In all the extant papyri from Roman Egypt published so far, there are almost twenty references to a physician entitled δημόсιοс ἰατρόс. Owing to the nature of the documents, references to physicians in general do not provide us with the information we need to know about their professional career². Physicians figure mostly in contexts which are not related to their work, such as receipts and contracts. Moreover, the uneven geographical and chronological distribution of the documents is an important point to consider. It may seem redundant, for example, to note that, in the documents referring to physicians exercising their profession, the δημόсιοс ἰατρόс figures prominently in the papyri of three major metropoleis in Middle Egypt: Oxyrhynchus, Hermopolis Magna, Heracleopolis, in addition to a single document from the Arsinoite nome in Middle Egypt³. All these documents show him inspecting dead bodies and victims of assault, which he did following an order from an official and in most cases in the presence of another⁴.

This paper’s aim is to demonstrate that the title demosios, which described some physicians in Roman Egypt from the seventies of the second to the end of the fourth century, highlighted above all a public and an official recognition of their knowledge of their art. As far as liturgies were concerned, it will be argued that the title served simultaneously two seemingly contradictory functions: it was, per se and by virtue of the public and official recognition which it signified, a proof that the demosios iatros deserved an exemption from public services; and secondly, based upon the official documents in which the title appeared, it was also a proof that he was performing a public service within the scope of his profession. This thesis will be demonstrated by discussing the following points: the question of the salary, the nature of the role of public physicians, the meanings of demosios in Roman Egypt and the limits of their exemption from liturgy.

First: did the demosios iatros of Roman Egypt receive a salary from his city or municipality? Scholars’ views about this question are far from unanimous. Stressing the peculiar conditions of Roman Egypt, Vivian Nutton was more inclined to note that positions of public physicians in this country were different from their positions elsewhere in the empire: «In addition to offering resident medical advice and assistance, the public doctor acted as a legal expert witness on behalf of the state. In return he may have received certain benefits and, at least in Ptolemaic times, a living allowance was given to many, if not all, doctors out of public funds.»⁵

This careful statement is certainly correct in its description of the public physician’s legal or official role within the city; this is a point which I will discuss shortly. It does not, however, state that in Roman Egypt he occupied an official administrative position as clearly as it does, for example, when it states his duties to the administration. The public physician’s position in the Roman period is only implied by the comparison with the Ptolemaic, which shows that Nutton does not think that the demosios iatros held a statesubsidized position in Roman Egypt, like the one held by the basilikos iatros before him⁶.

Marguerite Hirt-Raj has reviewed the evidence in her recent study on physicians and diseases in Roman Egypt. She has noticed that we do not have any documents concerning the salaries of public physicians, except for the case of the doctor of circumcision: ἰατρὸс περιτομῆс. Nevertheless, citing the example of public physicians in other provinces of the empire, and of the demosios grammatikos who was employed by the city of Oxyrhynchus in the middle of the third century among other officials, she went on to add: «There is . priori no reason to think that the situation [of Egyptian public physicians] was radically different: it is probable that certain cities and some metropoleis provided for their public physicians by means of a salary.»⁷ Hirt-Raj’s theory obviously goes a step further than Nutton’s by comparing the public physician with the public grammarian in particular. Still, it is all the more an argumentum e silentio when she suggests that public physicians were employed according to a «formal contract» by their cities. Her argument rests on more solid ground where she observes that the title of demosios conferred upon its bearer a special status among those working in his field who did not bear this title⁸.

Moreover, the cases of the professionals whom Hirt-Raj cites do not seem to prove the point. Nothing in the case of the embalmers who were ordered to inspect a dead body proves that they were paid for their task⁹. The superintendent of transport whom she refers to was hired on a daily basis¹⁰. The demosios grammatikos who was employed by the city of Oxyrhynchus, and whom we know about from his petition to the emperors Valerian and Gallienus in which he complained that he was not getting his salary regularly, does not also prove that the demosios iatros held a similar position¹¹. They might seem to have belonged to the «learned» professions, but they were still categorically different¹². Physicians, surprising as it may seem, belonged in the ancient world to the class of the craftsmen, the demiourgoi¹³.

