One aspect of the historical remains of ancient medicine that is the subject of much recent work concerns the status of the sources as literature. Some of the sections of the Hippocratic corpus represent the earliest sustained examples of prose surviving, while Galen was the most prolific prose writer of antiquity. Why was writing so important to ancient medicine? In some cases, it could have been about gaining a wider audience, or demonstrating one’s authority.
The Hippocratic corpus contains examples of texts demonstrating the features of literacy in its very earliest stages (Lonie 1983; Langholf 1990). In particular, some treatises are in the form of lists, reminiscent of inventories of treasure from the palace societies of early Greece. Once a list has been composed, it is relatively easy for its writer, or another user, to draw out shared features, which become more obvious once there is a written text to be read and reread; so, for example, in a list of aphorisms recording “A nosebleed is a good thing if the menstrual period is suppressed” and “Vomiting blood ceases if the menstrual period begins,” the next stage would be to group these together, as indeed has happened in the text of the fifth part of the Aphorisms. This suggests that the current form of Aphorisms represents the second stage, and that there was once an earlier medical text from which it derives. The third stage would occur when somebody not only noted the similarities exposed by grouping similar points together, but went on to develop a theory to explain them.
For the ancient historian, one of the most seductive aspects of medical writing is its sense of immediacy and reality; a case history, such as those in the Hippocratic corpus that give the progress of a disease from day to day, or Galen’s description of the woman sick with love for Pylades whose pulse changes when merely his name is mentioned (Prog. 6; Nutton 1979), seems to provide us with privileged, even unmediated access to the people of the classical world. This is, of course, an illusion. The case histories of the Epidemics are not like a modern hospital case history; we are not even sure of the audience or purpose for which they were written, or whether we have them in close to their original form, or only after several rewritings. Comments such as “Is this the rule in an abscess?” (Epid. 6.3.21) or “Does such excrement suggest a crisis, as in that of Antigenes?” (Epid. 2.3.11) suggest that they could be “notes to self” rather than something written for other people to read, meaning that even the unspoken assumptions behind them may need to be reconstructed. When the writer noted the season in which the illness began, this may be because he believed that the body was affected by the temperature and humidity of the time of year, or may be a reference to jog his memory when going back over his records.
Galen’s case histories were rather different, being written in order to publicize his talents and enhance his reputation; their focus is therefore more on the doctor and the reactions of his audience than on the patient. His work On Prognosis opens with the comment that it is “impossible for most doctors to predict the things that will happen in each disease suffered by their patients.” Instead of acquiring an accurate knowledge of medicine, most doctors spend their time pleasing their patrons, “going with them as they go home, and amusing them at dinner.” But Galen’s point is that he differs from “most doctors,” and so, when he makes an accurate prediction of what will happen next in the course of a disease, to those ignorant of his methods he appears to be a “wonder-worker” (Prog. 1 and 8). This is represented by Galen as a dangerous reputation to have; he claims that Quintus, “the best doctor of his generation,” was framed for murder by those envious of his talents and expelled from the city. This is very much a picture of medicine in the city of Rome, where several doctors can be assembled at the bedside of a sick person and engage in debate, and where considerable rivalry exists for the patronage of the wealthiest men.
Such rivalry was not only found between doctors, but extended to others caring for the sick. When the wife of Boethus was affected by a gynaecological complaint, she was too embarrassed to speak to the doctors, and instead consulted her midwives - who, Galen reckoned, “were the best in Rome.” When their treatments were unsuccessful, Boethus called together the doctors and they agreed to follow Hippocratic methods, which they interpreted as being to administer drugs to dry out not only the womb, but the whole body (Prog. 8). This course also proved unsuccessful, but neither “reasoning” nor “experience” offered any alternatives. When the woman’s nurse - also praised by Galen - was bathing her, she suddenly suffered severe pain and lost a considerable amount of watery fluid. Galen described her attendants “screaming and shouting,” and he rushed in to rub her stomach and warm her extremities, telling the women to “stop standing uselessly about.” The cure took place once Galen reflected on the feeling of the woman’s stomach muscles and concluded that the warming and drying treatments - which included laying the woman on warm sand - should be altered. Instead, he rubbed her body with honey and tried to remove excess fluid through the skin rather than just from the bladder, before going on to treat her with dietary changes, purgatives, and more honey massages. His treatment regime lasted for 17 days - unthinkable except with an elite patient such as this - and Galen’s reward for success was 400 aurei. When first-century ad Roman writers such as Pliny the Elder attacked Greek doctors, it was partly in terms of the enormous sums they demanded from their patients.
World History
