Bryn Mawr Classical Review 2006.08.15
Helen King (ed.), Health in Antiquity. London and New York: Routledge, 2005. Pp. 292. ISBN 0-415-22065-3. $87.50.
Reviewed by Philip van der Eijk, Newcastle University, School of Historical Studies
Word count: 1608 words
[Authors and titles are listed at the end of the review.]
History of medicine as an academic discipline has long been devoted to the study of disease and human suffering in the past and of the responses of individuals and social groups to disease as reflected in beliefs and theories about sickness and the body and in corresponding healing practices. Yet more recently, there has been a shift towards the study of disease's counterpart, health, its varying understandings and definitions through time and its relationship to other values held in a given society, as well as the ways in which health was believed to be capable of being maintained, managed and enhanced, both privately and in the public domain. The present collection of studies testifies to this development and applies some of its insights to the ancient world. This is very welcome and entirely appropriate, since for most Greek and Roman medical writers -- as well as their readers and patients -- the preservation and promotion of health was just as much part of the doctor's business as the treatment of disease, and they went into very considerable detail defining health and specifying its requirements.
In the introduction, the editor usefully discusses the plurality of definitions given for health both in antiquity and the modern world, ranging from the absence of disease (however defined) to happiness and mental well-being. She also discusses differences of perspective when it comes to the question of who decides, and by what authority, whether someone is healthy or ill -- the patient vs. the doctor, the individual vs. the society, Western vs. non-Western medicine, subjective experience vs. objective biomedical definition, etc.
After this introduction, the collection essentially falls into two groups of papers (though these are not designated as such in the volume). One group is devoted to a reconstruction -- largely on the basis of archaeological, palaeopathological and demographic evidence -- of the conditions of health and disease in various parts of the Greco-Roman world during different periods of antiquity. In other words, these are twenty-first century scientific attempts at assessment, by contemporary Western biomedical standards of health and disease, of the physical quality of life in the ancient world as constituted by nutrition patterns, hygiene, water and food supply, living conditions, environmental factors, spread of disease etc. The most interesting paper here is that by Charlotte Roberts et al., who offer an illuminating overview of the recent history of palaeopathological research into health and disease in ancient Greece (largely on the basis of skeletal evidence and, later, DNA) as initiated by Rudolf Virchow and greatly developed by the influential physical anthropologist and classicist J.L. Angel (a bibliography of whose publications is printed as an appendix); they also provide a balanced and sobering account of the opportunities and limitations of this kind of research (only a small minority of conditions leave traces in the archaeological record) and its methodological difficulties. Other studies are devoted to specific periods and areas. Thus Robert Arnott writes on health and the spread of disease in the prehistoric Aegean, while Sherry Fox provides a detailed report (backed up by statistics) on the incidence of various kinds of disease and injury in Hellenistic-Roman Cyprus (esp. Paphos) and Corinth. Ray Laurence describes health and the life course at Herculaneum; and Neville Morley assesses the healthiness of the Roman city, again by modern standards.
The second group of papers studies ancient understandings, experiences, perceptions, representations and attempts at management of health as reflected in Greco-Roman medical writings, literary texts, inscriptions and papyri, vase paintings, religious practice and surgical instruments. Thus Helen King deals with the interesting question of whether the (male) authors of the gynaecological writings in the so-called Hippocratic Corpus understood the health of the female body as fundamentally different from that of men, and whether their notion of female health automatically included conception and childbirth. Emma Stafford examines the cult of Hygieia in Greece and her rapid spread in the form of statues and votive reliefs since the introduction of the cult of Asclepius in Athens in 420. John Wilkins deals with that branch of ancient medicine devoted to health management, dietetics, and discusses -- in a critical evaluation of Ludwig Edelstein's influential 1931 (not 1967) paper on Greek dietetics -- to what extent ancient treatises on dietetics were prescriptive or descriptive and took account of social class distinctions (but his discussion would have been more valuable if it had not been restricted to the writings of Athenaeus of Naucratis but had also considered the evidence provided by the Hippocratic treatise On Regimen III 68-69, which offers exactly such a class-distinction, and by authors such as Diocles, Mnesitheus and Dieuches, who provided specialised dietetic advice to travellers, sea-farers etc.). Nicholas Vlahogiannis deals with ancient perceptions of disability (regrettably, the editor's caveats against generalisations about the Greek comprehension of disabilities are lost on this author). Peter Barefoot discusses archaeological evidence for the architecture of ancient health centres, with particular attention to the role of light and water (though one may have reservations about his holistic linking of past and present through the vehicle of the four elements). Ralph Jackson offers a rich account of bone surgery and instrumentation in the Roman empire (based largely on Celsus' De medicina and on surgical instruments) -- though obviously this is concerned with the treatment of disease and injury rather than health. Finally, Gillian Clark and Dominic Montserrat deal - in two separate papers - with the transformation of attitudes to health and disease in Neoplatonic and Christian thought, with Clark cautioning against the often too ready assumption that the Neoplatonists did not value bodily health (the ascetic Porphyry being an exception), and Montserrat discussing the Christian hagiographer Sophronius of Jerusalem's account of secular and saintly healing practices.
