Time is having a moment. M.'s book on time in ancient medicine joins a growing literature on the phenomenology of time in antiquity. The volume will be read in comparison with P. Singer's Time for the Ancients (2022) (cf. CR 73 [2023], 558–60), since the coverage of Galenic material is distinct enough in each book, but M.'s work deserves to stand on its own. (The acknowledgements of Singer and M. each state that they completed their manuscripts independently before sharing their results.) M.'s work is both broad and narrow. The book's title and the first half of the introduction (pp. 1–4) suggest to readers a chronologically wide-ranging history covering all of antiquity, investigating the technological development of timekeeping pieces and their deployment in then-contemporary medical practice in Chapters 1–2. But the second half of the introduction (pp. 4–11) and the individual chapter titles alert readers to a more chronologically limited and thematically restricted book about Galen's self-fashioning on the subject of time in Chapters 3–7. The earlier material, interesting of its own accord and most likely to attract a broader readership, is thus prefatory for the close reading of Galen. The Galenic evidence of the book consists of the ethical treatise Aff. Pecc. Dig., the preventative medicine treatise San. Tu., the venesection treatises (Cur. Rat. Ven. Sect., Ven. Sect. Er.), as well as the collection of treatises on fever and critical days (Adv. Typ. Scr., Cris., Di. Dec., Diff. Feb., Typ.). The latter is untracked ground even for a Galenist. M. focuses narrowly on the technology of timekeeping, attending to the practical intellectual and cultural consequences that result from its use. (Ancient philosophical consequences of timekeeping are treated in Singer 2022.) Finally, M. also invites comparison between ancient and modern medicine in the introduction and the conclusion.
M.'s book is a history of how human artefacts impact intellectual practices. We could set her account alongside dramatic technologies, for example the twenty-first-century development of mechanical thrombectomy coupled with systematic helicopter Medevac services to change outcomes in massive stroke, or alongside minor technologies, such as automatic IV infusions set to precise rates. For these modern adoptions medicine has not implemented thrombectomy and automatic infusions ex nihilo, but has relied upon wider social and logistical reorganisations that technologies of helicopters and rate-controlled pumps have enabled. M.'s account suggests the causal relationship held good also for timekeeping in ancient medicine. Embedding medical timekeeping within a broader historical culture of timepieces and timekeeping is thus essential to her overall thesis, in contrast to earlier critical literature, that precise timekeeping had real social significance before the early modern period.
Some of M.'s results are novel; others are familiar to Galenists. To my mind the most important conclusions are the following. Her reading of Aff. Pecc. Dig. insightfully concludes (p. 108) that Galen reverses the metaphor of human lifespans as clocks: how you construct a clock turns into a moral model for how you should live your life. Her sophisticated reading of Galen's temporal revisions to Hippocratic case histories (Chapter 5) is persuasive. Chapters 6 and 7 successfully show her overall thesis: a broader cultural landscape of healers who assumed a therapy typologised by the clock, Galen in turn asserting his authority by defining the limitations of timekeeping and reasserting the importance of experienced clinical judgement.
The subject matter itself provides a spur to readers. M.'s presentation of the fever treatises is fascinating. I most appreciated her reading of Galen's self-presentation as a moderate in debates on periodicity for venesection (pp. 148–51), a view consonant with Singer's 2022 reading of Galen's pulse treatises. From M.'s reading of venesection I came away with a stronger sense of Galen as a clinician and his emphasis on clinical indications for therapy. The presentation of the ancient environment of clocks and timepieces is delightful: in the Imperial period slaves announced time aloud (p. 49), public clocks were visible with rubricated markings or audible with bells for hourly timekeeping (pp. 51–2), clocks were prominent at bath houses (p. 55) and frequently used in astrologically beneficial calculations (pp. 58–9).
The integration of archaeological and iconographic evidence throughout is a strength of the book. Types of sundials and water clocks are described and analysed (Chapter 1); there are numerous illustrations of material remains. M. evaluates the functioning of ancient timepieces with reference to ancient astronomical texts – a significant accomplishment – in passages where I am not qualified to evaluate the evidence. More broadly in the historical mainstream, she discusses the iconography of sundials paired with philosophers and slaves looking variously contemplative or perseverative (pp. 50, 96–100, 177). M. presents solid readings of primary texts, building on themes sometimes better observed in other texts of the Galenic corpus, such as philosophy, scientific method, Hippocratism and the neōteroi vs palaioi distinction. She makes nice remarks on Cato the Elder (pp. 33–5); her reading of Hippocratic time formulas (p. 44) is full of reasonable caution. The metaphorical parallels between buildings, clocks and the human body (pp. 105–7) are charming.
On several occasions I looked for further discussion of the evidence. Might the implicit presence of the sun in the iconography of sundials with philosophers (pp. 96–100) foil a familiar association of ancient intellectual activity, viz. lucubrations carried on by night-light? According to ancient medicine overstudying has its own health consequences (Galen, Loc. Aff. 8.165–6 K; Celsus, De Medicina 1.2.1–5). Secondly, individual Galenic case histories (pp. 163–4, 174–5) show evidence of serial measurement from a clock, seemingly unremarked upon by M. The practice of serial measurement, where a measurement procedure is repeated within a short time frame or systematically at repeat visits, is widespread in modern medicine (e.g. ECGs, PHQ-9s). An acknowledgement of the thematic similarity is merited. Beyond these are a few minor issues: I missed the comparative use of Opt. Med. on medical communities (pp. 75–9); it is difficult to see any particular philosophical association of technology in the reading of Epictetus (pp. 103–4); English and Greek do not always match in the close reading of Aff. Pecc. Dig. (pp. 63–4, 69, 71); W.H.S. Jones's antiquated work on malaria deserves comment in citation (p. 139); the absence of an index locorum is regrettable.
In light of M.'s invited comparison between ancient and modern medicine more substantial disagreements are possible from my viewpoint as a physician-historian. Shared terminology is no guarantee of a shared genealogy of ideas between ancient and modern (pp. 139, 184–5). Historical caution is missing – and M. is not the only ancient historian to make this elision – for the retrospective diagnosis of intermittent fevers (p. 136): since the differential diagnosis of intermittent fevers includes parasitic, bacterial and viral causes, we should not assume that malaria alone stands behind historical discussion of periodic fevers. Yet most challenging, to my mind, is the way in which she frames the modern claims (pp. 1, 184) for an individual biological ‘chronotype’ for patients. The topic is not mere rhetoric, since it opens and closes the book. Personalised medicine is an aspiration for modern medicine. But with some exceptions (e.g. anatomical studies via CT scan, genetic studies, continuous glucose monitors with insulin pumps) claims for personalised medicine are at present still closer to advertising slogans than therapeutic realities. I am puzzled why her perceptive historical reading does not extend to recognising that such claims of chronotype more likely belong to medicine's longstanding fantasies of a therapeutic science of the individual. The aspiration was known already to Galen, who, in analysis of the problem, remarks that, while true medicine aims at the patient's nature, knowledge of the individual mixing of humours (idiosunkrasia) belongs to Apollo and Asclepius alone (MM 10.209K). The Galenic topos remains that clinical indications trump precision diagnostics.
But these are concerns tangential to the thesis, and M. is to be congratulated. Galenists will want to add the volume to their bookshelves. Its significant contribution to the literature on time in antiquity deserves and, I hope, will find a broader readership.
