Western Medical Thought from Antiquity to the Middle Ages (review)

Western Medical Thought from Antiquity to the Middle Ages. Edited by Mirko D. Grmek, coordinated by Bernardino Fantini, translated by Antony Shugaar. Cambridge: Harvard Univ. Press, 1999. Pp. 544. $49.95.

This collaboration of so many international scholars has inevitably produced a rich collection of essays, but the volume has also been carefully crafted and edited to provide an encyclopedic and unified picture of medical learning from the dawn of ancient Greece to the eve of Renaissance Europe. The essays gathered here synthesize a vast array of scholarship on the intellectual and professional structure of the physicians' art in ancient and medieval culture. It is not a volume dedicated to the full panoply of healing beliefs and practices, but one that seeks to explicate very specific traditions of learned thought in Western medicine.

Jacques Jouanna sets the tone for the collection with his essay on "The Birth of Western Medical Art." Jouanna lays out the construction of the Hippocratic corpus and the parameters of the Hippocratic conceptualization of medicine within the context of a new written culture in ancient Greece, and the concomitant birth of a new epistemology. While he rejects facile connections, Jouanna suggests that the very being of medicine as an "art" is deeply connected with the technologies of writing that preserve and objectify its "science." Mario Vegetti's contribution, "Between Knowledge and Practice," explores the "incomplete epistemological revolution" of Hellenistic innovators. While Hippocratic medicine treated the body as a black box and concentrated on pathological states, the Hellenistic revolution sought a new theoretical foundation in anatomophysiology and the conditions for health. The inability of innovators to tie their new epistemological methods to the demands of practice, however, led to a fracturing in this tradition, and to a series of splits in the medical profession itself. Danielle Gourevitch takes up the story at this point by placing Galen's work in the world of medical sects so characteristic of the profession in the Roman world. Galen, himself belonging to an eclectic sect of physicians, synthesized anatomophysiology and Hippocratic reasoning, and codified key concepts such as the doctrine of the four humors. Gotthard Strohmaier shows how the Galenic tradition was preserved and amalgamated with philosophical endeavors in Islamic and Byzantine cultures. Jole Agrimi and Chiara Crisciani move us to Western Christendom, with an examination of how notions of health and salvation figured in Christian concepts of charity and the development of hospitals in the middle ages. The development of learned medicine as it took root in Western universities is outlined by Danielle Jacquart. The scholastic tradition of questions sought to define and demonstrate the texts of Galen, Aristotle, and others. Within this tradition, the confrontation between Galen and Aristotle sharpened, and the difficulty of matching theoretical knowledge to clinical practice became clear. By the 15th century, in fact, practical medicine began to flourish at the expense of its theoretical cousin.

The second half of the volume deals primarily with diseases and therapies. Mirko D. Grmek analyzes the concept of disease as it passed from humoral pathology to clinical prognosis to Christian morality. Essays by Alain Touwaide, Michael McVaugh, and Pedro Gil Sotres describe respectively drugs, surgery, and regimens as therapeutic strategies. In each case, the authors emphasize major textbooks within each domain. The final essay, by Jean-Noël Biraben, lays out a historical epidemiology of ancient and medieval Europe.

This brief summary does no justice to the synchronic aspects of the essays. It is, however, the diachronic story that seems to drive the volume. To be sure, authors gesture toward social contexts and cultural syntheses of medical thought, but only in the case of the Agrimi and Crisciani contribution do these appear integral to the essay. It is important to remember, however, that this is a work about medical thought, and as such it largely remains tied to the vehicle in which thought is most articulated and stabilized, a corpus...