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  • Galen's Theory of Black Bile: Hippocratic Tradition, Manipulation, Innovation by Keith Andrew Stewart, and: Galen's Treatise Περὶ Ἀλυπίας (De indolentia) in Context: A Tale of Resistance ed. by Caroline Petit
  • Susan Mattern
Keith Andrew Stewart. Galen's Theory of Black Bile: Hippocratic Tradition, Manipulation, Innovation. Studies in Ancient Medicine, vol. 51. Leiden: Brill, 2019. x + 178 pp. $113.00 (978-90-04-38278-7).
Caroline Petit, ed. Galen's Treatise Περὶ Ἀλυπίας (De indolentia) in Context: A Tale of Resistance. Studies in Ancient Medicine, vol. 52. Leiden: Brill, 2019. vi + 296 pp. $87.00 (978-90-04-38328-9).

Volumes 51 and 52 in Brill's Studies in Ancient Medicine series are both about Galen's work. Galen's Theory of Black Bile: Hippocratic Tradition, Manipulation, Innovation, by Keith Andrew Stewart, is a monograph that clarifies Galen's concept of black bile, with a focus on how he manipulated previous medical traditions about the humors. Galen's Treatise Περὶ Ἀλυπίας (De indolentia) in Context, edited by Caroline Petit, is a collection of articles arising from a conference at Warwick University in 2014. Contributors focus on how the treatise—previously known only through fragments in Hebrew and Arabic, but discovered in the library of a monastery in Thessaloniki by Antoine Pietrobelli in 2005—illuminates Galen's work, the history of his day, and, in an epilogue by Pietrobelli himself, the later Arabic tradition of writing in the same genre. This collection is published as an open access title, while Galen's Theory of Black Bile is not.

Black bile is the most mysterious of the humors or "juices" central to Hellenistic Greek medicine. In the Hippocratic corpus it features mainly in the treatise On the Nature of Man, whose systematic approach connecting four humors to the seasons and stages of life was so influential on Galen. But black bile was also associated with melancholia ("black bile disease") and its strange symptoms. It is remarkable that despite the large quantity of scholarship on melancholia, no one before Stewart has fully understood Galen's concept of black bile. Stewart begins with a discussion of the history of the idea of black bile (chap. 1), and moves on to address the influence of previous medical writers, especially Hippocrates, on Galen's understanding of black bile (chap. 2). He demonstrates step-by-step how Galen selectively interpreted and manipulated previous authorities to bolster support for the four humor system outlined in Nature of Man. Chapter 3 explores how Galen characterized the properties and physical qualities of black bile. Chapter 4 is the heart of Stewart's contribution, in which he identifies the three types of black bile that Galen described. Stewart calls the first type "ideal natural black bile," a thick, viscous substance essential to life; this substance can accumulate as a sediment in blood, like the lees of wine, which Stewart labels "non-ideal natural black bile" and which can cause disease. The third type is the highly toxic "altered" or "acidic" black bile, produced from burning innate bile or yellow bile. [End Page 292] Chapter 5 further explicates Galen's theory of altered black bile and its properties. Chapter 6 describes Galen's theory of the spleen as the organ that cleanses black bile from the body, and chapter 7 addresses the diseases caused by black bile, with a specific focus on melancholia and quartan fever. A conclusion sums up the argument. (Indeed, the book is well endowed with summaries, conclusions, and other signposts.)

Galen's Theory of Black Bile is a revised dissertation and with a narrow focus. It does not address the broader cultural history of black bile, a context that would help explain why Galen thought he needed to distinguish different types of black bile. But future scholars of melancholia, humoral theory, or ancient concepts of disease will be indebted to this book.

Galen wrote Avoiding Distress shortly after the fire at Rome that consumed many of his books, drugs, and precious medical instruments in 192 C.E. Since its discovery, several editions and translations have appeared, as well as studies of its implications for our understanding of topics like Rome's libraries and its topography, the production and publication of books...


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