Princeton (2024) h/b 272pp £14.99 (ISBN 9780691206271)
This is the latest Loeb-style addition—Greek on the left, English on the right—to the ‘Ancient wisdom for modern readers’ series published by Princeton University Press. The author is particularly well qualified for this text as she managed to study both classics and medicine whilst at Harvard and now holds appointments in both disciplines at Vanderbilt University and Vanderbilt University Medical Centre.
This very readable book is entirely concerned with the opinions, theories and recommendations of the second century physician Galen. In her introduction to the book, we learn that Galen was born into a wealthy landed family resident in Pergamum (modern Bergama in Turkey). His father, Nikon, was an architect and praised by Galen as a devoted father, with knowledge of geometry, mathematics, architecture and astronomy. Nikon arranged for Galen to study philosophy and medicine. He observed at least four different doctors in Pergamum who followed different philosophies of medical practice. For example, the empiricists went by treatments observed to work, making and recording multiple careful observations, the dogmatists were guided by humoral theories of causality and the pneumatists thought that imbalance of the pneuma—‘breath modified by the brain and heart’—played a major role in illness.
After Nikon’s death, when Galen was in his late teens, he began to practise medicine in Pergamum and later in Alexandria. We learn of Galen’s success and his boast that in his first year as physician to the gladiators of Pergamum only two gladiators died, and that over his next 4 years there were no deaths. This in stark contrast to the 16 deaths under the previous management! In a quote that resonates down the years Galen observes ‘I am extremely amazed that, although health is highly valued, men are so remiss as to neglect it: they refrain from seeking instruction in an art by which they will regain health.’ With that we are off to obtain instruction…
The main body of the book is divided into 5 sections, dealing with ‘Mind and body connections’, ‘Exercising the body’, ‘Individual physiologies’, ‘Nourishing the body’ and ‘Definitions of health and disease’.
‘Mind and body’ contains a real 2nd century episode that could have come from a 21st century’s psychoanalyst’s couch. A young woman has sleepless nights, tossing and turning, and on seeing Galen covers herself in her bed sheet and turns to the wall. The clue comes when he notes a change in her appearance and pulse on being told that ‘Pylades was dancing’. No such change occurred with mention of other dancers. The diagnosis is clear, and one way in which the mind can influence the body also clear. Galen is also noted to approve of Aesop’s fable that we all carry two knapsacks around our neck, the one in front filled with the wrongs of others and one behind with our own. Thus we see the wrongs of others but not our own. His approval is based on his injunction that to be a good person we must know our own shortcomings, with detailed instructions as to how best to ascertain this. The instructions are full of what can only be described as a very modern sounding appreciation of human frailty.
The section on exercise is fascinating. At first, we learn that physical exercise for health takes precedence over food, and—as if that was not enough—‘that the best exercise trains the body and delights the soul’. Galen praises exercise such as hunting with dogs but concedes that this is only for the wealthy. There is considerable praise for exercising with a small ball. This is something that all can afford and exercises the whole body and the mind. It can involve vigorous exercise or gentler exercise by choice. It appears to involve competing teams, tackling and wrestling down opponents and catching, throwing and running with the ball (eat your heart out, William Webb Ellis!). Galen hints at some of the perils of exercise, still with us today, mentioning death as a result of falling off a horse … plus ça change!
The chapter on individual physiologies is an account of Galen’s theoretical underpinning of medical practice. Essentially, he subscribes to the ancient Hippocratic notions of 4 bodily fluids— ‘phlegm, yellow bile, black bile and blood’ against a background of the 4 elements—‘earth, air, fire and water’ and the 4 seasons—‘spring summer, autumn and winter’. Thus, phlegm is cold and wet, yellow bile hot and dry, black bile cold and dry and blood hot and wet. As is always the case, surprising complexity may arise from a small number of premises. The essence of Galen’s arguments (derived from Hippocrates) is that in health we have an equivalence between opposing characteristics, but with significant latitude in allowable deviation from the norm. What is more he states the obvious—‘what is appropriate for a dog is not appropriate for a fig tree or a man’. Disease arises from a serious imbalance, inevitably leading to therapeutic intervention aimed at correcting the imbalance. One has the feeling here that a clever intellect is bending the theory into a believable account of everything. It must be admitted with considerable success, as these ideas were not challenged seriously for hundreds of years.
The section on nourishing the body is not entirely for modern consumption. The advice is no fresh fruit! Nonetheless, food is regarded as very important, as a supply of in part nutrition and in part medication. It all depends on the individual. If a person is dry he needs wet foods to maintain humoral balance, and vice versa if wet. Foods may also act as medicines, in particular—given the examples provided—‘if acting on the gut, inducing vomiting or purgation’.
The final section—‘Definitions of health and disease’, has a very modern feel. Galen defines health as the ability to do what you wish, without pain, in an age-appropriate way. He points out that what is expected of an infant is very different from an adult, and relates this, as one feels he must, to age related changes in the body’s humoral mix.
Your reviewer is left with the feeling that if Galen could be teleported into a modern 21st century hospital and medical school he would soon be a leading physician, the author of numerous papers and many books. This book excels in revealing how very modern the ancient world was in some respects, and yet how delightfully different in many other ways. The Greek source material will be an additional bonus for classicists reading this most enjoyable book.
David Smith FRCPath