The only paper that fits in neither category is Karelisa Hartigan's discussion of drama as an ancient and modern healing practice. This should not have been included, for it manipulates the evidence in order to push through a modern agenda. Its main thesis, that drama was an instrumental part of the healing practice in the Asclepius cult, is entirely speculative, if not refuted by the fact - noted elsewhere in the volume - that no theatre was present at Cos, one of the most prominent Asclepius sanctuaries in the ancient world. Nor is it correct, as she argues, that the Hippocratic treatise On Regimen credits a healing power to dreams: to this Hippocratic writer, dreams only have a prognostic significance, but the prevention of disease is to be achieved by a combination of dietetic measures and prayer to the gods.
From the Preface we learn that this collection has arisen from a conference held in Exeter in 1994, and that some of the papers read at the conference were not included in the volume, while several other chapters were added at a later stage. One sympathises with the editor for having to take the project through this long and no doubt difficult gestation process which, together with a certain unclarity as to the kind of audience for whom this book is intended, probably accounts for some unevenness, duplication and inconsistency in presentation: thus we are told several times what the incubation practices in the Asclepius cult were like, we are given two translations of the hymn to Hygieia, and the editor's introductory observations are not always followed up in the rest of the volume. As so often with volumes of this kind, readers will peruse it for the individual papers it contains rather than for any overarching perspective that would make the whole more than the sum of its parts - let alone for comprehensiveness, for this has clearly not been achieved (and, presumably, not intended), some of the most obvious omissions being the theory and practice of ancient sport and fitness, Galen's systematic theory of health, and the use of the health metaphor in ancient political thought. Nevertheless, most papers in this volume provide stimulating facets of ancient beliefs, experiences, practices and representations of health or of the physical conditions in which these were developed. The volume is nicely illustrated, there is a comprehensive bibliography (though it is odd to see no reference to Georg Wöhrle's Studien zur Theorie der antiken Gesundheitslehre or I. Leventi's Hygieia in Greek Art) and a useful general index, though regrettably no index of passages cited (the preparation of which would have brought to light inconsistencies such as the references to 'Loeb II, 70' and 'Loeb II, 7' and 'Loeb II, 6', all on p. 155).
Introduction: what is health? (H. King);
1. Disease and the Prehistory of the Aegean (R. Armott);
2. Health and Disease in Greece: Past, present and future (C. Roberts, C. Boubou, A. Lagia, S. Triantaphyllou, A. Tsaliki);
3. Health in Hellenistic and Roman Times: The case studies of Paphos, Cyprus and Corinth, Greece (S. Fox);
4. Health and the Life Course at Herculaneum and Pompeii (R. Laurence);
5. Holding on to Health? Bone surgery and instrumentation in the Roman empire (R. Jackson);
6. 'Without You No One is Happy': The cult of health in ancient Greece (E. Stafford);
7. Hygieia at Dinner and at the Symposium (J. Wilkins);
8. Women's Health and Recovery in the Hippocratic Corpus (H. King);
9. Drama and Healing: Ancient and modern (K. Hartigan);
10. 'Curing' Disability (N. Vlahogiannis);
11. The Salubriousness of the Roman City (N. Morley);
12. Buildings for Health: Then and now (P. Barefoot);
13. The Health of the Spiritual Athlete (G. Clark);
14. 'Carrying on the Work of the Earlier Firm': Doctors, medicine and Christianity in the Thaumata of Sophronius of Jerusalem (D. Montserrat);