The Wikipedia article Medicine in Ancient Rome has this to say on the first hospitals in Rome:

The Roman medical system saw the establishment of the first hospitals; these were reserved for slaves and soldiers… Medical care for the poor was almost non-existent, so the poor had to resort to spiritual aid.

It is unclear what period this statement refers to (and there is no citation), but in the next paragraph it says

The earliest known Roman hospitals of the Roman Empire were built in the 1st and 2nd centuries AD

If the first statement is referring to the Aesculapium on Tiber Island, then the second statement doesn't make much sense as the Aesculapium was built in 293 BC, and it appears that others soon followed.

Concerning medical facilities for Roman citizens (and others?), it was not until 219 BC that the state seems to have done anything in the way of funding (though that is not to say that medical care was not available to those who could afford it):

… a vulnerarius, or surgeon, Archagathus, visited Rome from the Peloponnesus and was asked to stay. The state conferred citizenship on him and purchased him a taberna, or shop, near the compitium Acilii (a crossroads), which became the first officina medica

Other internet sources I’ve checked are also vague on dates (although I could of course have missed something). A potentially more authoritative source, Sandra R. Joshel’s Slavery in the Roman World does not seem to mention anything related to medical care or facilities for slaves.

In short, my question boils down to the one in the title:

Did slaves (and soldiers) at some time in the 3rd century BC have access to state-sponsored medical facilities which others did not? If so, in case of slaves, do we know why? (for soldiers the explanation seems obvious enough)

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    The "others did not" part makes this difficult. Why should a rich man go to the poor's hospital? If he would have desired so it was unlikely to be forbidden for him? (Legally, socially it would be disaster) – LangLangC Dec 9 '17 at 10:57
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    My point is: if the Wiki pages are to be believed, the state was providing something for slaves and soldiers but nothing for citizens (at least, until later). I'm not saying or even implying that citizens, rich or poor, would go to the same 'hospitals' as slaves, just that no state support seems to have been made available for citizens until sometime after it was made available to slaves and soldiers. Seems like it should be the other way round... – Lars Bosteen Dec 9 '17 at 11:56
  • State sponsored services are common for the underclass; bread and circuses. In a status based society accepting charity undermines your gravitas and dignitas. Not sure why this is any more surprising than "water is wet". – Mark C. Wallace Jun 13 at 13:30
  • @LangLangC - not all free Roman citizens were rich - hence "bread and circuses" - and, politically, it would have made more sense to provide medical care for poor men with a vote, than slaves with none, and who might be seen as their master's responsibility, just as his cow or mule was. – TheHonRose Jun 13 at 15:51

The information given in the WP article seems a bit misleading and has the occasional error. The army and navy had its special valetudinaria. Therefore a soldier would have been treated there and as long slaves were in or better with the army then they would have been treated there also.

But what this entails in republican times is quite different from our modern understanding of 'military medicine':

The Roman military provided the only organized military medical services in the classical age […] Romans seem to have had little expertise and less interest in medicine. For the most part, medical science was con ned to herbalism, people were expected to be their own doctors, and what professional physicians there were generally found themselves distrusted and denigrated. The rst Greco-Roman physician whose name we know was Archagathus, who emigrated to the city in 219 B.C. and established his taberna (clinic) with state help. He showed such a proclivity for the knife and cautery that he acquired the nickname carnifex (butcher) and a general opprobrium.
That attitude changed after the fall of Corinth in 146 B.C. and the absorption of Greece into the Roman state. The subsequent flood of Greek physicians to Rome led Pliny the Elder to complain that the city had done perfectly well for 600 years without doctors and he failed to see the need for them now. The standing of Greco-Roman physicians improved dramatically in 91 B.C. when Asclepiades of Prusa came to the city. His use of diet, baths, exercise, and massage and his avoidance of surgery and poison- ous medicines enhanced both his personal reputation and that of his profession.
The republican Roman army had no formal medical corps, and wounded soldiers were bandaged by their comrades and cared for in the homes of local citizens. Soldiers on campaign were at high risk of epidemic disease. Livy (Titus Livius) described an epidemic during the siege of Syracuse in which so many soldiers died that the overwhelmed survivors stopped burying the dead and left them to rot where they fell. Legionnaires became so despondent that they ung themselves unprotected on the enemy lines, preferring to die by the sword rather than from disease. Disease was not the only problem. Livy also noted that a Ro- man soldier was more likely to die from his wounds after a battle than be killed directly during the fray. (McCallum p 270–272)

But that changed starting with Caesar's campaign in Gaul and was quite professionalised by the time of Trajan.

