North Africa was the most prosperous province during the late Roman Empire and experienced a flowering in all fields, but especially in science and medicine. A great number of medical texts produced in this period in the Roman Empire at large originated in North Africa. Four outstanding physicians/medical authors in late fourth- and early fifth-century North Africa immediately attract our attention: Helvius Vindicianus, Theodorus Priscianus, Caelius Aurelianus and Cassius Felix.

It is my intention to envision these four authors in their own environment and time frame. The first chapter thus deals with Roman North Africa in general – its rise and its fall after three waves of foreign invaders had swept across the country; the development and demise of some of the cities, especially Carthage, where Vindicianus would have had his seat as proconsul, and Cirta, the home town of Cassius Felix; the people who inhabited these cities, each with their own language and culture; and some famous contemporary Classical and Christian authors.

The health facilities available so many centuries ago are astounding. The aqueducts, the massive bath complexes and the Cloaca Maxima, a sewer in which an ox wagon could turn around, are only a few examples of the amazing level of architectural and technological knowledge of the Roman engineers. Yet the cities were deficient in disposing of human waste, which must have led to many diseases. Hospitals, a Christian initiative, were only established in the fourth century.

Various epidemics for which there were no cures swept through North Africa in the fourth and fifth centuries, killing thousands of people. It is interesting to note the changing views of the reasons for these epidemics in the course of centuries.

The question then arises what the standard of health services was. Not only was the lack of antibiotics and antiseptics, discovered some 1500 years later, a problem, but also the fact that diagnoses and operations were done with little knowledge since there was a veto on dissection. The absence of a health board to supervise the standard of physicians meant that any quack could present himself as a doctor.