Also, the medical tradition of ancient Egypt excludes any possibility that the country suffered from a shortage of physicians in the Roman period, even in Greek speaking society, so as to force any city or metropolis to seek the services of a qualified physician as was the case, for example, in Asia Minor or in the Hellenistic East¹⁴. The tendency in Roman Egypt was rather to limit the number of physicians entitled to exemption from liturgies, particularly after Antoninus Pius’ edict, as we shall see. Therefore, it can be concluded that the evidence which is used to demonstrate that the demosios iatros of Roman Egypt was receiving a salary from the administration is not conclusive¹⁵. The consequence is self-evident: if he was not salaried, it cannot be certain that he was a municipal official, and we are equally entitled, indeed we may be obliged, to search for another more persuasive explanation for his title.

Second: we come to the role of the demosios iatros in Roman Egypt. All documents show him performing a task which he was instructed to do by a strategos or by a similar authority in the city. He usually appears inspecting cases of incidental death to certify their cause, or inspecting casualties and wounded persons to determine the limits of injury¹⁶. In other words, he was acting as a medico-legal expert, who writes a report to express his opinion. The formal nature of these documents is unmistakable and has duly attracted the attention of scholars. The procedure was described as being «in its formality peculiar to Egypt in the ancient world»¹⁷. It did not begin with the demosios iatros, however, since we encounter a physician doing the same task and using the same terminology in a document from AD 96, and two embalmers performing the same duty less than two decades before the appearance of our public physician¹⁸. The purpose of the procedure has been rightly defined as legal and economic, in accordance with the case examined¹⁹.

An attempt to address this peculiarity was conducted by Darrel Amundsen and Gary Ferngren²⁰. Having acknowledged the difficulty of determining the exact meaning of the title of the public physician in Roman Egypt, they went on to suggest two possibilities. Either the role of the demosios iatros was limited to investigating cases of injuries caused by acts of violence and to issuing certificates for casual incidents of death, or the title merely described this part of his forensic role²¹. Their theory was not well received. The first suggestion was described by Nutton as being «unlikely», while the other was summarily dismissed as being «unprovable»²².

Lately, Hirt-Raj has expressed a similar view to Nutton’s. She does not think that the role of the demosios iatros was limited to the occasional services of the medical legal physician. This argument obviously accords well with her view, mentioned above, that the demosios iatros was a municipal official while Nutton’s rejection can be explained by his attempt to find a place for him in the line of archiatroi as a whole²³. The importance of Amundsen and Ferngren’s thesis, however, lies in that they acknowledge, more than other studies have done, the peculiar role of the demosios iatros in Roman Egypt. He is to be considered, they maintain, among the «various categories of officials whose raison d’être was, from the state point of view, largely forensic»²⁴ Other studies usually tend to see him within the context of the historical development of the institution of the public physician in general²⁵.

To clarify this problem, we need to reconsider the nature of the public physician’s role as it appears in the documents. Although there is almost a dozen documents mentioning the demosios iatros while performing his legal duty in Oxyrhynchus, no single testimony shows him performing the usual or normal duties of his profession, namely treating sick or diseased people of the city. His sole task was to describe a case and to write a report including his opinion. The emphasis is always on inspecting (ἐπιδεῖν/ἐπιθεωρηθῆναι) and on reporting (προεφωνεῖν); and there is no reference whatsoever to him giving the necessary medical care to the people he was inspecting. Nor was this requested from him by the authorities or by the family of the wounded; the order given by the strategos and the petition submitted to him is always for him to inspect a case and to describe its condition.

Only in a single document, which incidentally confirms the preceding observation, do we encounter a demand for a medical treatment²⁶. In a petition to the strategos (P. Oxy. LVIII 3926, AD 246), a woman complains that some robbers broke into her house and took away what they could carry after they had badly wounded her husband and her son. She requests that an official be sent to her house to check their condition with regard to their getting the needed therapy (19-22): πρὸс τὸ δύναсθαι αὐτοὺε τῆε δεούсηс θεραπείαс τυχεῖν. As if to emphasize the formality of the procedure and to define the role of the public physician, the strategos disregards her comment and gives his assistant the usual formulaic command, ordering him to take a demosios iatros to check the condition of her husband and her son and to report to him in writing (35-40): ὅπωс сυμπαραλαβὼν δημόсιον ἰατρὸν καὶ ἐπιδὼν τὴν περὶ τὸν ὄνδρα αὐτῆс καὶ τὸν υἱὸν διάθεсιν ἐνγραφῶс προсφωνήсῃс.

