BMCR 2021.06.41

Ancient Greek medicine in questions and answers

, Ancient Greek medicine in questions and answers: diagnostics, didactics, dialectics. Studies in ancient medicine, volume 54. Leiden; Boston: Brill, 2020. Pp. xi, 242. ISBN 9789004437654 €106,00.

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

Originally presented at a conference in 2016, this volume of nine papers addresses the theme of questions and answers in Greek medicine from a number of perspectives. The chapters include analysis of texts which take an explicitly question-and-answer format (problemata texts and the so-called erotapokriseis medical Q&A papyri) as well as theorising Q&A in medical encounters and in logic. On the whole, the theme works well, with some helpful continuities between contributions. There is a strong trio of essays on medical papyri and a sustained focus on the relationship between Galen’s medicine and the school of his near-contemporary Alexander of Aphrodisias.

A brief introduction sets out the context of the work within the literature. Michiel Meeusen makes the case that there has been a great deal of recent work on ancient medical texts, including Q&A texts (e.g. Mayhew’s edition of Problemata Physica, Brill, 2015). However, as he points out, much of this work tends to focus on individual texts, whereas the present volume seeks to make a wide-ranging comparative examination from a variety of perspectives. It is successful in that aim.

The first contribution, from Andrés Pelavski, uses the Q&A format as a framework for discussing altered states of consciousness in the Hippocratic corpus. Pelavski argues that, although work has been done on mental illness in ancient medical texts, less attention has been paid to alternative explanations for acute episodes in which patients act or speak abnormally. The Q&A form employed by doctors to assess patients, implicit in various Hippocratic texts, displays a developed notion of altered consciousness (and therefore of consciousness) which has significant overlap with the modern notion. Pelavski further claims that this is separate from ancient philosophical discussions of the mind. His examples are well chosen, but his discussion of the absence of a theory of consciousness in other Greek thought is less convincing. For example, the idea is very clearly present in texts on prophetic mania, including in Plutarch and Philo.

Robert Mayhew focuses on the understudied prologue to Book 4 of the Ps.-Aristotelian Problemata Physica. The Problemata concern questions of a philosophical type. One question Mayhew analyses in detail is about the formation of seed, which was the source of significant doctrinal disagreement between Hippocratics and Aristotelians. Mayhew argues carefully and impressively that the Problemata, instead of being a set-piece on the topic, treats the subject (surprisingly) as a genuinely open question: the author of the Problemata takes aspects of both Hippocratic and Aristotelian accounts, raises questions, and gives speculative and sometimes mutually exclusive answers.

Katerina Oikonomopoulou seeks to identify the intended audience of the Supplementary Problems, a pseudo-Aristotelian Q&A text. As she shows, there is a very uneven distribution of topics, discussed at varying levels of assumed expertise, which makes it hard to assess audience. Oikonomopoulou helpfully compares the Supplementary Problems with more explicitly rhetorical texts like Plutarch’s Table Talk or Aulus Gellius’ Attic Nights, where the author functions not only as a formal expert but as a sophisticated raconteur disseminating knowledge in a social (as opposed to formal educational) environment. By making this case, she also implicitly makes a strong case for the volume as a whole as a method for studying the wider social context of medical Q&A texts.

Meeusen’s own contribution is on ‘unsayable properties’ (ἰδιότητες ἄρρητοι) in ps.-Alexander of Aphrodisias’ Medical Puzzles and Natural Problems. He shows that, for ps.-Alexander, epistemic limits on the doctor were not only – as in Galen – because of the lack of availability of reliable information, but also had a theological significance: some questions were ‘better left unresolved’. In arguing this, Meeusen also clearly sets out a wider agenda for the study of Q&A texts, which makes this chapter a linchpin in the work as a whole.

Luca Gili’s focus is on logic in Alexander of Aphrodisias and Galen. In particular, he demonstrates that neither Alexander nor Galen have an erotetic logic—that is a logical system which uses questions as logical terms. Both, however, clearly believe that question-and-answer dialogue with patients is an essential part of the diagnostic process, and both believe that such dialogues can (and must) be translated into syllogistic logic. Gili convincingly argues that, while Alexander used modal logic to encode the sorts of uncertainties endemic to patient interactions, Galen did not employ modal logic and instead attempted to encode uncertainty directly into premises in his syllogistic. Although the most technical, this chapter is perhaps the most exciting in the book.

