In The Concise Encyclopedia of World History, editor John Bowle states that the first physicians in Rome were slaves. Most were of Greek heritage, many of them freed slaves originally taken from Greece when Rome conquered it. Because of their heritage, the social standing of Roman physicians was quite low. Also, as many early physicians were charlatans, offering ineffective cures, there was a deep mistrust of doctors. One citizen commented that the new doctor in town was previously an undertaker and that what he was doing as a doctor wasn't much different than his work as an undertaker. Another contended that the doctor charged too much, used worthless medicines and drugs, and attempted to treat diseases for which he had no training or understanding.

Before the Greek physicians arrived, medicine was dispensed by a variety of Roman practitioners. Healing cures and surgery were administered by family slaves, often trained only by experience; by barber-surgeons, who used bleeding as a common practice; by priests, who exorcised or cajoled demons from the patient; and even by the slave masseurs, known as aleiptes. This latter category, like the family slave, was knowledgeable only through experience. These were times with no licensing (medical licensing would not arrive until 200 C.E.), and anyone who was willing to wield a scalpel did. The "masseur," working without limits and established within the gymnasium or the facilities of a rich householder, was able to dally in the medical sciences without much fear of reprisal, except a diminished reputation if he failed too often.

Into this environment came the astute and educated Greek physicians, who eventually took over the treatment of Roman citizens and their leaders. But their rise to acceptance was not an easy one. It wasn't until Julius Caesar "granted freedom to all freeborn Greek physicians practicing in Roman territory" in 46 B.C.E., wrote Douglas Guthrie, in A History of Medicine, that they were able to escape from the domination of their rich-household owners and the general scorn of the Romans, and rise to the heights of social and professional status.

Clear evidence of the role of massage in Roman medical treatment can be found in a letter to the emperor from Pliny the Elder (C.E. 23–79), a physician, telling about how his life was saved by the ministrations "of a medical practitioner who cured many of his patients by the process of rubbing and anointing." He derived so much benefit "from the remedy that he asked the emperor to grant the physician, who was either a Jew or a Greek, the freedom of the city and the privileges of Roman citizenship," wrote Douglas Graham, in Manual Therapeutics.

The influence of Hippocratic medical practice, including massage, continued in the work of a number of prominent Greek and Roman physicians. Thus medical practices of the time were built, as exemplified by the Hippocratic model, upon observation, trial and error, and especially on prescriptions for rest and proper diet. The theory of the four humors was still a working concept for most physicians, and the effects of massage fit well into their theories of circulation.

The Roman physician's knowledge of anatomy was very limited, since the study of anatomy through human dissection was prohibited in the Roman Empire. (Dissection of animals was allowed, however.) Whatever human dissection was performed at the time was done primarily in Egypt, under the authority of the conquering ruler, Alexander the Great. A man named Marinus, of Alexandria, is most often cited as the expert dissector of these times.

At the beginning of the third century B.C.E. the bodies of condemned criminals were made available to physicians, such as Herophilus and Erasistratus in Rome. The nervous system, and especially the human brain, received the greatest attention, and it was during this time that many advances were made in the knowledge of human anatomy. Despite these early studies of anatomy, there is no evidence that anatomical knowledge played any part in the physicians' use of massage, and anatomy was certainly unknown and irrelevant to those working in the baths and gymnasiums, since they received no medical education, nor did they treat any diseases.

Asclepiades (124–40 B.C.E.) was a Greek physician who settled in Rome to practice and teach medicine just before the dawn of the Christian era. Asclepiades was a most favored son of Greece and Rome; he was not a follower of Hippocrates and did not subscribe to Hippocrates' natural medicine. A famous story about Asclepiades is one in which he supposedly brought back to life a Roman citizen being carried to his grave in a coffin. His cure for the apparent dead man has been described as "several minutes of manipulation," wrote Sir William Osler in The Evolution of Modern Medicine. Perhaps Asclepiades' success is related to his "corpuscular theory"; Asclepiades believed that life was the result of atoms constantly on the move within the body. Disease or death were caused by an obstruction of this movement. Thus his manipulation may well have been a simple jostling massage which woke up the "sleeping atoms" to bring his patient back to life. In writing about Asclepiades, Sir William Osler states, "Diet, exercise, massage, and bathing were his greatest remedies."

Herman L. Kamenetz, writing in Manipulation, Traction and Massage, reports that massage was the third-most-important therapy used by Asclepiades, "after hydrotherapy and exercise … for abdominal pains Asclepiades said that the suffering parts should be rubbed with oil long and energetically to tolerance. To dispel the frigid torpor he advised that the parts be massaged with warm hands and then wrapped in cloth. For convulsions he rubbed the vertebral column day and night in the hope of dissipating spasms. He did not advise massage in fever except during its remission, but he prescribed it in dropsy and leucophlegmasia."

John Harvey Kellogg, M.D., founder of the Battle Creek Sanitarium at the turn of the century, claims that Asclepiades, "held the practice of this art in such esteem that he abandoned the use of medicines of all sorts, relying exclusively upon massage, which he claimed effects a cure by restoring to the nutritive fluids their natural, free movement. It was this physician who made the discovery that sleep might be induced by gentle stroking." Emil G. Kleen, a physician and author of Massage and Medical Gymnastics, acclaims Asclepiades as the father of "mechano-therapy" for the invention of several devices designed to produce fluid movement through swinging, vibration or violent motion.

The Roman encylopedist Aulus Cornelius Celsus (25 B.C.E.–57 C.E.), writing about Asclepiades, said, "Asclepiades speaks of friction as if he were the inventor of it. According to him there are only three therapeutic agents: first is friction, to which he devotes most space, then water and gestation [meaning to bear or carry, not pregnancy]. No doubt we should not take away from the young the glory of their discoveries, but that is no reason for not leaving to the older what they have established in their writings. Assuredly, no one has presented more precisely and clearly than Asclepiades how and at which parts of the body friction[s] are to be applied. However, in this respect he has added nothing to what Hippocrates expressed."

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