Ancient Medicine (review)

Perhaps no modern student of Greek and Roman medicine is so well equipped as Vivian Nutton to produce a volume that covers the entire field of medicine in classical antiquity. His extensive studies (on, e.g., Galen, Roman military medicine, medical practice, theories of contagion), spanning more than three decades, have prepared him to undertake a comprehensive survey of all aspects of classical medicine from Homer (eighth century BC) to Paul of Aegina (ca. 620).

Nutton begins in chapter 1 by asking how we know what we know about ancient medicine. Our evidence is incomplete, even spotty. There are preserved only a small proportion of medical works in Greek that existed as late as the ninth century, when older manuscripts were recopied, and an even smaller number than existed in Galen's time. There exist almost no medical texts in Latin. Fragments, mere titles, and summaries remain, but large tracts of ancient medical history are entirely unrepresented in the sources. The modern scholar must supplement the evidence from texts with the abundance of epigraphic, papyrological, and archaeological materials that help to fill the gaps. Nevertheless, the history of classical medicine is one for which huge lacunae remain. The largest is that of women healers: in spite of much recent scholarship devoted to the study of women in antiquity, we know little about female involvement in ancient medicine (pp. 314–15). "There are too many missing links within our surviving medical sources to invest total confidence in any hypothesis, and often the best that can be done is to lay out possibilities or define parameters" (pp. 7–9).

Although acknowledging its usefulness, Nutton does not write from the point of view of social anthropology (see p. 16). A classically trained historian, his strengths are a broad knowledge of the ancient world and a mastery of ancient texts, both of which are essential to a proper evaluation of Greco-Roman medicine. His work is a history not of healing, but of medical theory and medical practice. He traces the growth and development of medical practitioners, rightly (in my view) translating iatroi and medici as "physicians" rather than "healers." He emphasizes the diversity of the "medical marketplace," in which a variety of healers that included root-cutters, midwives, magicians, and exorcists competed—yet he argues (correctly, I believe) that physicians were, for a thousand years, central in Greek and Roman society for those who sought healing (p. 270). He understands, of course, that any attempt to reconstruct the world of ancient medicine must take into account the differences between ancient and modern disease categories, and he devotes an informative and perceptive chapter (chap. 2) to the subject. Nutton demonstrates that, in spite of enormous changes in cultural, political, linguistic, and geographical factors over time, ancient medicine was marked by many continuities that transcended conventional chronological boundaries. Although rational-speculative medicine grew up in the classical world, it survived into the Christian world and readily adapted itself to its radically different perspectives.

Nutton tries to be sensitive to chronology and avoids stereotyped approaches. He eschews the broad generalizations across the centuries that, in spite of frequent warnings against essentialism, remain common in the field. He does not privilege Hippocratic medicine, but describes the growth of medical astrology, number mysticism, and magical pharmacy (pp. 265–270) in the Roman Imperial age. No one has written more perceptively or in a more nuanced fashion on the social status of the physician than Nutton himself, and he devotes a chapter (chap. 17) to the subject. He accepts Ludwig Edelstein's view of the physician as basically an itinerant craftsman whose status was never secure, and who struggled at all times in the classical world for recognition and a secure status in a highly class-conscious society. Chapter 13 provides an uncommonly sympathetic survey of the controversial medical sect of the Methodists. Nutton devotes two chapters (chaps. 15–16) to Galen, about whom he writes both as a leading authority and with real affection; the second is full...