BMCR 2020.09.44

Thinking in cases: ancient Greek and imperial Chinese case narratives

, Thinking in cases: ancient Greek and imperial Chinese case narratives. Science, technology, and medicine in ancient cultures, volume 11. Berlin; Boston: De Gruyter, 2020. vi, 186 p. ISBN 9783110640700. €79,95.

[Authors and titles are listed at the end of the review.]

The subject of the volume to be reviewed is a type of text that, not least due to a seminal article by J. Forrester,[1] has recently attracted scholarly interest in a number of fields. These texts have in common that they deal in narrative form with particular instances of a general phenomenon (a disease, a crime, a natural phenomenon), i.e. that they present “cases” or “case histories” and thus can be considered to constitute a genre: “case literature”. The significance of this type of texts lies in its wide dissemination over time, space, and spheres of knowledge. The human mind seems often to practice something like a “thinking in cases”, and “case literature” appears to be its textual expression. That an investigation of this kind of material will be of both theoretical and historical interest immediately suggests itself. It will touch upon fundamental epistemological problems like the relationship of the particular and the universal; promote our understanding of the nature and history of sciences, but also of fields like medicine and law; provide insight into the social embeddedness of systems of knowledge; and shed light on the role literary forms and techniques play in these matters. In addition, given its universal appearance, its analysis naturally leads to comparative considerations.

It was in this context that the conference from which the present volume arose “attempted to develop and try out different approaches to cases and anecdotes chosen from a wide array of literatures and traditions” (v). Unfortunately, out of the twelve conference papers only six found their way into the volume (to be complemented by one outside contribution). Yet even in this reduced form the collection presents a “variety of topics, interests, and methods”, as the editor justifiably claims (v).

The first two papers concern the medical sphere, and both take a comparative approach. Susan P. Mattern investigates the “Structure and Meaning in the Case Records of the Massachusetts General Hospital” (9- 29) by analyzing case records of the year Sept. 2014 to Aug. 2015, published in the New England Journal of Medicine, against the backdrop of two case records found in Galen. Whereas the importance of laboratory reports and images and a higher degree of uniformity differentiate the MGH case histories from Galen’s (13-4), there are features which both share. One is the presentation of a case as “diagnostic puzzle” to be solved “from the clues given” (14), a presentation wholly suited, both in modern as in ancient times, to the display of diagnostic competence. More surprising are two that possibly compromise the scientific objectivity of the case histories. First, not only Galen’s presentations but also those from MGH often show a moralizing tendency by constructing a relationship “between the patient’s identity and his or her disease – between character and destiny” (16), Concretely, this means that while white middle-class patients, in general, are portrayed quite sympathetically, the diseases of non-white, poor or homeless people are not seldom connected with bad conduct and bad habits (17-20).  Second, there is the element of professional competitiveness, well known from the ancient Greek texts, but also present in the modern, in which “the hospital, MGH, plays the same [superior][2] role that Galen plays in his own, agonistic medical narratives” (24).

The paper by Lutz Alexander Graumann and Chiara Thumiger, “Children and the Art of Medical Storytelling: Contemporary Practice and Hippocratic Case-taking Compared” (31-48), compares pediatric case reports in the Hippocratic Epidemics with three reports on children’s injuries from the Marburg University Hospital.  The Hippocratic reports show several differences from the modern. They are very little concerned with the patient’s individual sensations, sentiments, and personal circumstances (43-45); they are exclusively written a posteriori, i.e. with hindsight and “a clear cut sense of failure and success” (45); they “present themselves as part of an ongoing debate” with frequent “reference to professional disagreements”, and thus contain a strong competitive element (45-46). Yet one fundamental commonality must not be overlooked, as it is an expression of the particular character of medicine as a science: the conviction that “case taking, the gathering of unique individual experiences“, is an “irreplaceable instrument of scientific knowledge, of medical training and practice” (46-7).

The contribution by Markus Asper, “Storytelling in Greek law courts” (49-66), extends the investigation into the field of forensic oratory, in which the litigants’ presentations of the case at issue is of central significance. The analysis is conducted from the perspectives of narratology (51-58) and epistemology (58-64). First, Asper shows that the speakers’ plot construction usually works in such a way that it makes “the bad and the good get what they deserve” if the judges bring the case to the suggested “just” closure (56). In other words: “speakers’ narratives construct a certain teleology which the jurors’ verdict is supposed to fulfill” (64). In the second part of his paper Asper examines the question whether this corpus of speeches can be said to be permeated by “thinking in cases” — “analogical thinking”, to use Forrester’s term (58). The result of Asper’s analysis is negative.  Because of the abstract nature of Greek law, which works not with precedents but general rules, the arguments in the court-texts are to a much greater part concerned with questions of “deduction and ‘subsumption‘” than with issues of analogy (64).

Paul T. Keyser’s subject is the (pseudo-)Aristotelian Problemata (“The Peripatetic Problems: Visions and Re-visions, That a Scholar will Revise”, 67-96), which he understands as a collection of cases that seem to constitute anomalies and thus to call current theories into question. After clarifying the discursive – Aristotelian and Theophrastan – background of the work (70-73), Keyser, in a detailed analysis of a number of verbatim quoted sections, distinguishes and characterizes different types of problem presentation (77-88). Notwithstanding this differentiation, the general goal of the collection “appears to have been to conform the case to the theory, as far as possible”, which Keyser takes as an indication that the work was “perhaps intended for internal use, among colleagues wrestling with anomalous cases” (88). Finally, Keyser locates the Problems in the history of ancient science by relating them to a host of earlier, contemporary, and later works of a similar kind (88-92).

