Efficacy

The many centuries of use of ancient medical texts, in which different Hippocratic treatises have gone in and out of fashion, raises the issue of how we should assess the effectiveness of ancient medicine for its patients. Traditionally, efficacy was judged by setting ancient medicine alongside existing knowledge. If we no longer believe in the disease described - a classic example would be the “wandering womb” - then to what extent can we judge how effective the remedies given to cure it would have been?

One approach is to re-evaluate ancient drug treatments in the light of modern scientific study, investigating how the different ingredients would have affected the bodies of those on whom they were used. This is not easy, as the identification of plants used in ancient medicine is not always straightforward, and, furthermore, the amount of volatile oils they contained would depend on factors such as the soil in which they were grown, and the time of year at which they were harvested. One group of healers in the ancient world were the “root-cutters,” who may have based their authority on precisely this kind of knowledge; drugs were also sold in the markets of large cities. The main problem in assessing ancient drugs by modern standards is that ancient medicine used “polypharmacy”; in other words, in most remedies several different ingredients were combined. Modern studies to date do not replicate this, but acknowledge that the combination would have had different effects than the use of ingredients in isolation. Another approach is to consider the plants and animals used in drugs as having value because their users made culturally specific connections between them and myths or rituals (Totelin 2007). Two examples from the gynaecological texts can illustrate this. Animal excrement was used in women’s disorders, perhaps to remove “bad” substances by sympathy, perhaps as fertilizer for the womb, widely compared to a field in Greek literature (von Staden 1992a). The vitex agnus castus, or “chaste tree,” used in gynaecological remedies, was also employed in the Thesmophoria, where it was placed under the couches of the women taking part in the ritual, to ensure their chastity during the three days in which they took part in the ceremonies, and/or their subsequent fertility on returning to normal life (von Staden 1992b).

Comparative work in anthropology suggests a third alternative. This is to think outside the context of drug treatments, and instead to concentrate on the explanations for ill health and for the remedies used given by doctors. According to this approach, illness means a breach in the patient’s ability to make sense of existence; the patient’s “story” is broken and the role of the doctor is to help fix it (Brody 1987) by creating a narrative, telling “the Good Story” (French 2003). We can see evidence of this in the Hippocratic Epidemics. The statement that the fever suffered by the wife of Euxenos “seemed to come from the steam bath” (Epid. 7.50) suggests an attempt to find a cause by looking into the recent past for anything unusual, as do the comments that the man from Baloia “had been very careless in his way of life” (Epid. 7.17), or that pain in the chest and ribs affected the wife of Simos, “shaken in childbirth” (Epid. 7.49). However, shaking was an established remedy to speed up a difficult birth, so this could be seen as a condition caused by previous medical treatment. The Hippocratic Prognostics also suggests that the doctor can tell the patient their past, present and future, again suggesting the creation of a story to explain the symptoms, and also to give the hope of a successful outcome. This story, on its own, was not always sufficient; the wife of Euxenos died. However, the focus on the story supports the suggestion that ancient medicine grew out of common beliefs. Just as medical language was based on everyday vocabulary, so medical theories may well have been only a little more developed than what people already believed; if the public did not believe in the importance of keeping their fluids in balance, it is hard to see how the Hippocratics, or even Galen, could have persuaded them.