“I ought to see the tribune of the camp,” I said, thinking aloud. “Where can I leave my trunk?”
The driver spat. He had a low opinion of foreign eunuchs cluttering up the post, and had not said much during the journey. “Where are you staying?”
“The hospital.”
“I’ll drop it there for you. Don’t worry, nobody’s likely to steal anything from there. No one goes there unless they have to.” With that he shook the reins and drove off, leaving me staggering. A few off-duty troops had come to the posting station to see the cart arrive: they stared curiously. I gave a feeble smile and said that I must see the tribune of the camp, and they stared harder. One of them offered to show me to the presidium.
The camp tribune was called Valerius; he was an older man, an Illyrian from a family of professional soldiers. His scribe showed me in to him as soon as I appeared, and when I said who I was, he stared. “I’d been told we’d have a new chief physician, a very learned Alexandrian,” he said. “But I thought you would be older and, umm, that is . . .”
“You weren’t expecting a eunuch,” I said. “Well, it’s not what I’d have chosen myself, if I’d been consulted.”
He didn’t laugh, only looked surprised. “Yes, well, the present chief physician — that is, the former chief — must be twice your age. It’s, umm, awkward. He isn’t happy. But I suppose the most distinguished Sebastianus knows what he’s doing. When is His Honor coming back north, did he say?”
I handed him some letters from Sebastianus. He glanced through them, then looked uncertainly back at me. “And you really are in charge of the hospital, then? His Excellency says that . . . well, you really are in charge. I, umm, suppose you’ll want a house.”
“I don’t need a whole house. I can manage with a room, provided it’s private — or I could stay at the hospital.”
“I should think you’ll want a house,” Valerius repeated, but he shrugged. “Well, leave it for now. I had better show you to the hospital.”
The hospital was in the town, outside the main body of the camp. It was an attractive building, an open square of stone and stucco, thatched, with a covered colonnade along the inside. The hollow of the square was filled by a garden of medicinal plants. When Valerius and I arrived we found three men standing in this garden examining my trunk, which had been deposited in lonely splendor beside the well. They all looked up and stared hard as we approached. Two of the men were of middle age, and might have been brothers: they were both dark and grizzled, thin and wiry, with heavy brows and bad teeth. The third was younger, a couple of years older than myself, with light brown hair and a beard; he smiled as I approached. The other two scowled.
“My dear Xanthos,” said Valerius nervously to one of the dark men; “esteemed Diokles,” to the other; “Arbetio,” to the last. “This is, umm, your new colleague, Chariton of Alexandria.”
“Of Ephesus, actually,” I said, and smiled at all three. “But I trained in Alexandria. I am delighted to make your acquaintance.”
There was a moment of icy silence. The two older men were now frankly glaring. Valerius coughed, said that he had to examine Sebastianus’ letters, and retreated to the presidium.
“Well,” I said, “could I perhaps see the hospital?”
The senior doctor, Xanthos, grunted. The younger man, Arbetio, smiled nervously. “What about this, Your Wisdom?” he asked, indicating the trunk.
“Is there some room I could have here, at least for the time being?”
“Oh, yes, there’s lots of space. I’ll take it — by Teutones, it’s heavy!”
“It has all my books in it. If it’s safe here, you could have a couple of slaves move it later.”
“Arbetio's a slave,” said Xanthos. He had a rough voice, deeper than one would expect from such a thin man. “He can take it.”
“He’ll need some help. I have a lot of books.” I took one end of the case, since the other two men were now glaring with disdain. Arbetio took the other end, and we carried it into the hospital.
The hospital had a long ward room down the back part of the square, the east side, with beds for forty patients. There were another ten beds on the north side, and a kitchen; the south had some operating rooms, storerooms, and the like. But there were only six patients in the ward. Two were recovering from amputations; one had a stab wound in the shoulder, which was infected; one was a case of smallpox, off by himself at one end; the other two had fevers. But they were all in a bad way. The fever cases in particular were extremely pale and lethargic, and when I examined them, I saw why. They had been bled white.
