Galen and the Rhetoric of Healing (review)

The extensive literary legacy of the imperial physician Galen (AD 129-215) has long been an area of research for medical historians especially. In recent decades, however, classicists have become aware that Galen's work contains a wealth of information not only in regard to the ancient understanding of disease and health, or to medical theories and treatments, but also in regard to social, cultural, and educational history, to mentality, notions of gender, and further aspects. In order to interpret Galen as a historical source, precise knowledge is required of the educational background connecting him with the "second Sophistic": the Hellenistic-based education of intellectuals during the Roman Empire was strongly rhetorical and used as a tool in social competition for status and prestige. An education of this kind inevitably influenced Galen's reports on his patients. A closer examination of his case histories promises interesting insight into the self-image of Galen, into the strategies pursued both at the patient's bedside and in the later literary presentation of his treatments. Susan Mattern submits this subject to detailed and fruitful analysis; her study does not discuss ancient medicine as such, for example, the question of the true nature of Galen's patients' ailments, but deals with "Galen's subjective experience and his subjective account of that experience" (p. 159). Her precise investigation of numerous questions of detail leads to important findings that profoundly enrich our knowledge of Galen.

Mattern's study, divided into five sections, works through the voluminous material in logical sequence. First, she places Galen's medical records in the context of medical, social, and literary history ("The Stories in Context," pp. 1-47), making it clear that Galen wrote for the educated elite as opposed to a wide audience. Mattern then examines the way Galen describes the Roman or countryside settings of his case histories and places the latter in relation to "medical time," that is to say, to the inner chronology of disease ("Place and Time," pp. 48-68). Chapter 3 is devoted to the permanent competitive situation to which Galen, like other physicians in Rome, was exposed ("The Contest: Rivals, Spectators, and Judges," pp. 69-97). This situation is mirrored by his case histories of patients from the higher strata of society: "The social world around the sick person is a public, competitive, male one in which the patient's loyal friends and male relatives advocate for the patient, contend with physicians and support one over the other, offer their own opinions on the case, and choose the victor in the medical 'contest.' It is not a private, domestic scene, even though it usually takes place in a house" (p. 89).

Chapter 4 focuses on the patient as described by Galen ("The Patient," pp. 98-137). The author demonstrates that Galen's ideal-typical patient at the same time amounts to a self-portrait. This ideal patient is a Greek-educated man in his prime who is sufficiently affluent to be able to afford to take care of his body; permanently competing for social esteem, he is subject to overwork, stress, anxiety, and illness. Galen's concept is reflected by the rarity of reports on patients of younger or older ages; similarly, in regard to the stages by which adulthood is reached, less emphasis is placed on phases such as puberty than on the development of social maturity through physical and intellectual training, a process lasting into the twenties. As Mattern emphasizes, this is an "elitist concept" (p. 108), underlying Galen's attachment to the aristocratic ideals of his time. However, when Galen's accounts are viewed as a whole, the social status of patients rarely plays an important role. Mattern explains this rather surprising finding with the argument that the authority of his patients was less important to Galen than the authority that he himself wanted to win over those he treated.

The fifth chapter...