Bryn Mawr Classical Review

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Medicine and Society in Ptolemaic Egypt is the latest title published by Brill in their 'Studies in Ancient Medicine' series.¹ It presents a rich overview of the forms of healing employed across all strata of society in Ptolemaic Egypt, from 'temple medicine' to scientific approaches to medical issues. The term 'society', however, means here primarily the Egyptians and the Greeks, whose testimony to healing practices and theory presented in literary, archaeological, papyrological and epigraphic evidence represents the core source material for the book. Medical traditions and theoretical approaches of social minorities like the Jewish communities, for instance, do not find their way into the text for 'simplicity's sake' (xi). Consequently, much of the volume is concerned with the contrast between ethnic and cultural approaches to medicine among the native Egyptians and the Greek settlers, and the evaluation of arguments for and against the possible influences these two medical cultures may have had upon each other. Lang covers a broad canvas in this compact study, recognizing a number of socio-cultural factors as medically relevant (namely agriculture, botany, demography, linguistics and religious practice) in order to explore how inhabitants of Ptolemaic Egypt might have experienced and dealt with disease.

The book is divided into six chapters, organized by theme, the longest being over 60 pages and the shortest 24. Lang provides a large amount of information in her study, but, despite the uneven division of her chapters, the text is easy to navigate, and sections dealing with specific problems are clearly marked by sub-headings. The first chapter (1-43) provides an introduction to the study by addressing a variety of socio-cultural matters that affect epidemiological situations, largely by means of contrast between Egyptian and Greek views on medicine. Issues discussed include climate, diet, social standing and geographical location. Though Lang concludes that the Greek influx of the Hellenistic era had little impact on the experience of disease, she considers the roles that cultural, ethnic, linguistic and political identity played in Ptolemaic comprehension of medical concepts. To complete the picture she examines traditional views on medicine within the two cultures, focusing in particular on references to Egyptian customs as described in Greek literature. Lang rightly admits that, while this kind of evidence attests to the Greek attitudes towards Egyptian medicine, its utility for the study of Egyptian traditions is limited. She argues that the comprehension and experience of medical concerns in Ptolemaic Egypt were inextricably linked with individual perceptions of cultural identity.

Chapter Two (45-100) deals with Ptolemaic oracular medicine, or 'temple medicine'. It contextualizes the topic through a series of short sections describing how temple medicine worked and contrasting dream-related healing within Egyptian temples with that performed in the Greek Asclepieia. Since similar procedures of temple medicine, incubation in particular, appear present both in Egypt and the Greek world, Lang asks whether parallel aspects of this type of healing can be attributed to cultural influences or to the 'oracular mode' that was characteristic to specific Egyptian sanctuaries. Discussing both textual and archaeological evidence of major sanctuaries, such as the Sarapieon in Memphis and the shrine of Imhotep and Amenhotep in Deir el-Bahari, Lang concludes that, while two types of healing activity can be associated with Ptolemaic temple medicine (one is characteristic of oracular consultations with the gods through abstract materials such as the healing cippi, the other encompasses more elaborate procedures at temples), incubation was not a predominant healing mode within the environment of Egyptian temples. Its presence at the sites under discussion appears to be associated with the Greek tradition.

Chapter Three (101-139) provides further explanations for models of Greek and Egyptian comprehension of illness. It assesses situations in which medical theories of one of the two cultures might appear authoritative for the other within the environment of Ptolemaic Egypt, providing balanced arguments for the occurrence of parallels within these theories. A substantial part of this chapter discusses the current debate concerning the Greek theories of 'residues' and their similarities to the Egyptian concept of whdw. Lang rightly admits the limitations of our evidence for pathological theories. She understands this evidence consists solely of extant written material, predominantly produced by, and for, elite members of both societies. She also acknowledges the practical difficulty of this written evidence in determining exact time scales and defining the geographical area in which the pathological theories applied. Given the material available, the evidence for a close connection between Egyptian and Greek theoretical concepts appears inconclusive. On the other hand, Lang stresses that a number of cultures, such as classical Chinese and Native American, exhibit a degree of similarity in their approaches to theoretical medicine. Common variants include theories that view disease as an outcome of the actions of gods or spirits, and others that view disease as a sign of the body being out of its natural balance.

