Greek with a healthy ego threw light on all that ails us

A generation or two ago, a book titled Ancient Medicine would probably have consisted of a series of extracts from the Hippocratic corpus, Galen, Soranus and a few other major medical authors in antiquity. Its purpose would have been to remind modern readers not fluent in the classical languages of the glory that was Greece. Since then, the study of Greek and Roman medicine has become genuinely historical rather than primarily philological. The production of critical editions of ancient authors is still a worthy enterprise, and many major texts remain untranslated into any modern language. Nevertheless, classicists have become as concerned with what the texts and fragments mean historically, as they are with their philological nuances. What used to serve as the end of classical scholarship now is a necessary tool in the pursuit of other goals.

Vivian Nutton has produced, within the limitations of the sources, a social history of ancient medicine. To do this, he has had to go beyond the medical texts and exploit a range of materials, such as archaeological evidence, passing comments from philosophers, playwrights, poets and ancient historians, and information from inscriptions, tombstones, surgical instruments and other artefacts from the period. The result is a masterful evaluation of health and disease within the long millennium from Homer to Oribasius.

Those of us who work on the social history of more modern periods should appreciate both the constraints and the security of Nutton's enterprise. A PhD thesis can be written on some new fragment from Herophilus. By contrast, historians of modern medicine are often overwhelmed by the richness of their potential sources (and are sometimes secretly relieved when they know that certain avenues are closed to them as it relieves them of yet another archive to check). Classicists always want more, not less, on which to base their judgements, and Nutton's introductory discussion of the miracle that anything written survives from 2,000 years ago is a salutary reminder of how lucky we are to know so much of our forebears.

As befits a work of this kind, Nutton's name index contains several hundred entries. Most of these largely forgotten individuals survive for us only through a passing comment or quotation by a major author, because they were mentioned in a legal document, or because an inscription on a plaque, statue or tombstone has fortuitously survived. These healers seldom have historical individuality, but they are here used collectively and effectively to illustrate such issues as the status and social standing of medical practitioners, the nature of medical debate, or the sheer complexity of health matters in his period.

Although he never uses the word or makes explicit the technique, Nutton's monograph reminds us that prosopography, the study of collective biography, was invented by the classicists.

The familiar outlines of ancient medical history are, of course, contained here: two chapters on the Hippocratic corpus, an intervening chapter on what Clifford Allbutt called "Greek medicine in Rome" and two chapters on Galen. But there is also much that reflects the newer social approaches to medical history: fascinating material on health advice, spas and watering places, the rough and tumble of charlatans and a vigorous medical marketplace, the importance of religion for the medicine of antiquity.

Indeed, Nutton's discussion of religion reminds us of how narrow is the common view that the Hippocratic treatise on "The Sacred Disease" provided a completely secular interpretation for disease and its treatment, a kind of declaration of independence of medicine from religion. Instead, Nutton highlights the religious dimension of the temples of Asclepius, the continuing prevalence of religious and magical elements in popular disease explanations and remedies, and the gradual triumph of the Christian over the pagan world-view.

Despite the fleeting appearances of so many obscure practitioners, two presences inevitably dominate: the Hippocratics and Galen. Nutton reviews the debates about the elaboration over a couple of centuries of the writings that are sometimes attributed to a single "father of medicine".

But Galen above all casts his long shadow on this monograph, as he does on our knowledge of ancient medicine. Nutton himself has studied this loquacious but clever doctor for more than 30 years. Galen's is the one personality here to emerge into the historical sunlight. He is, as Nutton remarks, one of a handful of ancients for whom it is possible to write a real biography. More words of his survive than those of any other author from antiquity, medical or otherwise, and to him we even owe much of our veneration for Hippocrates. Galen's own admiration for Hippocrates ensured that Hippocratic ideas won out against the several medical systems with which they had competed for centuries. Since Galen's prolific writings inform us of much that we know of earlier practitioners, and since what Galen said became medical orthodoxy for the next thousand years, he is clearly the pivotal figure in Western medicine. Indeed, without Galen and other Greek doctors working within the Roman Empire, the Western medical tradition might have taken on a completely different orientation.

What Nutton's monograph demonstrates most powerfully is the fact that we expect a book by this title to be about Greek and Roman medicine. Egyptian, Babylonian, Indian and Chinese medicine all require the additional adjective to identify them. The "ancients" for us means the Greeks and Romans, and for medicine, mostly the Greeks, whether they worked in the 4th century BC or the 3rd century AD. Never short of ego, and a patriotic Greek, Galen would have been pleased.

W. F. Bynum is emeritus professor of the history of medicine, Wellcome Trust Centre for the History of Medicine, University College London.