Allen Lane (2020) h/b/ 404pp £25 (ISBN 9780241277058)
This timely, ambitious and energetic book has at its heart one anonymous hero: the ‘doctor-author’ who produced the text which has come to us as Epidemics 1 and 3. He lived and worked on the Greek island of Thasos for almost four years in the 5th C BC and gave us the first glimpse of what is recognisably modern medical practice. This author (who may or may not have been Hippocrates himself) is said to have come from Cos—the Harley Street of the Greek world—and was (LF argues) the first writer to produce an exclusively naturalistic account of sickness with no reference to divine intervention. He can be said to have ‘invented’ medicine, as we know it.
Reading this book will rid you of any romantic illusions about life in ancient Greece. Greek doctors were trying to treat illnesses without being able to look inside the body—a bit like trying to fix the car’s engine without opening the bonnet. They confused cause and coincidence and produced some dangerously silly conclusions: in one year pregnant women succumbed to fever more than menstruating women which (to them) bore out the erroneous idea that evacuating blood was a good thing: our doctor-author often comments approvingly on nosebleeds as a positive benefit, and menstrual blood was elsewhere said to travel up to the breasts to become milk (p. 95). Knowing nothing of germs, viruses and the like, when a group of young men all came down with what is obviously mumps (Epidemics 1.1) the doctors did not twig that they caught it from one another but ‘may well have assumed’ that the exertion brought on the ‘fiery heat’ (p. 230), even though similar exertion produced no similar effects elsewhere. Men who have too much sex are said to be ‘dried out’ by it—and the author of the later text Epidemics 7 concluded that sex was a good cure for dysentery.
Part one of this book (‘Heroes to Hippocrates’) looks at the state of medical knowledge before Epidemics was written, from Homer’s healers who can cut out arrows and apply soothing remedies (e.g. Iliad 11.514-5) to later texts which give evidence of the medical treatments in use: plants (either for concocting drugs or for topical application), bandages, trepanning, enemas, cupping, cauterizing and general lifestyle advice. Many of these ‘treatments’ would be dangerous and even lethal: unsterilised implements would produce infection, drawing blood would make sick patients anaemic, while drilling into the skull obviously risks permanent brain-damage and death. By modern standards, all of these physicians would be struck off—and yet we hear of some of them being regarded as wonder-workers (such as Democedes from Croton [pp. 50-56] who was the star physician of his day [Herodotus 3.125.1], who healed the wife of the King of Persia and who made a fortune out of his craft), and others getting away with real or metaphorical murder until they didn’t—such as Apollonides at the Persian court who prescribed (and performed) sex as a cure for a daughter of King Xerxes and ended up being buried alive when his behaviour was found out.
Sick Greeks sought divine assistance, but the Epidemics doctor-author, we are told, introduced a ‘godless’ system of pathology. Where everyone else was sacrificing to Apollo or sleeping in the temple of Asclepius, this rationalist hero ‘observed diseases as processes inside the body, not as individualized agents attacking it from outside. Heir to the new idea of nature, of which man is a part, he never mentioned the actions of any daimon or any need to enlist divine help’ (p. 298). This doctor followed the science, chronicling the history of each patient day by painful day and symptom by agonising symptom. He recorded outcomes—recovery or death—because people expect him to be able to predict the likely outcome (Epidemics 1.11) and it would be almost as bad to predict death in a patient who recovers as to predict recovery in a patient who dies. LF also takes time to discuss the famous Hippocratic Oath (pp. 78-84)—but (as the dating and authorship are so uncertain) he wisely concentrates on the ethical code enshrined in it (promising amongst other things patient confidentiality and avoidance of any abuse) and the evidence it affords of the wider dissemination of medical practice to new recruits.
Part Two (‘The Doctor’s Island’) takes us into the doctor’s surgery in Thasos. This is the heart of the book: a masterly piece of historical research, fully supported by cogent argumentation all backed up by detailed footnotes and three closely argued ‘endnotes’. Argue he must: Lane Fox’s radical thesis is that this text was written many years earlier than has hitherto been supposed, putting it into the late 470s rather than c.412-408 BC. The argument is fascinating and well-explained: the evidence of coinage is suggestive rather than conclusive but the stone inscriptions which list the magistrates of Thasos in chronological order and which can coincide with named patients are used to excellent effect. This evidence also helps to bring the bustling town of Thasos to life: one brilliant chapter (‘Art, Sport and Office-holding’) tells of the artist Polygnotus (who fades from the scene after the 460’s but was a theorus thirty-seven years before a known patient of our doctor-author) and the wonderfully named Disolympios (‘twice Olympian’), the son of the amazing Theogenes (who uniquely won two Olympic crowns in two different events in successive games and was undefeated as a boxer for 22 years [pp. 172-5]). Lane Fox also sees the fact that the text says nothing about the political bloodshed which befell Thasos towards the end of the century as a sign that it was written earlier—an argument from silence which is less convincing as this doctor-author is dealing with disease rather than injury and (as a stranger in town) will have known better than to have made any comment which could be construed as critical of any political events. The text itself can also, he suggests, be dated on internal stylistic grounds to an era before the other ‘Hippocratic’ writings which begin to appear from around 420 (pp. 148-53). If LF is right, and this text is from the period just after the Persian wars, then it shows that his thinking ‘stood far apart’ from his contemporaries Aeschylus, Herodotus, Pindar, and was closer to the pioneering era of the sophists long before they were born.