Moreover, the public physician never gave the medical care needed on his own, or else we will have to suppose that all documents deliberately ignored the issue completely. This fact becomes even more peculiar when it is emphasized that the phenomenon was not limited to Oxyrhynchus. The reports of the public physicians of Hermopolis Magna further confirm the same conclusion²⁷. Indeed, it may be «unlikely» to believe that the cities employed their public physicians to perform the legal duty attributed to them in these documents; but, the peculiarity of the procedure requires us to think of a peculiar explanation for the role of the demosios iatros in Roman Egypt. We will not think it unlikely if those public physicians were performing their role as a public service. This suggestion has been lately put forward by Carsten Drecoll in his study of liturgies in the Roman Empire in the third and fourth centuries on the basis of a remark by Libanius who says that the law demanded from physicians only one liturgy, pertaining to their profession: ὁ νόμοс τοὺс ἰατροὺс μίαν ἀπαιτεῖ λειτουργίαν τὴν ἀπὸ τῆс τέχνηс²⁸. Drecoll asserts that this liturgy which he refers to «compares well» with the duty of the demosioi iatroi in the papyri. He does not, however, discuss the papyrological evidence in any detail, and moves on with his discussion on liturgies; and Libanius was after all a fourth century writer. Nevertheless, it can be confirmed that this thesis is substantiated not only by the absence of any documents regarding the salary, but also by the special meanings of our physician’s title in Roman Egypt.

Third, the title demosios had various meanings and uses which can be traced historically and which can shed more light on its use in describing the physician: a) it was first used as a replacement of the ancient title basilikos to designate farmers working on public land and who were accordingly referred to as demosioi georgoi²⁹; b) shortly after, it was used to refer to people working in public spheres as opposed to those working in private domains; and in this sense we encounter the public bankers³⁰; c) it was also used to indicate that a person is a resident of a certain area³¹; d) it was used to describe an official charged with a certain task without specifying its nature, probably as being understood³². e) It was also used, more importantly, to designate holders of liturgical offices such as those mentioned in the γραφὴ δημοсίων, which dates to the middle of the second century³³.

As may be concluded from this brief discussion of the meanings of the title demosios in general, in the case of the public physician it can well be a later replacement of the title of basilikos, known to have described physicians in the Ptolemaic period; but it was not a duty of the royal physician to issue certificates of death³⁴. It is more likely, however, in particular on the basis of the conditions in which demosios started to describe a physician, towards the end of the second century, that the title was used to emphasize his residence in a locality which recognized his expertise, and to indicate, as we shall see, that he was exempted from public services in areas other than his profession.

Finally, we come to the question of exemption from liturgy. That physicians were entitled to exemption from public services in Roman Egypt and in the empire as a whole is beyond dispute³⁵. The relevant papyri and inscriptions have been discussed by Naphtali Lewis³⁶. He observes that «the language of these papyri and inscriptions carries the clear implication that – at least from the second century on – exemption from liturgy was not enjoyed by all physicians as a matter of course, but only by those to whom the privilege had been specifically granted by imperial, provincial or municipal authority.»³⁷

Physicians had to undergo a scrutiny called dokimasia, and only those dedokimasmenoi were «admitted to the class of physicians enjoying certain civic and fiscal privileges including exemption from liturgy»³⁸. It was not a matter of license, either³⁹. Although it is difficult to determine how public acknowledgement referred to by the term was attained, dokimasia was certainly a necessary step without which no rights to exemption were assumed⁴⁰.

It is almost half a century since Lewis’ article first appeared; during this interval, several documents were published, shedding more light on the subject⁴¹. Discussion of the immunity granted to physicians was thus expanded to include the nature of their exemption and the privileges endowed upon them by the dokimasia. It has been noted, for example, that these privileges acquired in the Roman period a «passive» character compared to the preceding Hellenistic era⁴². Also, it became necessary to note the special importance of the procedure in determining a physician’s status in a province like Egypt, where doctors might have been undistinguishable from embalmers and both could have been confused with those practicing magic.