The second paragraph quoted in the question is quite misleading, as they at least mixed up AD and BC abbreviations, correctly noted in the question. Apollo the healer and Aesculapius were well introduced within Rome by then. And they were imported officially, by the state itself.

More serious is that the article seems to amalgamate anachronistically the non-existant duality of physical and spiritual healing, which were often found together on one and the same continuum, despite what progressivist apologetes of Hippokrates – "Father of Modern (non-spiritual) Medicine" – would like to believe. Providing a public facility for spiritual healing was one form of "medical facility". (Cf. Hortsmannshoff: "'Did the god learn medicine?' Asclepius and Temple Medicine in Aelius Aristides' Sacred Tales" p 325-342.)

The earliest references to any Roman involvement with the Greek world of health and healing are not concerned with secular healing, but with the importation of new gods to defend the Roman state during an epidemic. We have already encountered the introduction of the cult of Apollo the Healer in 433 BC, but it was the arrival of Asclepius that attracted most attention from later writers. In 293BC, after three consecutive years of plague in Rome, it was revealed, after a priestly consultation of the Sibylline Books, that the epidemic could be halted only by summoning Asclepius from the shrine of Epidaurus. The next year a formal embassy, led by Quintus Ogulnius, was dispatched there by the Roman senate; the god himself consented; and, in the form of a snake, he was conveyed to Italy. […] Several features of this account deserve notice. First, the introduction of Asclepius and his cult to Rome is a formal act by the Roman state, not an ostensibly private initiative, […] (Nutton, p 162.)

Before that, folk and family medicine and remedies, and mountain men, Marsi and snake handlers (considered experts of healing even by the later Galen!) were giving out both herbs and tincture, venoms and poisons, performing operations, prayers, chants and rituals. For sick to go or be brought for incubation near a temple of a benevolent god or one known to possess and share his healing powers was entirely common.

What our literary sources do not tell us, but has been revealed by archaeology, is that similar healing sanctuaries were common in central Italy, often near springs. At many of them, sufferers dedicated votive offerings in the form of terracotta models of the affected part of the body – feet, hands, eyes and sexual organs in particular. Incubation may even have been practised at a shrine at Lavinium, not far from Rome. Although the form the cult of Asclepius took in Rome is assuredly Greek, the arrival of Asclepius can also be interpreted as an index of the assimilation of Roman Italy as a whole into the Greek world. (Nutton, p 164.)

Rather, Hemina is emphasising a distinction between Romans and Greeks: whatever healing skills the Romans themselves might have possessed, they did not count as medicine, since that was a purely Greek import. (Nutton p 164.)

But whatever your status: having access to a real (Greek) doctor was a matter of prestige, whatever the status of the doctor. It seems to be quite well known that a human doctor was superior to incubation, and therefore preferred. In case a 'professional' wasn't available Roman family structure already provided an alternative in the pater familias being responsible for curing maladies. But going to such a sanctuary does not seem to have been restricted to any class.

‘Keep away from doctors’, Cato’s advice to his son, is not a condemnation of all forms of medicine or of all those with healing skills, but only of the Greeks or those who follow them. He approves of the Roman way of healing, by which the head of a household took responsibility for the health of all its members, animals included. He himself is said to have kept a notebook in which he wrote down prescriptions and diets for his household. This medicine is confined to the household: it is not bruited abroad, or traded for cash; and, so Cato claimed, it is effective, for it kept him and his family hale and hearty for many years. (Nutton p 165.)

Precedents from Hellenistic Greek cities almost certainly lie behind the action of Julius Caesar, perhaps around 49 BC, in conferring Roman citizenship on any doctor practising in the city of Rome, and, scarcely a decade later, behind the granting to all doctors and teachers throughout the Empire of immunity from conscription and from having troops billeted upon them. In 23BC or shortly after, following his dramatic cure by an ex-slave doctor, Antonius Musa, the emperor Augustus is said to have granted tax immunity for ever to all practitioners of medicine. The number of immigrant doctors who took advantage of this generosity to become full citizens and the procedures whereby one proved one’s qualifications as a doctor or a teacher are both unknown. (Nutton p 167.)

By contrast with the Greek East, where there were medical dynasties and, even occasionally, doctors drawn from wealthy families, the practitioners of medicine in Rome were at best parvenus, and, far more often, drawn from what in law were the very lowest sections of society, slaves and ex-slaves. Although the figures are a little distorted by the abundance of information provided by inscriptions coming from the emperor’s Roman household of slaves and ex-slaves, scarcely 10 per cent of doctors recorded epi- graphically from Italy and the western Latin provinces of the Empire before AD 100 are Roman citizens; over 75 per cent are either slaves or ex-slaves; and fewer than 5 per cent bear a non-Greek name. Although the percentage of citizens and of non-Greek names rises over the next two centuries, the general pattern remains the same. (Nutton p168.)

