Bryn Mawr Classical Review 2003.04.13
Lutz Alexander Graumann, Die Krankengeschichten der Epidemienbücher des Corpus Hippocraticum. Medizinhistorische Bedeutung und Möglichkeit der retrospektiven Diagnose. Aachen: Shaker Verlag, 2000. Pp. 272. ISBN 3-8265-8216-0. DM 98.00.
Reviewed by Monica Bontty, Anthropology, Utah State University
Word count: 985 words
Graumann writes this work so that the specialist gains a better understanding of the case histories of the seven books of the Epidemics of the Hippocratic Corpus, a name given to a collection of medical treatises written by various doctors in Northern Greece in the fifth and fourth centuries B.C.E. Ancient medical texts have long been a rich resource for medical history. However, the unreflected application of modern medical concepts and terminology to ancient medical texts is problematic since illness had a different meaning in antiquity. This work aims to remedy this situation. To accomplish this task, the author successfully uses the notion of "retrospective diagnosis" to achieve a more precise, coherent view of the case studies of the Epidemics.
In the introductory section of the book, questions and methodology are provided. Section 1.2 describes the Hippocratic Corpus in great detail. Questions of authorship and the identity of Hippocrates are discussed in 1.3. Next, in 2.1, the author traces the origin and history of the Hippocratic Corpus. This is not, as the title suggests, the work of one author. It is a collective work with contributions made by many different physicians. Graumann then gives a splendid overview of the historical transmission and reception of the Epidemics from antiquity to the present. A detailed structural analysis of all seven books, including the De Humoribis is offered in 2.3. Graumann arranges the Epidemics into three groups: the first includes Epid. I and II, a second consists of Epid. II, IV and VI as well as the De Humoribis, while Epid. V and VII make up the final assemblage. The De Humoribis has traditionally been described as the eighth Epidemic book, but the author includes it in the second set based on similarities in style and content (theory).
Form, content and function of the case studies of the Epidemics are explained in Section 2.5. As shown by the author, the Epidemics were not intended for a wide audience, but instead were the observations of technical people for technical people. This explains why they are at least functionally similar to modern medical case studies. In addition, the Epidemics had a didactic as well as practical character.
Graumann analyzes the concept of diagnosis in Section 3.1. Here the modern definition of a medical diagnosis as the recognition and naming of an illness is not contested by the author. Moreover, diagnosis is a system of reference. The author makes it abundantly clear that diagnosis had a different meaning in antiquity, and the limits of the modern concept of diagnoses are contrasted with the ancient notion, which was not a clear concept to describe the medical activity of recognizing illness. Here the author demonstrates that prognosis was the main goal of the texts of the Epidemics.
In addressing the notion of "retrospective diagnosis" (also known as "retro-diagnosis" or "paleo-diagnosis"), the author presents a useful model whereby an ancient illness can be identified with the modern name of an illness. Historically this task is nothing new and was even used by the ancient Greeks for an illness of Hercules. What is innovative is the manner in which it is done. Graumann relies heavily on the methodology of M. D. Grmek (Diseases in the Ancient Greek World, 1989). Problems and considerations of the "retrospective diagnosis" are elaborated upon. Although many modern medical terms are derived from Greek, their ancient meanings are often quite different from the modern meanings used today. In addition, modern medical diagnosis is, as a rule, etiologically oriented and gives its concepts a pathological-anatomical system of reference. This is problematic when applied to the Epidemics. In spite of problems such as the use of modern medical terminology and deficiencies in the texts themselves, a retrospective diagnosis is still possible. Nosological terminology is explained in Section 18.104.22.168, where the author distinguishes between the naming of illness and the concept of symptom in the ancient texts.
After commenting on the climate of ancient Greece (Section 22.214.171.124), the author turns to paleo-epidemology and describes bacterial and viral infections, parasites, diseases of the joints and wounds, diseases caused by malnutrition, genetic diseases and finally tumors.
The concept of "pathocoenosis" and its method of retrospective diagnosis (as developed by Grmek) is discussed and evaluated in Sections 3.24. and 3.2.5. In contrast, the views of K. H. Leven ("Krankheiten - historische Deutung versus retrospektive Diagnose," in Norbert Paul and Thomas Schlich (edd). Medizingeschichte - Aufgaben, Probleme, Perspektiven (Frankfurt, 1988), 153-185) , who disagrees with the feasibility of the "retrospective diagnosis" based upon methodological reasons, are taken up in Section 3.2.7.
Next, the author argues the medical historical meaning of the case studies of the Epidemics before applying his theory to an ancient text, taken from Epid. VII 83. A translation of the Greek and commentary follow, whereby the author suggests possible diagnoses. This detailed look at a case study gives a clear picture of the possibility of the use of the "retrospective diagnosis" and demonstrates the difference between the ancient and modern concept of illness.
The work concludes with an extensive bibliography (pp. 163-184), followed by Tables 1-3b in addition to a short biography and bibliographic notes on Hugo Kühlewein (pp. 263-265). Table 1 lists patient data (i.e., name, address and outcome of the disease) taken from the case histories of the first group (pp. 186-187). Table 2 presents a concordance between aphorisms and illness (pp. 188-192), while Table 3 is a reference according to patient name (pp. 194-207). Finally, a diagnostic table of symptoms, retrospective diagnoses, and the modern citation of the diagnosis is given in Table 3b (pp. 208-262).
Graumann's work is informative, well thought out and will prove useful for anyone interested in Classics, medical history or medical anthropology. At times the medical terminology can be daunting, but overall this is a superb book. The use of the "retrospective diagnosis" is promising, and the author is to be congratulated for a job well done.