Serafina Cuomo’s “Thinking in Cases in Ancient Greek Mathematics” (97-107) problematizes the idea “that there were different traditions within ancient Greek mathematics – theoretical and practical, axiomatic-deductive and applied” (97). The textual basis of the paper are three papyri from a small town in the Egyptian Fayum (98-103). All three present various cases of problems of measurement – partly couched in the form of a riddle or tale – which the (student-)reader is supposed to go through in sequence in order to acquire familiarity with the respective problem-solving procedures. According to Cuomo, Kuhn’s idea of the function of “exemplars” might be useful in describing the practice of the papyri. Discussing in a second step the question of how the “mathematics of the specific” relates to the “mathematics of the general” (103-105) Cuomo argues that the opposition is not so clear-cut as usually assumed, and that even Euclid’s Elements, which count as a model case of axiomatic-deductive mathematics, can be considered a “collection of cases”, through which “a style of proof is learnt” by applying it to one geometrical figure after another (105).

With the two remaining papers we return to medicine and pharmacology but move from Greece to China. Nalini Kirk in “Rhetoric, Treatment and Authority in the Medical Cases of Xiao Jing (1605-1672)” (109-146) investigates the case of a scholar-physician (109) who “quite obviously battled to establish his authority as an expert” (111). A voluminous literary work “Xuan Qi jiu zheng lun” played a central role in his endeavor. Apart from treatises on different medical topics it contains a collection of cases which takes up two of six fascicles and “which was intended to illustrate and prove his medical principles” (114). Kirk analyses this collection from several perspectives: how the author presents himself socially — in intimate contact with members of the upper layer of society and as benevolent Confucian towards patients of a lowly background (115-127); how he explains cases of failure by  blaming the skepticism and hesitation of patients’ families towards the treatment suggested by him (127-132); and  how he uses strategies like the construction of lineages of knowledge, the application of technical terminology,  but also straightforward slander and self-praise in order to establish or secure his authority (132-142).

Andrew Schonebaum is concerned with a different kind of Chinese case histories. In “Demonological Poison (Gudu) and Cutting the Flesh [to Make Medicine] (Gegu): A History of Two Case Histories” (147-179) he examines the histories of two pharmacological practices, one designed to create a most powerful instrument to kill an enemy, the other to create – by harming one’s own body – an equally powerful medicine to save the life of a loved one. Though it is unclear to what extent these practices were really carried out they were for centuries “widely discussed in all manners of texts until the first decades of the twentieth century” (147), and even “elicited … responses in the form of codified laws and imperial proclamations” (176). Schonebaum in the two main sections of his article comments extensively on collections of passages from the different textual genres in which gudu (152-166) and gegu (166-176) are dealt with. In this way he presents the reader with detailed overall pictures of the literary treatment of these quite curious pharmacological “cases”.

The papers united in this volume impress not only – as said before – by the colorful variety they offer but also by the intrinsic interest each of them can claim. Nevertheless, the question has to be asked as to whether the volume works as a volume. The editor – self-consciously – calls it “slender, and slightly eccentric” (6). This characterization is correct, and it points to a problem. Since the contributions are few and come from very different fields, generalizations and even comparisons are difficult to draw from them. The exception is medicine – a field where case histories have particular significance anyway. With four of seven contributions relating to this field and two of them being explicitly comparative, a number of interesting commonalities and differences are visible: case histories play an important role in the medical practice of ancient Greece, of the modern West, and of China; some case histories, even though in different ways, reproduce alongside scientific observations moral evaluations and social biases; in different degrees but in surprising agreement many serve also competitive purposes etc. All these observations are potential elements of a future interculturally comparative history of medicine. But the scope of the volume transcends medicine. At stake is the question of whether, and if so, where and when, in intellectual history we encounter a kind of thinking – in cases or by analogy – which is not to be taken as a mere variation of the inductive-deductive mode of thought but has an authentic claim to argumentative weight.  Here the other papers, on Athenian forensic oratory, on problems in the natural sciences, and on mathematics, come into play. They are relevant to this question, but the basis they provide is too narrow – the volume is too “slender and eccentric” – to allow for far-reaching conclusions or even wider initial hypotheses. This is not to say that the volume is a failure but, as its inspirer and editor seems to be well aware, its merit does not lie in presenting final results but in pointing to a field of research which is worth studying and in indicating some questions that could and should be pursued. As “an invitation to further work” (v) the volume undoubtedly has value.

Table of Contents

Preface – V
Markus Asper, Introduction – 1
Susan P. Mattern, Structure and Meaning in the Case Records of the Massachusetts General Hospital – 9
Lutz Alexander Graumann and Chiara Thumiger, Children and the Art of Medical Storytelling: Contemporary Practice and Hippocratic Case-taking Compared – 31
Markus Asper, Storytelling in Greek Law Courts – 49
Paul T. Keyser, The Peripatetic Problems: Visions and Re-visions, That a Scholar Will Revise – 67
Serafina Cuomo, Thinking in Cases in Ancient Greek Mathematics – 97
Nalini Kirk, Rhetoric, Treatment and Authority in the Medical Cases of Xiao Jing蕭京 (1605–1672) – 109
Andrew Schonebaum, Demonological Poison (Gudu蠱毒) and Cutting the Flesh [to Make Medicine] (Gegu割股): A History of Two Case Histories – 147
Notes on Contributors – 181
Index Rerum Nominumque – 183


[1] If p, then what? Thinking in Cases, History of the Human Sciences 9.3, 1996, 1-25. The article is referred to by almost all the contributors of the volume.

[2] My complement.