The prefect Valerius Eudaemon indeed had a point when he doubted the physician who complained that he was enlisted as a liturgist by the very persons whom he treated, and who knew that he was a doctor. The prefect told him that he might have treated them badly and asked him to show his credentials to the strategos⁴³. In another document, a physician complained that he was nominated to perform a public service, making it clear that practitioners of the medical profession were exempted from public service, and especially those who were scrutinized, just like himself: μαλ[ί]сτα [δὲ oἱ δὲ]δοκιμαсμένοι ὥсπερ καὶ ἐγ[ώ]⁴⁴. The first of these two papyri dates to the middle of the second century, while the latter is roughly dated to the same century, probably by comparison with the first⁴⁵. By then, the declining economic conditions in the country seem to have forced administrative officials to disregard the immunity from taxes (ἀτέλεια) given to physicians from the time of Augustus⁴⁶.

These disputes concerning the subject of exemption were probably enhanced by the edict of Antoninus Pius, which limited the number of physicians to be allowed immunity from liturgy according to the size of their respective cities. The edict also paved the way to subjecting physicians to the procedure of the dokimasia, thus creating a «gradation of status and privilege» among those working in the medical profession in the following years. Since the procedure of dokimasia implied not only residence in a locality but also a public recognition of the physician’s expertise, it conferred upon him a legal status which distinguished him from other unscrutinized physicians. As Nutton suggested, «it is easy to identify them with the “public doctors” who made their appearance at Oxyrhynchus between AD 170 and 173.»⁴⁷ Hirt-Raj goes even so far as to suggest a possible date between AD 150 and 170 for the adoption by physicians of the title of demosios⁴⁸.

But was the title of demosios in the case of the public physician merely a sign of status? We have already seen that he could not have been a municipal official. It has been further demonstrated that the title emphasized his residence in a place and, what is more, his exemption from liturgy. It has also been suggested that the problem of explaining his role as a medical legal physician could be solved by considering it a sort of public service. To demonstrate this point we need to investigate the issue within the context of the administrative changes taking place in the metropoleis and of the liturgic developments in the country as a whole. In other words, we need to bring together two seemingly different trends of scholarship: ancient medicine, and liturgy and institutions. The administrative and liturgic changes were so inter-twined that it is fairly legitimate to see in them both an attempt to deal, in part, with the growing economic difficulties. Commenting on the wide range of the administrative changes in the metropoleis where they first began, Bowman says: «The creation of a ’Greek’ magisterial class in the nome-capitals [of Roman Egypt] introduced a type of local civic government previously unknown. With it came the introduction of a new and a wide-ranging liturgical system.»⁴⁹

The manner in which the title of the office of the demosios iatros began to appear can thus be construed as follows. By the reign of Trajan the elaborate liturgic system in Roman Egypt has reached its peak, and it is reasonably certain that it encompassed all individuals who could perform a service of some sort to the state⁵⁰. With the growing economic difficulties, the burden of liturgy began to encompass some personnel who were previously exempt. Thus, the edict of Antoninus Pius, issued in the early years of his reign, while limiting the number of exempted physicians, created at least in every nome capital a group of acknowledged resident physicians and other professionals. These developments obviously reflect the difficult economic conditions and were also accompanied by the creation of new liturgies⁵¹. Now, the first time a list of the liturgic demosioi appeared in the documents was in AD 158/159⁵². By then, if not before, the title of demosios must have acquired a technical meaning, in addition to its previous connotation which merely contrasted the public and private domains. Obviously, it began to emphasize not only an individual’s residence in an area but also the fact that he was performing a public service to the state.

