Three decades ago, inspired by socialist traditions in British history, Roy Porter challenged historians of medicine to move beyond the outmoded top-down historiography that constructed their discipline from the perspective of practitioners and major breakthroughs, calling instead for an approach that gave a more active role to patients in medical encounters. Through the 1970s, patients were marginal players in medico-historical narratives and, employing the ideas of Michel Foucault and medical sociologists, scholars tended to consider them as passive individuals who stood in relation to active physicians. Especially in the case of ancient medicine, patients came to be seen “virtually by definition as an object, as subordinate to the pouvior medical, deprived of her individuality” (502). In the 1980s and 1990s, the urging for a radical reconsideration of the role of the material in the history of medicine—of how studying bodies and commodities is essential for understanding how individuals perceived suffering and medical treatment—was met with enthusiasm, even inspiring a new name for this type of historiography among German language practitioners: Patientengeschichte.
Unfortunately, “development of the history of the patient's view has in fact fallen short of what was promised,” and historiographical discourse continues to be shaped predominantly by the physician's gaze (2-3). In response, this book takes up Porter's challenge anew. Drawing on the expertise of scholars of classics, religion, philosophy, literature, and medicine, as well as physicians and individuals with health care policy experience, this collection focuses not on patients (in their relation to practitioners), but on patiens. The participle in the title references not the patient, but the “afflicted,” or “suffering” individual, recognizing the necessity to “further advance the theoretical and clinical foregrounding of the patient in the medical encounter by offering a historical perspective on the contributions made by ancient patients” (4).
This path to an effective history of medicine from below is not without obstacles. Aside from difficulty locating sources that provide access to the patient's experience, scholars must decode a “rhetoric of power” inherent in ancient medical texts while also interpreting the realities that could lie beneath prescribed patient accounts that purport objectivity. Moreover, they must recognize they cannot simply transcribe modern medical taxonomies and diagnoses onto accounts of doctors and sufferers who viewed the bodies and afflictions around which their relationships were formed in ways far different than we do today. Scholars of the ancient world are aware of these difficulties and know to examine the past with an eye for historical contingencies, decrypting highly stylized accounts, and employing material objects to come to a truer understanding about how ancients viewed their bodies and the world they inhabited. Because of that recognition, the authors of this book are uniquely situated to help advance the role of the afflicted in the broader history of medicine. In doing so, they of course offer another lens through which to consider late antique scholarship but, perhaps more importantly, also highlight pedagogical tools that can assist medical students and practitioners to better comprehend how their patients’ experiences are shaped, hopefully leading to a clearer understanding of the importance of differing approaches to treatment such as palliative healthcare.
The essays in this collection are grouped around six themes. Part 1 considers medical authority and patient perspectives. Using a Greek funerary inscription, pediatric surgeon Lutz Graumann and historian of ancient medicine Manfred Horstmanshoff combine the study of “Greek literature and linguistics, epigraphy, social and religious history, and ancient medicine” to “show the contradictions inherent in proposing retrospective diagnosis [of tuberculosis in this case], without neglecting the relevant information modern medicine has to offer” (23). Melinda Letts's “Questioning the Patient, Questioning Hippocrates: Rufus of Ephesus and the Pursuit of Knowledge,” examines Rufus’ Questiones medicinales. Whereas that text has traditionally been viewed as a procedural handbook, Letts argues that its true significance lies in Rufus’ insistence that physicians must question patients and understand the singularity of their experience to properly understand and treat illness. This argument provides a historical precedent for the epistemic value of patients’ points of view in diagnostic encounters and processes of healing central to the “narrative-based medicine” movement that originated in the late 1990s.
Part 2, “Case Studies in the Hippocratic Corpus,” continues with a focus on patient reports found in fifth- and early fourth-century texts in the Hippocratic Epidemics. Chiara Thumiger's “Patient Function and Physician Function in the Hippocratic Cases” surveys important stylistic features of reports in Epidemics to decode the point of view of patients. She highlights the highly composite nature of such accounts, of which the sufferer must be a major contributor. John Zee extends the argument that ancient medical texts were constructed from specific points of view and for specific purposes. His “Case History as Minority Report in the Hippocratic Epidemics 1” argues that the twelve cases in that text were preserved because of how unusual they were; case studies were not used to explain typical sickness, but rather to show exceptions to general ideas about and approaches to illness. Closing this section, Colin Webster examines “Voice Pathologies and the ‘Hippocratic Triangle’” to demonstrate that while physicians encouraged patients to report the sensations they felt, they also created wide-ranging techniques to decrease their reliance on the patients’ verbalization of their symptoms. He concludes that “Hippocratic authors treat patients’ mouths not so much as the loci of potential subjective expressions, but as orifices secreting verbal discharges” (166).