I had never truly appreciated the wisdom of Hippocrates until I saw the way medicine was practiced at Novidunum. Hippocrates says that doctors must work with nature to effect a cure, only assisting the body in its own efforts to heal itself, never trying extreme and violent remedies unless everything else has failed. Xanthos and Diokles were ignorant, brutal, and incompetent butchers, and the suffering they inflicted on their patients was enough to turn my stomach. They had not the least idea of hygiene. The water for cleaning in the hospital came from a stone trough set against the side of the building to catch the rain. It was green with slime, and the camp horses drank from it. Xanthos and Diokles would use this water to wash the patients’ infected wounds, and the wounds would fill with worms. “But rainwater is pure!” Xanthos told me when I objected to this. “It’s pure when it falls, but it becomes rotten very quickly on standing!” I told him. “You should use boiled water and a cleansing solution with vinegar on wounds, and pure well water or spring water even for cleaning the rooms!” “We’ve been using that water since the hospital was built,” sneered Xanthos. “But of course Your Wisdom knows better than army doctors of years’ seniority.” “It’s not just my idea; Hippocrates recommends it!” I said. “Book-learning!” said Xanthos with deep contempt.
Besides knowing nothing of hygiene, Xanthos and Diokles were very free with their knives, and bled patients who were ill with anything from mild enteritis to lockjaw, bled them repeatedly until they were quite white, bled them to death. And they also liked dosing with hellebore after the bleeding — a course of treatment calculated to kill anyone, since the hellebore purges whatever the bleeding misses, and leaves the patient a dried-up husk. When I told them how dangerous this course of treatment seemed to me, they just sneered at my book-learning again. They had both learned the art of healing from Xanthos’ father, who had been the previous chief physician of the camp. They did things the way they had always done them, and that was the right way to do them, and if the patient died, well, it just went to show that he was feeble and would have died soon anyway. On my first day I gave up trying to conciliate either of them. They despised me because I was foreign, a eunuch, young, and overeducated; I despised them because of their travesty of the art of healing. Xanthos in particular was difficult: brutal and superstitious, and always in the way. Diokles did not in fact spend much time at Novidunum; he had private patients in Histria, and only spent the odd week back at the camp.
Arbetio was another matter. He was a very clever surgeon. The other two had bought him to help them out after seeing him practice dentistry with his previous master, a peddler. They worked him very hard, giving him all the messy jobs, so that he ate, slept, and lived at the hospital and had almost no time for himself. He was not their personal slave; he’d been paid for out of camp funds. That didn’t stop them from sending him out on personal errands, though, and generally treating him as though he were one of the camp servants, born to chop wood and cook. This was doubly deplorable because he was a better doctor than either of them and genuinely loved the art. He was literate and intelligent; he had clever hands and a fine instinct for correct treatment that not even Xanthos and Diokles had been able to debase, and, unlike the other two, he was eager to learn. As soon as he was certain that I genuinely did know more than Xanthos and Diokles, he was my firm friend and ally. The fact that I treated him with more respect had very little to
do with it. I was glad of his support. I needed an ally, even a junior and servile one. I made a lot of changes at that hospital.
I realized within a week that my plan of staying at the hospital was impossible. I had no privacy there. There was nowhere that I could wash without being watched, and people kept coming into my room, wanting things, even when I was asleep. So I handed Valerius another piece of my mother’s jewelry (a pearl necklace that fetched sixty-five solidi), and I bought a house. Valerius owned it, and he let me have it cheap. It was a pleasant house, fairly standard for the camp, which meant it was a mixture of Roman and barbarian that would have been gaped at anywhere else. It had a large kitchen in the center, with a loft over it where the slaves slept, and two other rooms, one on either side of the main one. The kitchen had an oven, which provided heat during the winter. The house was near the hospital, and had a cowshed and garden. (I added a bathhouse after the first winter, so that I could wash in comfort rather than shiver over a basin in my room.)