There are both social and intellectual reasons for this reluctance. The true practice of medicine is incompatible with the indecent pursuit of ‘quaestus’, monetary gain: for all his knowledge, Celsus and many of his intended audience were and remained gentlemen, interested at least as much in warfare and agriculture as in medicine. Like Cato, Celsus implies that one should confine one’s medical attentions to one’s family and friends, and certainly not attempt to treat large numbers of patients all over town, for one would not be able then to give them the individual attention so necessary for a cure. (Nutton p169.)

What is today understood as a 'hospital', not a little private clinic, seems to be a much later invention. Though still in 'Roman times' much of the above is true as early as the early republic, hospitals seem to belong into late antiquity.

With the legalisation of Christianity in the fourth century, the Christian duty of care for the sick and needy became ever more visible, expressed in bricks and mortar in a new architectural form – the ‘hospital’. (Nutton p 314.)

What a travelling doctor could do was inevitably limited by the drugs and instruments he had at his disposal, and by the time he could spare before moving on. ‘Whoever can cure the sick while on the move?’ wondered Seneca, disapprovingly, for ‘travel doesn’t make a man a doctor’. By contrast, a doctor resident in one town could turn his house into a surgery or a cottage hospital, where the sick might spend several days under the watchful eye of the doctor and his assistants. (Nutton p 270.)

The idea of a 'hospital' for the sick did not develop until the Byzantine period, pace H. Avalos, Illness and Health Care in the Ancient Near East (Atlanta, 1995), 184, suggesting that the Gula temple might have served as a healing centre, similar to the Asklepieion. (Horstmanshoff p 39).

Returning to the concept of valetudinarium:

Virtually all Roman medical advances came from the military rather than from civilian physicians, and the best of Roman physicians, including Dioscorides and Galen, served with the army. Roman medical educators advised those who would be surgeons to find themselves an army and follow it in battle because they would never see enough wounds in the civilian practice to become competent in their craft.
In sum, Rome brought the organization of military medicine to a level never before achieved. Its military hospitals surpassed anything again seen until the late 19th century, and the technique of its surgeons was probably as good as it could have been with neither anesthesia nor antisepsis. (McCallum p 273.)


Lacking complete surveys: it might be argued that indeed there was a time when there was one type of state sponsored health service unavailable to ordinary citizens within the walls of Rome. But there are certain limits to this conclusion:
This only holds true for the hands-on military medicine in the imperial time, available only to those who where with the army. – All other types of medicine and care, private or public, seem to have been available to all classes most of the time, in principle.
'The state' being a problematic concept in itself, when applied to the Roman Republic or Empire, did provide direct and indirect sponsoring: temples, baths and markets (where healers practised), exempted doctors from duties like taxes and service, regardless where they served the public good (that is: health).
Regarding state sponsoring: for example the public buildings of 'the state', the res publica, were largely funded by private benefactors, not the tax payers as modern readers might expect. It would therefore be quite peculiar to demand that rich benefactors paying into a public pool would count as contributing to "state-sponsored medical facilities" but patrons covering the costs for their family members and slaves would not.
As shown above having access to a type of 'hospital' (in the modern sense implied in the Wikipedia article) does not say anything about the quality of care to expect there. Since the early forms were indeed with the military, and the military practitioners had horrendous track records before Caesar, being sent there was no advantage at all. The same holds true when the Empire began its steady decline in the 3rd century when it was again preferable to be treated at home or at least away from the camps and garrisons.
Since this was specifically mentioned in the question: "the poor had to resort to spiritual aid". Not only was spiritual healing a perfectly accepted fine form of healing. This "last resort" holds also true for the rich in many cases when the doctors just couldn't do much more then to comfort the sick and maybe alleviate some symptoms. Much of the tradition of family and folk medicine from Roman times is lost now. In extant writings acknowledging their wisdom and successes we might conclude that the gaps between just waiting, using folk medicine and seeking a Greek professional might have been much smaller than we like to expect.

