[ bookreviews ]
Think "ancient medicine", and for most, Hippocrates comes to mind. The famous oath, which Hippocrates himself almost certainly had nothing to do with, has preserved the name into the age of mass pop culture; one recalls Homer Simpson begging Dr Hibbert to "remember your hippopotamus oath." Perhaps some have dimly heard of Galen or other medical figures of classical antiquity, but Hippocrates is undoubtedly number one. Many would have also some awareness of the theory of the four humours, the four fluids which ancient doctors felt went "out of balance" in illness.
Professor Vivian Nutton, in his magisterial study that is, apparently, "the first large-scale history of ancient medicine in a single volume for almost 100 years", looks beyond the Hippocratic method and tradition to the other medical practices of the Ancient Greeks and Romans. He acknowledges that much, and in particular much of the folk tradition and the role of female healers and midwives, is out of our reach because of the nature of the sources that have survived, and avoids making the book a dry account of the famous names and competing theories.
The history of medicine, Nutton writes, is the history of "men and women striving to come to terms with illness, whether as sufferer or as healer." Hippocrates and the Hippocratics are dealt with fully, but Nutton is keen to bring us the full range of ancient medical thought. He pays especial attention to Galen of Pergamum, a figure much of his academic work has been concerned with and one whom he evidently feels a special affinity. But Galen tended to present himself as a lone fighter for truth amidst ignorance; Nutton introduces other schools of thought, less of whose works have survived (almost three million of Galen's words are with us still), such as the Methodists, Pneumatists and the various groups of Hippocratics.
Medical thinking inevitably informs and is informed by the wider culture. The detailed description of wounds and their treatment in the Iliad lead some fanciful commentators to postulate that Homer was a medical officer attached to the Argives during the Trojan War. And Thucydides famously dispassionate description of the plague that befell Athens during the Peloponnesian War bears the influence of the Hippocratic method and has also inspired speculation that the author has had medical training.
Nutton discusses the interplay between medicine and religion. It comes as a surprise to discover how pliable the Ancient Greek Pantheon was. The cult of Ascelpius, god of healing, only emerged in the fifth century BC. Nutton suggests that there was not competition between medical and magical models of healing in the Greece of this time. It is easy to write of where ancient doctors got things wrong; certainly the four humours (blood, phlegm, bile and black bile) do not feature much in contemporary biology. However, their major insight, that illness was not necessarily a supernatural judgement from above, but something that could be understood and alleviated, was perhaps the most significant breakthrough in thinking about disease in history.
Most commentators have tended to be rather dismissive of Roman medicine. At least some of this is due to an equation of Roman with Latin and a more limited, insular culture than the Greeks; as Nutton writes, this was certainly true of the Republic but not of the multilingual Empire. Galen was a man of the second century AD. The book is strong on the medicine of the later Empire, with the rise of Christianity occasionally clashing with medical thinking but on the whole complementing it. The new religion, with its emphasis on the New Testament injunction to love one's neighbour, oversaw the creation of the modern hospital in the early fourth century AD.
Nutton's main focus is an attempt to reconstruct the individual lives of patients and doctors. He writes that he wants to "give a sense of ancient medicine, what it must have been like to have seen Hippocrates at the bedside of a patient, Erasistratus experimenting, Asclepiades or Thessalus holding forth, or Galen dissecting a pig." Ancient doctors were independent spirits, and Nutton's attempt to reconstruction the contention of different ideas of healing and illness is entirely admirable. The traditional, heroic account of ancient medicine as the gradual accumulation of skills and knowledge from early Greece to Galen is not abandoned, but balanced.
For a scholarly work, Ancient Medicine is a readable story of the ordinary lives of history. Nutton is a patient, fair-minded and wise guide to the array of medical practices of the classical past. The book acts as a corrective to misconceptions about the classical past, without indulging in revisionism for the sake of it.