As earlier medical reports show, the services of some medical personnel were occasionally needed by the administration. In the report immediately preceding the appearance of the demosioi iatroi, the task was done by two embalmers⁵³. In a yet earlier report that has the same formulas, the duty was performed by a physician who was accompanied by the same official whom we meet later with the demosios iatros, namely the ὑπηρέτηс⁵⁴. As a part of the administrative changes and as a result of liturgic developments, the task was then assigned to a resident scrutinized physician who was accompanied by that very official. Thus the title of demosios began to refer to the physician who was to perform the duty of the medical legal doctor as a public service, as was the case with his fellow demosioi. Those demosioi iatroi were the qualified experts to rely upon in the cases recorded in our reports and whom the administration called upon to perform those duties. Needless to say, this service did not acquire in their case the usual technical meaning of public service. Public physicians were never included in any liturgic lists or rosters since it would have represented by then a flagrant violation of their exemption. The service they performed was after all occasional and any resident physician who had undergone the dokimasia in the locality could perform it.

Indeed, in no single document do we encounter a reference to the public physician. In all documents referring to a single demosios iatros and whether he refers to himself as being a public physician or he is referred to as such, no definite article is used. Thus a certain Dionysius addresses the strategos, stating that the report therein is given by a demosios iatros of the city of Oxyrhynchus⁵⁵. Another introduces himself to the strategos of Oxyrhynchus as being a demosios iatros of the same city⁵⁶. An example of a context where the public physician is referred to comes in an order from a strategos to a lower official to take with him a demosios iatros to investigate a case⁵⁷. We are left with the implication that there was always more than one public physician even where the reference is to a single doctor.

This implication is confirmed by some documents which refer to more than one public physician. These documents date mostly from the fourth century, are few in number and are geographically limited to Oxyrhynchus⁵⁸. Together with two documents from Hermopolis Magna which refer to a chosen (?) number of scrutinized public physicians within the city, documents from Oxyrhynchus are clear enough to prove the point⁵⁹. In the first papyrus which dates to the year 316, a report is forwarded to the logistes of the city of Oxyrhynchus from four doctors who describe themselves merely as demosioi iatroi⁶⁰. Four more documents indicate that the duty of the public physician was performed collectively by four demosioi iatroi at least from 316 till 354⁶¹.

Our evidence, however, does not allow us to speculate about the total number of public physicians either in Oxyrhynchus or in any other city in Roman Egypt, thus giving more weight to the idea that they were performing that duty as a public service; or else we will have to suppose that more than one public physician might have been employed by the cities where the demosioi iatroi appeared. Indeed, despite some repeated references to «four public physicians» in Oxyrhynchus, we still do not know if their number always remained the same, nor how they were replaced. Thus, the interpretation of this apparent numerus clausus varies. It has been suggested that defining the number in such a way can be linked to the Antonine edict, but the date of the documents is more than two centuries later⁶². The four physicians were also said to have represented all the physicians to have undergone dokimasia in Oxyrhynchus but, interestingly enough, we encounter only a single reference to them with the definite article as «the four public physicians»⁶³. The hypothesis that they represent a group whose members may have filled the office for a long period of time and who were replaced in case one of their members died or retired is even more difficult to accept, since we do not have enough evidence to warrant it⁶⁴. At least we do not have the names of the physicians who kept that position for two or three consecutive years.

It would seem more probable that the four public physicians of Oxyrhynchus reflect an internal administrative change inside the city, particularly since they were not accompanied by any other official while performing their duty. It is also significant that the reports were addressed by then to the logistes instead of the strategos⁶⁵. The four public physicians could possibly have been the ones chosen to perform the liturgic duty for that specific year. It is noteworthy that the title of archiatros began to appear around the middle of the same century and finally replaced the title of demosios iatros towards the end of the century.

In conclusion, the evidence shows that we need to pay more attention to the title and to the role of the public physician in Roman Egypt in order to understand the nature of his duties. The legal and the economic conditions in which the office appeared show that he was not an employed official, unlike the other demosioi iatroi in the Greek world. On the basis of the function assigned to him in the documents, the demosios iatros in Roman Egypt had more to do with his neighbouring demosioi who were performing their duties as a public service. His office was established in the context of the municipal changes within the metropoleis of Egypt, and as such he owes a lot more than his name to the Greek world. Moreover, since no documents show conclusively that he was a paid official, and on the basis of the formal and legal nature of his role and the connotation of his title, we will probably be on a firmer ground admitting that he was performing this duty, qua demosios iatros in Roman Egypt, as a public service within his field of expertise.