In 175 CE Galen, then one of the court physicians of the emperor Marcus Aurelius (r. 161–180), gave a public lecture in Rome on the knowledge and competence of contemporary physicians. In the lecture he pointed out some serious problems in this regard and suggested a number of criteria by which the best doctors could be recognized. Although the standard set by this brilliant (but insufferably arrogant) physician was unrealistically high (he took himself as norm), there must have been some truth in his statement, since the information about the (in)competence of doctors described in another later source is equally negative. In a compilation of letters serving as introduction to a collection of medical recipes assembled by Marcellus (end of fourth and early fifth centuries), a Gallic nobleman of Burdigala (now Bordeaux in France), it appears that doctors were found lacking in many respects. In addition to this there is a letter from Vindicianus (late fourth century CE; proconsul of the province of Africa Proconsularis, but also renowned physician) to the emperor Valentinian I, in which Vindicianus fulminates against his colleagues who, because of ignorance, applied the wrong therapy to a seriously ill patient.

The problem

Criticism of doctors can be traced back to the earliest medical manuscripts and occur in practically every literary genre. The problem is that there was no official licensing by the state, or by a body such as a general medical council, to ensure that those presenting themselves as doctors have the necessary medical knowledge and competence. There was also no consensus about what the training of those aspiring to become doctors should comprise. People with little or no competence could thus practise as doctors, with the result that doctors acquired a bad reputation, as is reflected in the works of, inter alia, the satirist Martial, who remarks in one of his epigrams, ‘Diaulus was a doctor until recently, now he is an undertaker; what he does now he also did as doctor.’ And in the first century CE Pliny the Elder, in his encyclopedic work the Natural History, has much to say about the ignorance of doctors that put patients’ lives at risk. His remark that only a doctor can commit homicide with complete impunity speaks volumes.