Then I had to buy two slaves to keep the house for me. Slaves are cheap on the frontier. I paid twelve solidi for Sueridus, who was a man about my own age, a Theruingian Goth by birth, good with horses, fair at gardening, strong enough to do all heavy work; for Raedagunda, a housekeeper and a good cook who was fifteen when I bought her, I paid ten solidi — less than what I later paid for my horse. In Ephesus or Alexandria I would have paid three times as much. But most slaves in the great cities are born slaves, and very few are ever sold. It’s different on the frontier. Sueridus had been captured when he was twelve in Valens’ campaign against the Theruingi. Raedagunda had been sold to a trader by her parents when she was seven, because they needed a new plow ox and some money to restore what the campaign had destroyed. There are thousands of Gothic slaves with similar histories. I suppose my Maia’s father had once been like Sueridus — he’d come from Scythia too.
I got on quite well with my slaves, except that they thought that I was a sorcerer. They thought this first because I was a eunuch, and they accounted such sexual mutilation a very powerful charm. Second, I brewed drugs in the kitchen, planted herbs in the garden, and did the occasional dissection in the cowshed: all clearly sorcerous practices. They also thought that I had some distinctive sorcerous marking, perhaps a tail, which I did not want them to see — this because I insisted on bathing and dressing myself behind locked doors. They never, so far as I knew, tried to observe this supposed tail. Perhaps they were afraid I would curse them. However, Goths do not despise sorcerers the way Romans do, so my household remained friendly toward me, and even, I discovered, boasted of my magical powers in the marketplace. Which was just as well, because I had quite enough trouble at the hospital without having to worry about things at home.
The hospital had problems other than the incompetence of its doctors. Perhaps because of its systems of treatment, it was much dreaded by the troops. If a man up the river fell ill, he and his friends kept it secret as long as they could. So a man would come down with a fever, and instead of receiving treatment, he kept on at his work as long as he could stand; when he couldn’t stand and was found in bed burning and vomiting, he was packed into a little supply boat with a load of chickens or wheat, without receiving any sort of nursing, and sent downriver, sometimes for a two- or three-day journey; and if he was somehow still alive when he arrived at Novidunum, Xanthos and Diokles would kill him. The soldiers also tried to treat for themselves any wounds they received in fighting with the barbarians (or among themselves), and this was even worse than their “treatment” of fevers. They would tie tourniquets very tightly around the affected part to stop the bleeding, and pack the injuries with moss and spiderwebs and magic charms composed of bits of animals, and the inevitable result was that the wounds became gangrenous. When the patients arrived in Novidunum, if they were lucky they had to have an arm or leg amputated, and if they were unlucky they died, usually of injuries from which they could have recovered easily if they had received proper treatment.
The third class of problems had to do with money. The regional troops are not funded, paid, or privileged as well as the field armies, and there was a shortage of funds for anything other than pay, and that of course included the hospital. There were no regular attendants when I arrived; instead, the troops stationed at the fort worked at the hospital on a rota. The hospital duties were hated by all of them, since they found the work slavish and were afraid of catching something, so it was felt to be fair to have all of the men taking their turn. I can think of no better way to insure that if there is some serious disease about, everyone in the whole Scythian army is exposed to it. It also meant that the standard of nursing was very low, since no one bothered to learn any standard procedures for a one week tour of duty. Moreover, there was no money for drugs. Xanthos and Diokles grew a few of the commonest medicinal herbs in the hospital garden — hellebore, of course, and wormwood, and hemlock and foxglove and the like — but apart from that, there was nothing. They had never heard of opium, let alone some of the more exotic Indian herbs I’d been accustomed to use in Alexandria. Arbetio had to perform his amputations on conscious patients, as his learned chiefs didn’t even know the use of mandragora as a general anesthetic. I went through my copy of Dioskourides and worked out a number of substitutes for the herbs I was accustomed to — ivy juice instead of cedar oil as an antiseptic; nightshade instead of melilot for earache — but I couldn’t find any substitute for opium except hellebore. Now hellebore is all very well; it is a powerful narcotic, and does dull pain. But it is also a powerful purgative, and to give it to the old, the young, or those weakened with disease can be fatal. But giving a patient nothing for his pain can be fatal too, since the pain exhausts him and makes him sick. Opium, a narcotic that is not a purgative, is the perfect solution, and in Egypt it’s cheap and so common that some of the peasants eat it for pleasure, as we drink wine. But there was no authority that could order opium in quantity from Egypt and pay for the shipping of it.