Part Three (‘The Doctor’s Mind’) shows the physician’s ‘modern’ methods and principles at work. He is seen (for example) advising patients on how to deal with their diseases, thus giving primacy to the patient to fight his illness—whereas many more vainglorious medics viewed it as their job to vanquish the disease and the patient’s role to lie down and shut up—all this prefiguring by some time Socrates’ analogous notion of himself as ‘midwife’ to the ideas of his interlocutors.
LF is concerned to stress the pioneering thinking which this book shows and so brings in other fields of cultural and intellectual endeavour, but his attempts to discredit other genres by comparison with the doctor-author are flat-footed and inadequate. We are told (for instance) that the Oresteia’s use of ‘ the Furies, Apollo, Athena and miasma (pollution) had no place in [the doctor’s] own way of describing diseases and derangement’ (p. 260), and that ‘if Sophocles had been confronted with mumps on Thasos, he would probably have traced its predominance among young men to the anger of Aphrodite, goddess of sex’ (p.261: he omits to mention the praise of medicine as a human achievement at Antigone 360-364).
This line of reasoning ignores obvious generic differences: these poetic texts, which dramatise human beings as they seek to wrestle meaning out of their painful lives, are not intended to pass muster as medical texts, any more than the author of Epidemics 1 and 3 would have had a chance of winning even 3rd prize at the City Dionysia. Does anyone read Virgil’s Georgics for the farming? Or King Lear as a handbook on gerontology? Euripides was not writing a paper for the Lancet, and where he shows a deranged Herakles killing, one by one, his helpless children, hallucinating that he is murdering the children of his enemy Eurystheus (Euripides Herakles 962-1015) this is a moment of supreme ironic terror—and itself a critique of religion as the dénouement bears out—which LF however misreads (p. 265) as Herakles simply thinking he is competing in the Isthmian games. The merits of the Epidemics are not helped by this sort of pointless sneering at great literature: and besides, in a world where pain was endemic, understanding of it was poor and treatments generally worse than useless, who can blame anyone from reaching out to the gods? Saying prayers by (or over) a sick person would be less harmful than many of the procedures used by Greek doctors, and when the doctor is sticking an enema tube up your bottom, drawing blood from your flesh and/or drilling a hole in your head, I would imagine most people would be tempted to invoke a deity if only to curse.
But LF is on firmer ground with Thucydides, whose account of the plague in Athens clearly owes a lot to the medical methods and insights of the time—although he makes no mention of the moment (7.15) when Nicias sends a sick-note to the Athenians because of his kidney disease, and many readers will disagree with his refusal (p. 282) to see the Sicilian expedition as in some ways tragic.
Epidemics was written for fellow doctors and did not seek to be ‘an easy seductive read’ (p.181). This book, however, is itself eminently readable and even page-turning in its narrative verve. It is written both for fellow-scholars—who will find the secondary literature abundantly referenced in the notes—and also for the general public who will learn a huge amount from it about the methods used both by ancient physicians and also by a modern ancient historian in full argumentative flow. The style is scholarly but also wonderfully light-hearted at times: the terms of an inscription from Thasos (GHI 104), for instance, are glossed (p. 183) as ‘no tits at the windows, no bums on the roof’ and there is a fascinating (and unexpected) section (p. 258) on the depiction of pubic hair in sculpture and the later ‘democratic bush’.
Copy-editing is exemplary and misprints almost non-existent. The book has an index, almost thirty pages of bibliography, almost fifty pages of notes, fifteen colour illustrations and four maps. References in the notes and bibliography are clear but I would have liked to see reference to the many digitised sources of inscriptions freely available online. This book, coming at a time when all our minds are concentrated on one particular disease, and competitively priced, deserves the widest possible audience for its insights, its astonishing range of reference and its infectious enthusiasm for pushing the boundaries of what we know and explaining to us why it all matters.