Reviewed by Marquis Berrey, University of Iowa (marquis-berrey@uiowa.edu)
Here is a new idea: the first volume on the patient's perspective in ancient medicine. In 1990 the American Medical Association released its first statement on patients' agency, with an allusion to Hippocrates Aphorisms 1.1: "From ancient times, physicians have recognized that the health and well-being of patients depends upon a collaborative effort between physician and patient."1 By then the patients' rights movement was already underway, whose conceptual history traces back to developments in Western society's twentieth-century human rights movements. 2 Patients' histories as "medical history from below" have assumed a place in other periodizations within the history of medicine. Yet the conference volume under review is the first contribution from classicists to the field of medical or health humanities, the attendant humanities perspectives used in preprofessional and professional medical education.3 The twenty papers collected are the most sustained discussion of the ancient evidence of humanistic topics central to contemporary medical education: patients' emotional experience, pain management, fees, patient autonomy, narrative medicine, the clinical encounter, embodiment, and confidentiality, among others. While BMCR readers are likely to be most interested in the disciplinary contributions to ancient studies, the volume's most innovative contributions do not limit themselves to that discipline. The term 'medical humanities' does not appear in the index, although the editors include those scholars among their intended audience (6, 18). Three different times (1-18, 109-114, 497-514) the volume recounts a history of medical humanities in order to situate contributors' scholarly interventions. Despite the evident methodological concern, only a few papers offer a vision for contribution to a contemporary discussion in medical education. In fact, the volume suggests the difficulty of writing the ancient patient's perspective "freed from any Foucauldian connotations", as the editors put it (1).To what extent is it possible to speak of patients without invoking some sort of medical paradigm, even if that paradigm is not the doctor's objectification of the patient? The question is at the heart of the modern patients' rights movement, since phenomena related to illness and health are not only the purview of professionalized medicine. Perhaps medicine since its ancient origins has needed a constructed category of patient.4 With a few exceptions, the contributors mostly offer us the ancient evidence of the patient's role in the clinical encounter rather than the patient's perspective freed from connotations of medical power. Since contribution to the larger discussion of medical humanities is a stated aim of the collection, I will discuss the historiographical perspectives adapted in the volume and depart somewhat from the ordering of the papers. The outstanding paper of the volume, Lutz A. Graumann and Manfred Horstmanshoff "'This I Suffered in the Short Space of My Life.' The Epitaph for Lucius Minicius Anthimianus (CIG 3272; Peek GV 1166)", adapts dual historiographical perspectives of historical contextualization and transhistoricism. While the text's language parallels other memorials for deceased children, the inscription's description of Lucius' three illnesses is exceptional. Modern readers have uniformly offered a retrospective diagnosis of tuberculosis. Building on Graumann's earlier work, the authors distance themselves from this reading by historicizing the retrospective diagnosis of tuberculosis: Western medicine of the 1920s and 1930s, when the first retrospective diagnoses of this case were published, set out a new child-saving ethos with tuberculosis among its notable targets. A truly interdisciplinary paper, Graumann and Horstmanshoff's historical contextualization of retrospective diagnosis may be the most important theoretical contribution to the historiography of retrospective diagnosis since Mirko Grmek. Two papers adopt a comparative anthropological perspective. Susan P. Mattern "Galen's Anxious Patients: Lypē as Anxiety Disorder" considers Galen's patients afflicted with lypē as an exploration of anxiety disorders. Tracing the historical terrain of ancient anxiety disorders offers a cross-cultural and cross-historical comparison to the standardly Western, contemporary DSM-5. Galen locates a specific response to some his patients afflicted withlypē (beyond translations of "grief" or "distress") to what we would call anxiety. Mattern argues that anxiety disorders existed in antiquity with symptoms of comorbidity and exhibited mechanisms of feedback cycles. Katherine D. van Schaik "'It may not cure you, it may not save your life, but it will help you'" compares contemporary Australian Indigenous cancer patients with the chronic sufferings of Aelius Aristides and unsurprisingly concludes that both patient groups prefer(red) treatments guided by their beliefs in a medical marketplace of multiple healing modalities. Given the prominence of narrative approaches in medical humanities, other scholars might easily adopt the analysis of Chiara Thumiger "Patient Function and Physician Function", who investigates the narratological functions of the patient and physician in the Hippocratic Epidemics. Thumiger discusses how patients express emotions, agency, and sense-experiences and physicians express judgment and pose questions. She sees a parallel between sifting the systematic agenda of the physician-author for patients's voices with other attempts to recover marginalized voices from written texts. The final paper in the collection, Michael Stolberg "Approaches to the History of Patients: From the Ancient World to Early Modern Europe", discusses the longue durée of patient history. He finds the case history to be an important historical genre for patient voices and perspectives, and pleads for a more sympathetic approach by premodernists toward historical continuities with the present. By far the most common historiography in the collection is historical contextualization. Two papers discuss the healer's non-invasive techniques for learning about the patient's body. Melinda Letts "Questioning the Patient, Questioning Hippocrates: Rufus of Ephesus and the Pursuit of Knowledge" argues that the investigation into the patient and caregivers in Rufus' Quaestiones Medicinales embraces the patient's ethos and individuality. Jennifer Kosak "Interpretations of the Healer's Touch in the Hippocratic Corpus" discusses the ethics of touch in Hippocratic texts. The healer's touch of the patient's body was not gendered. Classical Greek society regulated the touch of non-family members through laws, but nothing except persuasion and tradition regulated the healer's touch. Three papers beyond Thumiger's and Stolberg's discuss case histories. John Z. Wee "Case History as Minority Report in the Hippocratic Epidemics 1" argues that the twelve cases in Epidemics 1 were preserved specifically because they are reports of diseases atypical of those in the katastasis. In an insightful paper Colin Webster "Voice Pathologies and the 'Hippocratic Triangle'" focuses on the physician's observations of the patient's voice. Hippocratics treat the patient's mouth not as a locus of subjectivity but as an orifice emitting verbal, bodily discharges. Petros Bouras-Vallianatos "Case Histories in Late Byzantium: Reading the Patient in John Zacharias Aktouarios' On Urines" discusses the rhetoric of the eleven case histories in this fourteenth-century Byzantine physician. John's case histories are patterned after Galenic rather than Hippocratic case histories and serve as exempla undergirding John's expertise in individualized care. Two papers consider the ancient patient's emotions. Lesley Bolton "Patience for the Little Patient: The Infant in Soranus' Gynaecia" shows that, while Soranus evidences criticisms for adults of all roles, he is consistently compassionate toward the infant in both physical comfort and emotional wellbeing. She argues that the abundance of diminutives in Gynaecia 2 suggests Soranus is drawing on women's oral tradition. Amber J. Porter "Compassion in Soranus' Gynecology and Caelius Aurelianus' On Chronic Diseases" argues that these Methodist physicians exhibit concerns for their patients' emotional states. Two papers discuss patient autonomy in Galen. Courtney Roby "Galen on the Patient's Role in Pain Diagnosis: Sensation, Consensus, and Metaphor" shows that, while we might expect Galen to theorize the subjectivity of pain and its communicability, he ignores the first question at the expense of the second. Galen's ideal patient is a physician himself, who is objectively cognizant of his pain while experiencing it: tacit pains can be described with metaphors that still make clear the referent; most pains are common and standardized, as if they were not subjective but rather objective experiences. John Wilkins "Treatment of the Man: Galen's Preventive Medicine in the De