David Wootton argues, from the fifth century BC until the 1930s, doctors actually did more harm than good:.
Although we believe that people who choose to live high-pressure lives may bring on heart attacks, we rarely blame people for getting cancer or arthritis; ancient medicine, by contrast, implied that all diseases reflected deficiencies in lifestyle. In some respects this empowered patients. Are you an old man who wants to make love to a young woman? Then eat the right food first–– pigeon breasts are particularly recommended. (p 56.) [Or to be even more polemical] Put simply, the fundamental puzzle about medicine from the fifth century bc until the end of the nineteenth century is that doctors found patients who were prepared to pay for treatment that was at best ineffectual, and usually deleterious. (p 67.)

Although this is getting a bit lengthy already and prone to misunderstandings, the following from the same page has to be quoted as well: "But the fact that there was no progress––far too little to have any systematic impact on life expectancy––and the fact that medical intervention did more harm than good, does not mean that doctors did not cure patients. "

Quotes from:

H. F. J. Horstmanshoff & Marten Stol: "Magic and Rationality in Ancient Near Eastern and Graeco-Roman Medicine", Studies in Ancient Medicine 27, Brill: Leiden, Boston, 2004.

Jack E. McCallum: "Military Medicine", ABC-Clio: Santa Barbara, Denver, 2008.

Vivian Nutton: "Ancient Medicine", Routledge: London, New York, 22013.

David Wootton: "Bad Medicine: Doctors Doing Harm Since Hippocrates", Oxford University Press: Oxford, New York, 2006.

  • I'm accepting this as, although this doesn't provide a complete answer to the question (which may not even be possible anyway), a lot of work has gone into it, and it does go someway towards providing an answer. – Lars Bosteen Feb 14 '18 at 9:26

It seems that the word 'hospital' would be misleading. The majority of ancient institutions treated only specific parts of the population, while modern hospitals don't make that distinction. Also, in general physicians went themselves to the houses of the sick, and not the other way around (this, of course, if the sick could pay). But there were some institutions that treated specific sectors of the population, such as slaves and the military.

About Valetudinaria: Romans had valetudinaria for slaves and military infirmaries, examples of such institutions. But this was not always the case, at least for slaves: until 50 CE sick slaves were in general dumped in the Aesculapium and not treated by their masters, which only changed when emperor Claudius issued a decree forbidding such a practice. Nevertheless, the 'physicians' in slave valetudinaria were even compared by Cornelius Celsus with veterinarians and barbarian doctors, and did not offer high-quality care. I didn't find any sources that stated that these were state-sponsored institutions, though, and it seems to me that they would be generally privately owned, so as to reduce money losses by the owners in the form of dying slaves. I also could not find sources that told what happened to these slave institutions in the 3rd century in specific, although if something changed with them probably these changes would have been mentioned in the works used.

About military valetudinaria, however, there is more information. As you said, the motivation for these institutions was pretty obvious, to maintain a healthy and functional military, and a standard plan for the fortresses built by the military included a valetudinarium in a quiet sector of the fortress. Nevertheless, in the 3rd century it seems that the military institutions had declined, and Alexander Severus (222-35) "allowed soldiers who were seriously ill to retire to a city and convalesce with some family of the town." (quote from Miller)

About the Aesculapium: For the Asklepieia, temples of the god of medicine of which the Aesculapium is an example, it seems that they didn't provide hospital care. They didn't provide suppliants with a place to sleep, with food, or even with nursing care. Pausanias seems to provide some backing to the claim that these institutions really took care of the sick, specifically about the Aesculapium at Phocis, and says that the sacred precinct included the temple together with dwellings for both the sick and the servants of the god. This, however, doesn't mean that all Aesculapium had these facilities, and evidence for the contrary seems scarce.

The ritual for curing, for example, didn't include medicinal care or anything like this, and was more of a ritual practice. The sick made a sacrifice to the god Asklepios, and then went to sleep on mats on the floor; after some days, the god might cure the sick person, or appear in his dreams asking him to perform a specific action, or even recommend an accepted medical remedy, that doesn't seem to have been provided by the Aesculapium. These specific actions sometimes included things like jumping into an almost frozen river, for example. Physicians did work as priests in these temples, but they don't seem to apply medical knowledge in treating the sick, preferring to ask for spiritual help.

About hospitals in general: The works I read made specific claims about institutions resembling true hospitals only appearing at the 4th century, namely the xenodocheia or ptochotropheia. This kind of institution was in general backed up by a church, by ecclesiastical means, and could be used by everyone that wished to do so. Nevertheless it seems that the richer part of the population still preferred to be treated by private physicians instead of going to these institutions.

Works used:

MILLER, Thimothy. The Birth of the Hospital in the Byzantine Empire, 1997.

NUTTON, Vivian. Ancient Medicine, 2004.

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