his professional reputation, but for me, that he feared; that he was not content to indicate remedies, but also applied them; that he sat at my bedside among my anxious friends, that he hurried to me at the crises of my illness; that no service was too burdensome, none too distasteful for him to perform; that he was not indifferent when he heard my moans; that, though a host of others called for him, I was always his chief concern; that he took time for others only when my illness had permitted him -such a man has placed me under obligation, not as a physician, but as a friend" (English translation by J.W. Basore, op. cit.). 45 Sen. De benef. VI, 36, 2. 46 J. Korpela, Das Medizinal personal im antiken Rom: eine sozialgeschichtliche Untersuchung, Helsinki 1987, p. 86, 99. 47 Plin. HN XXIX, 20: "I will not abandon Cato exposed by me to the hatred of so vain-glorious a profession, or yet that Senate which shared his views, and that without seizing, as one might expect,

Ne avaritiam quidem arguam rapacesque nundinas pendentibus fatis et dolorum indicaturam ac mortis arram aut arcana praecepta, squamam in oculis emovendam potius quam extrahendam 48 .
Secondly, doctors were ignorant and could not prove that they had the knowledge they were proud of. Pliny calls attention to the ignorance displayed by that crew and reproaches them for their arrogance, quackery and ignorance about natural remedies and pharmacopeia. It is true that during Roman times there was no official and regulated medical training, just as there was no title which ensured their knowledge and ability 51 . Nevertheless, it is also true that there were some doctors with guaranteed authority whose good acts earned them fame and prestige. Pliny's criticism was more personal hostility than a reflection of the generalized feeling among the elite in that time. Through this attack, he went back to Cato's speech, based on the protection of the Roman gravitas and cultural atmosphere typical of the 2 nd century BC. But, in the time Natural History was written, Greek medicine had undergone any chances of accusation against the profession. For what has been a more fertile source of poisonings? Whence more conspiracies against wills" (English translation by W.H.S. Jones, op. cit.). 48 Plin. HN XXIX, 21: "Let me not even bring charges against their avarice, their greedy bargains made with those whose fate lies in the balance, the prices charged for anodynes, the earnest--money paid for death, or their mysterious instructions, that a cataract should be moved away and not pulled of" (English translation by W.H.S. Jones, op. cit.). 49 Plin. HN XXIX, 18: "Besides this, there is no law to punish criminal ignorance, no instance of retribution. Physicians acquire their knowledge from our dangers, making experiments at the cost of our lives. Only a physician can commit homicide with complete impunity. Nay, the victim, not the criminal, is abused; his is the blame for want of self-control, and it is actually the dead who are brought to account" (English translation by W.H.S. Jones, op. cit.). 50 Plin. HN XXIX, 25: "It is plainly a showy parade of the art, and a colossal boast of science. And not even the physicians know their facts; I have discovered that instead of Indian cinnabar there is commonly added to medicines, through a confusion of names, red lead, which, as I shall point out when I discuss pigments, is a poison" (English translation by W.H.S. Jones, op. cit.). 51 In the 2 nd century AD, Galen proclaimed the need for organised training in the field of medicine (Gal. Quod opt. 4 = Kühn I, 62). The earliest evidence of instruction in medicine in Rome dates to the reign of Severus Alexander, who established a salary for physicians and auditoriums in which they gave lessons (SHA, Alex. Sev. 44). its own evolution in the Roman sphere, since the elite had had access to scientific medical literature and doctors' characters had been accepted. This return to 2 nd -century BC thinking is related to the defense Pliny makes of traditional therapy, based on remedies closer to Cato's than to Greek medicine.