After I’d been at Novidunum for a couple of weeks, I sat down at the kitchen table in my new house one evening and thought about what I should do. I’d had a couple of futile shouting matches with Xanthos that day, and one with Diokles; I’d seen another man die who should have lived, and I was angry. Sebastianus had put me in charge of the hospital, trusting in Athanaric’s recommendation and in my Alexandrian qualifications. But Valerius refused to support me in any of my proposed changes. I would tell Xanthos not to bleed a patient; he would sneer, then bleed the man behind my back. If I complained, Valerius hummed and fidgeted and concluded that Xanthos and I had different methods. “You have one way of treating patients; the most respected Xanthos has another. We here can, umm, judge of the values of both.” If I recommended a new rule, Valerius said that he would think about it. He was suspicious of change, and Xanthos was an old friend of his. If I was do to any good at all, I had to put Sebastianus’ support to the test, and get a clear declaration that I was in charge and could reorganize things as I liked. That would certainly cause a lot of resentment, but the present system was impossible. It was killing and maiming the troops it was meant to help. And it couldn’t be reformed gently from within; there was too much wrong. I would write to Sebastianus with a list of concrete recommendations and a plea for help in implementing them. If he helped, good; if not — well, then I would have to see. I could always go to Constantinople.
The first thing to do must be to establish a good system of hygiene. Well water for washing floors and linen, cleansing solutions and boiled water for injuries, and the place cleaned at least once a day. To do this without Xanthos’ cooperation would mean changing the system used for hospital attendants, which I wanted to do anyway. I determined that the best system of recruitment would be to take on men who were former patients — the cripples and amputees. These men had an insecure and unhappy position in the army. The tribunes of some forts thought it most important to keep up the front-line strength, and they dropped cripples from the rolls, turn
ing them out to beg. At other forts they were kept on at half-pay, doing menial tasks while their officers kept the other half of their pay in return for this favor. To use them in the hospitals wouldn’t cost the state a copper drachma, and would give me a group of attendants that I could train into what I wanted.
The second thing was to curb Xanthos’ and Diokles’ blood lust. I would prefer to get rid of them both, especially Xanthos, but that was beyond my authority. It would have to suffice to get a declaration from Sebastianus, and from Valerius the tribune, that they were not to bleed or dose patients without my consent. That would be humiliating for them, but it couldn’t be helped. If they wouldn’t agree to that, perhaps Sebastianus could transfer them somewhere else; I wouldn’t have them butchering men before my eyes. Come to that, I ought to establish a rule that Arbetio should perform only medical duties. It shouldn’t be too hard: it was what he’d been bought for.
The third thing would probably have to wait until the end of the winter. I would have to go and talk to the troops upriver. I had to convince them of the dangers of tourniquets, give them instructions for treating the milder fevers on the spot, and tell them when to send someone to Novidunum. If, as Sebastianus had said, there was plague further to the west, it would also be a good idea to set up some mechanisms for isolating plague cases and purifying the camps.
I would have to find someone to get me opium and a few other drugs, too — Thorion could probably buy them for me in the capital, if he was willing. But I could afford to leave that for the moment.
So I went to my room at the back of the house (I’d been sitting in the kitchen, as it was early November and the rest of the house was already cold) and fetched some papyrus and a pen. “Chariton of Ephesus to the Most Excellent Duke Sebastianus,” I wrote. “Esteemed Lord, very many greetings.” Then I stared at the papyrus, wondering how I could best convince the duke to do what I wanted. I thought of him reclining on his couch in Marcianopolis, enjoying his concubine and his Chian wine. But that was an inaccurate picture: at Novidunum, Sebastianus was greatly admired for his energy and efficiency in his command. I would do better to be energetic, efficient, and straightforward myself.
The Beacon at Alexandria Page 26