The fourth chapter (141-203) addresses the issue of responses to illness by individuals, groups of individuals and practitioners alike, as being embedded in diagnosis, prognosis and therapeutics. Lang asks whether any responses to illness were distinctive of either Greek or Egyptian culture under Ptolemaic rule, and whether some elements of medical practice were the result of ethno-cultural preferences. The chapter is organized into sections discussing specific issues associated with medical practice, including pharmacy, non-material and preventative medicine, and surgery. Lang approaches each of these topics by assessing the textual evidence for its perceptions within both Greek and Egyptian medical thought and practice before examining its appearance in Ptolemaic Egypt. Some forms of treatments, notably in the surgical field, seem more characteristic of the Greek tradition. She concludes that while the coexistence of Greek and Egyptian customs offered room for negotiation between two medical systems and the possibility of alternative cures, the choice of therapy in Ptolemaic Egypt and the experience of illness would appear connected to the comprehension of socio-cultural identity by both the patient and the practitioner and their attitudes towards different medical systems.

In Chapter Five (205-41), Lang sketches out matters of adaptation and interaction of cultural patterns in medical fields by examining the textual and papyrological evidence for definitions used in the identification of medical practitioners in both Pharaonic and Ptolemaic eras and the means by which those practitioners were administered, in particular in the extant tax records. She argues that in addition to advertising individual expertise through specialization, the medical titles used in earlier periods indicate the official positions and status hierarchies of their bearers. The Ptolemaic record does not show distinctions in the same way, suggesting a possible change in the administration of medical practitioners and comprehension of their identities. The Greek model of medical taxation briefly introduced in Ptolemaic Egypt is discussed in detail as a good example of means by which Hellenism could be displayed and possibly preferred, showing fluidity in adaptation and the interaction between Egyptian and Greek modes of administration within the medical discipline.

In her last chapter (243-266) Lang focuses exclusively on Alexandria. She acknowledges the Hellenocentric focus on incorporating the city into the Greek world both through architectural and intellectual means. At the same time, however, she offers arguments that suggest an adaptive and incorporative approach, in which two sets of traditions, i.e., Egyptian and Greek, acted as a resource for a new local identity. In this way she explains the omission of exclusively Egyptian ideas from Greek texts and some of the unique features in medical fields that evolved at Alexandria, such as aspects of the pharmaceutical tradition. Other solely Alexandrian characteristics of medicine, namely human and animal vivisections, she explains through short-lived intellectual interests, which failed to contribute to the science. The final part of this chapter concerns elitism in Alexandrian medicine. Lang sketches a distinction between medicine practiced by intellectually elite members of society and the rest of the city through a detailed discussion of the emergence of medical sects and their impact on the discipline. She interprets the existence of elite medicine in Alexandria as derived from the political and cultural framework that focused primarily on the expression and maintenance of Greek identity. In her conclusions, the engagement and competition of non-elite practitioners of medicine with different medical traditions stands opposed to Greek exclusivity in the elite circles of the society.

The book is accompanied by footnotes, many of which 'signpost' the text itself (e.g. 56 n. 36; 69 n. 94; 112 n. 49). There is also comprehensive bibliography (267-94), and, more unusually, indices organized by subject, proper names, places and citations (295-318) — a welcome format that allows for easier orientation in the book as well as for closer reading of the evidence and further research. Additionally, Lang incorporated three illustrations into the text, two of which act as particularly useful visual aids: a map of Ptolemaic Egypt (xiv) and a plan of Alexandria under Ptolemaic rule (242).

In conclusion, the book offers an important contribution to the study of both ancient medicine and social history. Lang admits that she assumes little prior knowledge of either Egyptian or Greek history, or ancient medicine altogether (xii), suggesting the expected audience of her work is spread more widely than the ranks of expert Egyptologists or classicists. She therefore includes a substantial amount of descriptive information that she puts to good use contextualizing her chapters. Medical terminologies, especially terms describing medical practitioners and officials of both the Egyptian and Greek languages, are well explained to an untrained reader (e.g. 177-8; 206-12; 216; 239-41). Though it would have been useful to accompany the text with more maps and plans of some of the specific sites that Lang analyses in detail (especially in Chapter Two, dealing with healing in sanctuaries), this is only a small criticism of what is otherwise an excellent and well-written piece of work, which contributes immensely to our understanding of how disease could have been understood and experienced by the inhabitants of Ptolemaic Egypt. The lack of extra visual aid does not detract from the overall quality of the book, which will appeal to a readership of both experts and enthusiasts alike.

1.   Medicine and Society in Ptolemaic Egypt is volume 41 in the series. Previous titles are listed at Studies in Ancient Medicine.