However, although doctors were part of Roman society, this did not avoid them being mocked by the elite. This is observed in Martial's epigrams. The situations he described have no historical background, but it is evident that the mockery was well-accepted among the general public, which demonstrates the Romans' conception of the profession. In some of his poems, we can see how the doctor is shown as a character who, instead of curing, is sometimes the cause of illnesses, or even death, so it is a logical step to turn these professionals into gravediggers or gladiators. Their threat was so great that even seeing them in dreams could cause death. The elite were aware of doctors' utility and, together with mockery, there are also examples of gratitude towards the physicians' work. The letters of Pliny the Younger describe a positive attitude which improved the situation of some doctors. Thus, he asked Trajan to give Roman citizenship to the iatraliptes Harpocrates and the relatives of doctor Postumius Marinus, who had cured him from a gravissima valetudo. It is obvious Pliny appreciated the intervention of both professionals, their art and job, and, therefore, he found fair to grant them with citizenship 55 . 52 Mart. Epig. I, 30: "Diaulus was once a surgeon, now he's an undertaker. He's started to practice medicine the only way he knew how" (English translation by D.R. Shackleton Bailey, Martial. Epigrams, Vol. 1-2, Cambridge-London, 1993). In another poem devoted to the same physician, Martial makes a similar joke: "Nuper erat medicus, nunc est vispillo Diaulus: quod vispillo facit, fecerat et medicus" (Mart. Epig. I, 47: "Diaulus used to be a doctor till recently; now he's an undertaker. What the undertaker does, the doctor used to do"). 53 Mart. Epig. VIII, 74: "You are a gladiator now, you were formerly an eye-doctor. You did as a doctor what you do as a gladiator" (English translation by D.R. Shackleton Bailey, op. cit.). 54 Mart. Epig. VI, 53: "Andragoras bathed with us, ate a cheerful dinner; the same man was found dead in the morning. Do you enquire the cause of so sudden a demise, Faustinus? In his dreams he had seen Doctor Hermocrates" (English translation by D.R. Shackleton Bailey, op. cit.). 55 In the same period, the physician C. Calpurnius Asclepiades was granted Roman citizenship for himself and his family by the Emperor Trajan (CIL XI, 3943 = ILS, 7789). The requests from Pliny the Younger to Trajan are another example of the proximity forged between doctors and the elite. Nevertheless, we have to point out that only a select group of physicians enjoyed such a position, since most of them lived in a more humble situation. An illustrative example of this reality is found in Dasumius' will, dated 108 AD and written by a member of the elite 58 . In this document two doctors are mentioned. The former was a servus who was part of a legacy for the first-grade heiress, whereas the latter was included in the final codicil of the will as heir of ten thousand sestertii, the same as other individuals, such as the Emperor Trajan.

CONCLUSIONS
The different texts show a very interesting picture of the elite's points of view of the "other" in the context of the Roman world. Doctors, who had arrived in Rome from a distant territory that had been subjugated by Roman power, were accepted, but also severely observed by urban aristocracies. However, under no circumstance did their presence go unnoticed. In literary sources, members of senatorial orders highlight how, from their point of view, Greek physicians were part of another reality different from theirs, at the same time as they interacted and forged close bonds with them. The sources reveal a complex scenario involving 56 Plin. Ep. X, 5, 1-2: "When I was seriously ill last year, Sir, and in some danger of my life, I called in medical therapist whose care and attentiveness I cannot adequately reward without the help of your kind interest in the man. I pray you therefore to grant him the Roman citizenship. He is a resident alien, Arpocras by name, and was given his freedom by his patron, also alien. She was Thermuthis, wife of Theon, and died some time ago" (English translation by B. Radice, Pliny. Letters, books VIII-X. Panegyricus, Cambridge-London 1969). For the answer of Trajan and following letters about this, see Plin. Ep. X, 6, 1-2; 7; 10. 57 Plin. Ep. X, 11: "My recent illness, Sir, put me under an obligation to my doctor, Postumius Marinus, to whom I can make an adequate return with your help, if you will grant my petition with your usual kindness. I pray you therefore to confer citizenship to his relatives […]" (English translation by B. Radice, op. cit.). 58 CIL VI, 10229 = ILS, 8379a = AE 1976, 77 = AE 1978, 16 = AE 1991, 76 = AE 1996 different personal opinions and prejudices, typical of a strongly hierarchical society with a strict collective identity, as in the case of Rome. The main characteristic which turned the physician into the "other" was his usual Hellenic origin. There were other factors which differentiated him from senators and equites. On the one hand, a medicus was frequently a slave or a freed man, and not a citizen of free origins; on the other hand, he carried out a remunerated job, which was a non-honorable activity. Many criticisms and mockeries from the elite were, curiously, based on the fact that, for Roman collective stereotypes, a foreigner, from humble origins and a wage earner, could only be considered an inferior. Another aspect to take into account is the incomprehension of some typical procedures in Hippocratic medicine, which were not understood in Rome and caused, at that time, a powerful cultural shock.
Once the unfavorable cultural atmosphere of the 2 nd century BC, which perfectly explains Cato's hostility, had been overcome, the Roman elite showed a more liberal attitude towards physicians. We have to stress citizens' role as an instrument that made possible the political integration of this group, overall from Julius Caesar's time. In this way, doctors with citizenship were recognized as lawful. The fact that some citizenship requests came from private initiative, as made by Pliny the Younger, highlights this as an instrument to recognize the usefulness and benefit of the ars medica.
Another interesting aspect, which played an important role in the elite's opinions, was the interaction between aristocracy and physicians. The strengthening of close ties between doctors and members of Roman aristocracy, even with the imperial court, improved the positive opinions. They were impressions that came from personal experiences, which introduced a complex element in the equation, that is, the human and psychological factor. Besides, we have to bear in mind that elites had access and were interested in medical literature, which allowed them to become used to doctors' way of working according to that medical deontology. The acquisition of an intellectual status on the part of medicine in Rome, the same as the proximity to doctors' activity, promoted a favorable attitude among the elite, not exempt from mistrust though, as shown by the suspicion of murder to which doctors were often subjected.