Sanitate Tuenda" treats Galen's version of the homo sanus, whose continuum of wellbeing moves from healthy to requiring medical intervention. Wilkins finds that Galen extends autonomy only to the healthy patient for his own wellbeing. Two incisive papers consider patient-physician interactions. Giulia Ecca "The Μισθάριον in the Praecepta: The Medical Fee and its Impact on the Patient" shows that the Hippocratic Praecepta promotes medicine's beneficence and moral reciprocity, juxtaposing the liberal and mechanical arts so as to place medicine in the former. Orly Lewis "The Practical Application of Ancient Pulse-Lore and its Influence on the Patient-Doctor Interaction" discusses why patients took interest in the pulse. Pulse-taking was public in the ancient clinic encounter: physicians took the pulse in gymnasia and set the patient at ease with polite chatter before pulse-taking. When patients became aware that the pulse was (353) "a means to reveal the hidden physical and mental condition of the patient", physicians set higher levels of skilled knowledge in touching and measuring the patient's pulse as standards of professional credibility, in order to compel the patient to depend on a professional interpretation. Two papers reflect on non-professional healers. Jane Draycott "Literary and Documentary Evidence for Lay Medical Practice in the Roman Republic and Empire" shows that lay individuals wrote primarily to their family members for care and pharmaceuticals. Draycott comes closest in the volume to a discussion of the non-professionalized social role we would call "nursing". Georgia Petridou "Aelius Aristides as Informed Patient and Physician" highlights the features in Aelius Aristides' Sacred Tales that show him as an informed, active patient not only in relation to his human healers but even to Asclepius. In scenes of divine epiphany Aristides contests the god's initial orders; Aristides' citation of Hippocratic texts also seems to indicate the active patient envisaged by Galen's On Examining the Best Physicians. The volume's innovative topic is attuned to disciplinary trends but its conclusions reflect the early results of scholarship in this area. Since much remains to be done, I hope future work, including scholarship beyond studies in ancient medical history, will engage with the results of this collection. The volume translates ancient and modern languages into English and cross-references its own papers. It includes 11 illustrations, an index locorum, and an index rerum. There are a few misprints.5
Notes:
1. Baker, R. et al., eds., The American Medical Ethics Revolution. (Baltimore, 1999) 360.
2. The editors' "Introduction: Towards a History of the Ancient Patient's View" offers an account of changing intellectual trends within medical history; scholarship on the social changes includes Bleakley, A., Medical Humanities and Medical Education. (New York, 2015); Faden, R.R. et al., A History and Theory of Informed Consent. (Oxford, 1986); Jonsen, A.R., A Short History of Medical Ethics. (Oxford, 2000).
3. Bioethics and narrative medicine are its dominant concerns. Previous described as "anarchic" humanistic intervention in medical education, the field is becoming more systematized with the introduction of textbooks and readers: e.g. Cole, T. et al., Medical Humanities: An Introduction. (Cambridge, 2014); Jones, T. et al., Health Humanities Reader. (New York, 2014).
4. Condrau, F., "The Patient's View Meets the Clinical Gaze" Social History of Medicine (2007) 20.3: 525-540.
5. p.120 read "pour on warm oil"; p.130 read "Ἀλγέοντος"; p.132 read "ὁ ἰητρός"; p.134 read "explicitly"; p.136 read "Langholf, V. Medical Theories in Hippocrates"; p.212 read "using the verb agōniān"; p.351 read "Aristoxenus of Tarentum"; p.387 read "Consilio et Auctoritate Academiae"; p.416 read "the educated person (the sort of person who reads Galen's books) can guard"; p.444.n47 the translated English of the main text is missing the Greek "θεραπεύσω αὐτὸν ὧδε ἕξω"; pp.471-495 the running title header "The Chronically Ill in the Ancient World" disagrees with the essay's title; p.484 read "skillful physician"; p.486 read "ἀδύνατον· τοῦτο" and "νούσημα ἀνταγωνίσασθαι· γνῶναι οὖν"; p.487 the English translation is missing for the Greek printed without brackets (although excluded by Kühlewein and Jones) "ἅμα δὲ καὶ εἴ τι θεῖον ἔνεστιν ἐν τῇσι νούσοισι"; p.488 read "ἁγνοτάτου· ἀλλὰ"; p.508 read "to reduce quite simply"; p.518 read "Ashgate".
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