This is a rather interesting collection of different ways of considering the patient in Ancient and Byzantine Greece, Rome and Medieval Islam, on the grounds of medical treatises and laymen texts, including some documentary and archaeological data. The contributions were first presented at a conference backed by the Alexander von Humboldt Foundation (Berlin, 2012).
The studies are divided into six parts. In the first part, ‘Medical Authority and Patient Perspectives’, M. Horstmanshoff and L. Graumann comment on a long funerary epigram in Greek dedicated to a child (pp. 23–80). Horstmanshoff comments on the text of the inscription (late second or early third century a.d.), and Graumann reviews the described symptoms, concluding that tuberculosis is just one of the possible retro diagnoses of the child Lucius’ condition. In my opinion, nowadays a genetic disorder such as MSMD,Footnote 1 rare as it is, has to be suspected, which could provoke a fatal or really impaired immunity response to mycobacteriae. In any case, retro diagnosis is a difficult challenge, DNA findings excepted. In the second chapter of Part 1, M. Letts comments on Rufus of Ephesus’ insistence on questioning patients (pp. 81–103). Letts rightly contrasts Rufus' attitude to that of the Hippocratics and Galen.
‘Case Histories in the Hippocratic Corpus', the second part, includes different views of case histories, ‘giving space to the voice of the sufferer’ in T.’s words (p. 109). Relying on a narratological approach, T. cleverly studies the patients’ insight into their illnesses in the Epidemics and some other Hippocratic books (pp. 107–37). C. Webster presents voice pathologies as a field where Hippocratic doctors rely more on their knowledge than on the patients’ report (pp. 166–99). On the other hand, J.Z. Wee (pp. 138–65) studies individual case histories against general ‘constitutions’ in the Hippocratic Epidemics 1, and considers the importance of precise individual histories in order to prevent other doctors from false prognosis. As for the date of Epidemics 1, which Wee situates in the second half of the fifth century b.c., K. Deichgräber's opinion (Die Epidemien und das Corpus Hippocraticum [1933], p. 169) is widely accepted (410 b.c.). On the other hand, Wee comments on several proposed divisions of the case histories in Epid. 1 and 3: I would say that probably the best division is that of A. Esteban Santos (CFC 4 [1994], 47–76), who finds that the first group of Epid. 3 follows the case histories of Epid. 1, comprising a single group.
In Part 3, ‘Patients and Psychological Illness’, lypê, madness, and the physician's touch are considered. S.P. Mattern (pp. 203–23) takes into account the affections that Galen calls lypê: Galen describes not just emotional conditions but pulse, insomnia and wasting. She concludes that in modern terms lypê would be an anxiety disorder. Madness in medieval Arab-Islamic medicine is the subject of P. Koetschet's paper (pp. 224–44); he compares its types with those described by Greek doctors.
In Part 4, ‘Emotional Aspects of the Patient–Physician Relationship’, J. Kosak (pp. 247–64) explains that Hippocratic physicians were intent on avoiding the impression of harming the patients when touching them. Her comments on coetaneous laws are an important contribution. L. Bolton (pp. 265–84) remarks on Soranus’ concern for sick infants, while A.J. Porter (pp. 285–303) insists on Soranus’ compassion: ‘a physician who acknowledges and is aware of their patients’ emotions, beliefs and attitudes, and who exhibits compassion for them’ (p. 285). ‘Galen on the Patient's Role in Pain Diagnosis’, by C. Roby (pp. 304–22), deals with the system of terms developed by Galen in order to name the different types and intensity of pain. The data source is De locis affectis.
Part 5, ‘Material Aspects, Diagnostic Techniques and their Impact on the Patient–Physician Relationship’, explores the incidence of medical fees (G. Ecca, pp. 325–44) and pulse diagnosis (O. Lewis, pp. 345–64) on the patient–physician relationship. This section also includes the visual imagery of Graeco-Roman physicians (P.A. Baker, pp. 365–89) and the attitude of the Byzantine physician I. Zacharias Aktouarios (early fourteenth century) towards his patients (P. Bouras-Vallianatos, pp. 390–409). The physician's fee is a delicate matter, needing to avoid greed but to preserve a good reputation (discussed in the Hippocratic Praecepta, a late treatise that Ecca has just edited [2016]). The pulse diagnosis (based on Galen's data) is rightly stressed as a means to facilitate the doctor–patient relationship. Through visual imagery Baker suggests that artists tried to reflect the actual role of the doctor in society, depicting them with the instruments of their specialty. The case histories of I. Zacharias Aktouarios are welcome, late Byzantine medicine not being well known.
In Part 6, ‘The Informed Patient: Self-Healing and the Patient as Physician’, J.M. Wilkins (pp. 413–31) surveys De sanitate tuenda in order to assert Galen's confidence in a healthy life based on his own advice to keep healthy, provided the person dedicates enough time, is wealthy and lives in an organised city. J. Draycott (pp. 432–50) analyses lay medical practices in Rome, relying on documentary and literary data, and rightly argues that it is necessary to examine ‘healthcare, nursing, agriculture, animal husbandry and veterinary medicine’ in order to find them. In this same line of laymen as physicians, P. (pp. 451–70) presents the case of Aelius Aristides, a new type of ‘knowledgeable patient’. She argues against his supposed hypochondria after an in-depth review of some passages of the Hieroi logoi, and she makes her point. It would be good to mention the knowledge of medicine by Greek laymen in the fifth–fourth centuries b.c. K.D. van Schaik (pp. 471–96) focuses on the importance of a patient's confidence in the physician who diagnoses and explains clearly the nature of the disease and the possibilities of treatment. She presents Greek and Latin texts to test such positions, based on her own experience of sick indigenous Australians.
By way of an epilogue, M. Stolberg (pp. 497–518) adds a perspective on the doctor–patient relationship in medieval and early modern Europe, concluding that it is rather difficult to find reliable sources.
The volume is a sophisticated survey of the patient's role in front of ancient physicians. Were their words considered by the doctors? Not as much as they should have been. To diagnose before hearing the patient could increase confidence in the doctor – and the number of clients. It is not just pride but a practical issue for them, if not so for the patient. On the other hand, when people feel really sick, at times they seek any means to find relief, not just the first physician who treats them: many an Aelius Aristides can be found nowadays.
The aim of the book is to place the patient at the centre of the medical activity, not just as the passive receptor of diagnosis and treatments, but as a person whose voice, suffering and opinion have to play a decisive role in the doctor–patient relationship. A number of the contributions are by junior scholars. It is important that a new generation of researchers considers the state of a given subject and throws new light on it so as to complete or confront older approaches, even when the background could be, at times, insufficient. The division into parts is right, the research level is high enough, and the conclusions are usually correct. Some of the contributions use Greek characters and others transcribe, but the texts are always translated. Most of them rely on modern editions of the texts. It is not easy to find misprints (‘facea bnormal’ on p. 97). This well-edited collection of essays has earned a place in the library of historians of medicine.