Antonio Ricciardetto’s chapter (which is in French) discusses medical documents among Egyptian papyri. Ricciardetto examines a number of records of patient examinations in which injuries are described, usually in a non-specialist register, and demonstrates convincingly that many of the descriptions are for use in a legal setting as evidence of violence. Ricciardetto makes a comparison with case histories in the Hippocratic text Epidemics which take a very similar form. This contribution is a fascinating look into the texts and into the social context of everyday people’s injuries (the infant patient who has been injured with a potsherd by another infant, the man who falls from the top of a baker’s oven, the young woman who is joking around and accidentally slaps her friend too hard). It is not, however, immediately clear how it fits with the Q&A theme; Ricciardetto concludes that in both the Hippocratic case histories and the papyri, the doctor has apparently worked through a checklist of symptoms phrased as questions – but this seems a tenuous use of the volume’s theme.

Isabella Bonati’s piece, which is also papyrological, focuses on the erotapokriseis, a category of Q&A medical texts well represented among papyri. Though traditionally regarded as teaching manuals, these have been considered in more recent interpretations to be in line with scientific writings of the problemata type. By examining a set of specific medical terms and comparing their use in the erotapokriseis and in other medical texts, Bonati demonstrates that the erotapokriseis exhibit a greater degree of ordering and lexical particularisation than has usually been supposed.

Nicola Reggiani also discusses the erotapokriseis, but from a papyrological and digital humanities point of view, building on interpretations (such as Bonati’s) which take the Q&A format as essential to the organising principles and structure of these medical texts. Given various papyrological features of erotapokrisic texts, including the fact that questions are often indented or indicated with diacritical marks, it is important to establish the proper layout for them in editions or online. Reggiani provides a clear programme for how this can and should be done, building on work undertaken by Isabella Andorlini. He demonstrates the difference between visually reproducing paratextual features of printed editions of papyri and actually representing them in code, and argues that with a better set of editions, it may become possible to distinguish whether there are consistent differences in paratextual features used among subgenres.

Laura Mareri’s contribution examines the use of questions and answers in patient interactions in Alexander of Tralles’ Therapeutica. As Mareri notes, Alexander only rarely engages in dialogue with patients, preferring to work off his own Hippocratic and Galenic principles, but in some cases he must rely on their answers to make a diagnosis of physical or mental illness. This short chapter has resonances with Pelavski’s work earlier in the book but does not push its conclusion very far.

The volume is provides excellent coverage of the medical papyri and problemata-style texts, with essays on audience, genre, logic, structure and text-critical and papyrological issues cohering closely together. However, at times, the theme of Q&A becomes a little unfocused: a lengthier theoretical introduction or a conclusion might have helped to solidify the theme. Nonetheless, it is generally successful in its aim to use Q&A as a springboard to provide unexpected ‘windows’ onto wider cultural, philosophical, and textual features of ancient medicine. It will certainly be of interest and use not only to those working on ancient medicine more generally but also to scholars interested in wide-angled approaches to genre. It is a well-produced book with a thorough index.

Authors and Titles

Introduction: Michiel Meeusen
1. Questioning the Obvious: The Use of Questions and Answers in Assessing Consciousness in the Hippocratic Corpus – Andrés Pelavski
2. Peripatetic and Hippocratic seeds in Pseudo-Aristotle, Problemata 4: Raising Questions about Aristotle’s Rejection of the Pengenesis Theory of Generation – Robert Mayhew
3. Author(s) and Reader(s) in the Supplementary Problems (Supplementa Problematorum) – Katerina Oikonomopoulou
4. Ps.-Alexander of Aphrodisias on Unsayable Properties in Medical Puzzles and Natural Problems – Michiel Meeusen
5. Erotetic Logic, Uncertainty and Therapy: Galen and Alexander on Logic and Medicine – Luca Gili
6. La réponse du médecin : les rapports d’inspection médicale écrits en grec sur papyrus (Ier – IVe siècles) – Antonio Ricciardetto
7. Definitions and Technical Terminology in the Erôtapokriseis on Papyrus – Isabella Bonati
8. Digitizing Medical Papyri in Question-And-Answer Format – Nicola Reggiani
9. Questions on the Unseen: Alexander of Tralles’ Patient Interaction – Laura Mareri