Homo Patiens’ editors argue that the history of mental disorder and psychiatry “may be seen as providing the model, the archetype for any discussion about the subjectivity of the medical experience and its deep rooting in any medical communication” (14). In an assessment of “Galen's Anxious Patients,” Susan Mattern explores anxiety disorders in ancient Rome from a cross-cultural and cross-historical perspective while Pauline Koetschet's “Exploring Madness” compares Arab and Greek physicians’ typologies of mental patients while also evaluating how Islamic physicians treated mental patients and whether the purpose of sanatoriums found in Islamic hospitals was to treat or confine patients.
Part 4 considers the emotions involved in the subjective experience of suffering, reflecting especially how gender, social class, age, and authority influenced that experience. Jennifer Kosak evaluates the connection between a physician's touch and the gender of patients in “Interpretations of the Healer's Touch in the Hippocratic Corpus,” while Lesley Bolton's “Patience for the Little Patient” investigates the attitudes the physician Soranus had toward child patients, focusing particularly on his attempt to cater to their emotional needs. Amber Porter extends the study of emotions to both patient and physician in “Compassion in Soranus’ Gynecology and Caelius Aurelianus’ On Chronic Disease. She argues based on these texts that there was a shift towards an increased attempt by physicians to empathize with their patients’ suffering starting in the first centuries of the first millennium. Finally, Courtney Robey's “Galen on the Patient's Role in Pain Diagnosis” shows how Galen used himself as a subject to explore the communicability of suffering.
Part 5, “Material Aspects, Diagnostic Techniques and their Impact on the Patient-Physician Relationship” explores how diagnostic techniques were perceived by physicians to impact their rapport with patients. Giulia Ecca's close reading of Precepts, a Hippocratic treatise dealing with medical ethics, shows financial transactions and exchanges of favors were important in shaping the relationships between sufferer and healer. Orly Lewis’ contribution focuses on pulse-taking, showing that while patients recognized what their pulses could explain about their bodies, physicians increased the impression of their professional credibility to compel patients to rely on their interpretations. Similarly, Patricia Baker's “Images of Doctors and their Implements” concentrates on visual representations of ancient medical encounters to examine how they might improve our understanding of how patients perceived their relationships with physicians. Concluding this portion of the book, Petros Bouras-Vallianotos studies John Zacharias Aktouarios’ On Urine, arguing that Aktorious’ detailed accounts of patient visits helps shed light on how physical contact and gender variables affected diagnoses and treatments.
The final section, “The Informed Patient: Self-Healing and the Patient as Physician” explores a more active role for patients and also looks at access to medical knowledge in the ancient world. John Wilkins’ “Treatment of the Man” looks at Galen's De sanitate tuenda and shows that for Galen the ideal patient was one who engaged in preventative medicine, suggesting that patients with some medical education could act as healers as well. Examining the Roman Republic and Empire, Jane Draycott reveals that laypeople corresponded most with family members about care and drugs, while in “Aelius Aristides as Informed Patient and Physician,” Georgia Petridou offers a close reading of the Hieroi logoi and continues a focus on “the knowledgeable patient” who sees himself or herself as “an active agent in the healing process and as equally important partner in the medical encounter” (451). Concluding this section with a text that makes perhaps the most direct link between ancient medicine and contemporary medical treatment, Katherine van Schaik, a historian of medicine and physician in training, evaluates the treatment of disease in the ancient world and concludes that evidence supports the idea that since antiquity good healing and maintenance of health “occurs when healers communicate clearly with their patients about disease and treatment progression, and when healers are open-minded about patients’ utilization of multiple treatment modalities” (471).
In his Epilogue, “Approaches to the History of Patients,” Michael Stolberg explains that Homo Patiens “pleads for a cautious and nuanced approach” to ancient history of medicine, “recommending that historians consistently ask in which contexts and in what way the application of modern diagnostic labels to pre-modern accounts of illness can truly contribute to a better historical understanding rather than distort it” (499). He then goes on to declare triumphantly: “The history of the patient has come of age” (514). While that concluding thought may be overly optimistic, the essays in this collection make a notable contribution to a bottom-up history of medicine destined to be of great use to historians, physicians, and modern sufferers alike.