BMCR 2009.04.36: Reid on Mattern, Galen and the Rhetoric of Healing

Susan P. Mattern, Galen and the Rhetoric of Healing.  Baltimore:  Johns
Hopkins University Press, 2008.  Pp. x, 279.  ISBN 9780801888359.
$55.00.

Reviewed by Shelley Reid, University of British Columbia
([email protected])
Word count:  1594 words
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Susan Mattern's monograph on Galen of Pergamum is perhaps slightly
mistitled: she may have been more justified in replacing the phrase
"the rhetoric of healing" with "the narratives of healing," since the
focus of her work is a close examination of the medical narratives
found in the writings of Galen.  This opening quibble about the title,
however, is just that: a very minor criticism of a work which
successfully renders an interesting and readable portrait of the varied
complexities of the social aspects of ancient medicine.  Mattern's work
is not, as she rightfully stresses, a book about medicine; it is rather
a detailed picture of the place and role of the physician in
Greco-Roman society of the second century, one produced by drawing upon
the admittedly subjective, but nonetheless valuable, evidence of its
most famous medical practitioner.

As any researcher who has approached the works of Galen can attest, the
sheer volume of his writings can be both immensely exciting and rather
intimidating (Vivian Nutton has estimated that the Galenic corpus
accounts for almost ten percent of extant Greek literature up to 350
AD).[[1]]  Galen's writings have of course been frequently mined by
historians of medicine, who are looking for a greater understanding of
the medical theories and practices of the classical world, both those
of Galen himself and those of his rivals, whom he frequently
excoriates.  Mattern, for her part, narrows in on those sections of
Galen's work which she reasonably equates with the modern medical case
history: the narrative account of the patient and his (only
occasionally her) presenting symptoms, the diagnosis and prognosis
offered, the therapeutic actions taken by Galen and others, and the
outcome of these actions.  (An appendix is very helpfully supplied, in
which is listed all of the narratives to which Mattern makes reference.
This is not an all-inclusive list of the narratives to be found in
Galen's writing, for she excludes the Hippocratic case histories to
which Galen refers and those which are clearly hypothetical or which do
not pertain to a particular individual.)  Galen's narratives do not
always include all of the elements of a case history; now and then, for
example, he will fail to include the outcome of a case, which is the
sort of detail likely to frustrate the modern reader.  Mattern
contends, however, that Galen often wrote with more than one aim in
mind: on most occasions he employs narrative to display or convey his
medical knowledge, but on other occasions his purpose is far more
obviously literary or social, and sometimes two or three motives are
evident in a given narrative.

The value of medical narrative as social and cultural evidence has long
been noted by both anthropologists and historians, but Mattern is the
first, to my knowledge, to place Galen's medical narratives in this
particular spotlight.  Medical narrative has a long tradition in the
ancient world; Mattern cites not only Hippocrates' Epidemics (for which
Galen himself wrote commentaries) but also works as varied as those of
Aelius Aristides and the votive inscriptions offered to Asclepius and
other gods of healing.  The fact that Galen's narratives lack the sort
of precision and regularity which modern medical case histories contain
is duly noted by Mattern; she argues, however, that while these
passages from Galen may be of dubious quality as historical or even
medical documents (and she wisely eschews the practice of retrospective
diagnosis in these narratives), it is precisely their anecdotal and
subjective quality which renders them valuable as evidence of Galen's
own perception of his position and status as a physician within his
society, from which one can draw further inferences about his society
at large.

The bulk of the first chapter is taken up by a more general discussion
on medical narrative and its place in Galen's writings.  This is
accompanied by a brief but useful overview of the demographics of
disease, both urban and rural, in the Roman empire, as well as some
biographical background on Galen himself.  The second chapter seeks to
provide some temporal and spatial context for the narratives; this is a
daunting task, as the evidence from Galen's narratives is sparse, but
Mattern does well with the limited material with which she is working.
Most notably, she argues that the vagueness of Galen's references to
time and space implies a close connection between the writer and his
audience, which she identifies as being composed of not just his fellow
physicians but also of the pepaideumenoi, that class of educated men
who considered a grasp of medicine an important aspect of their
education.

This audience of physicians and fellow pepaideumenoi plays a crucial
role in Mattern's third chapter, in which she outlines the strongly
agonistic aspect of ancient medicine.  Medicine was an activity which
was highly competitive (and almost exclusively masculine) in nature;
the practice of medicine was a social, often even a public, event, not
the private and closeted activity of today.  Mattern sets Galen's
writings upon the broader canvas of the Second Sophistic (and thus, no
doubt, her titular reference to rhetoric).  The physicians of Galen's
day not only competed with each other at the patients' bedsides, but
also readily participated in the rhetorical and competitive
performances -- medical debates, demonstrations, dissections and
lectures -- to an audience which came to cheer or jeer, depending upon
their loyalties and the persuasive efforts of the competitors.  These
public performances might occur in front of an audience of a half dozen
(in the sickroom, for example) or of sufficient numbers to fill a
theatre, but Mattern notes that whatever the venue, victory was
predicated upon a therapeutic outcome, a purely intellectual exercise
of diagnosis and prognosis, or a verbal debate, or at times upon any
combination of these elements.

Mattern's account of this competitive aspect of ancient medicine is
well done, but it is in the final two chapters that the book takes full
shape and becomes most interesting.  In these chapters, she turns her
scrutiny away from the audience and rivalries surrounding medical
performances and refocusses it on the main actors: the patient and the
physician.  Even in agonistic settings, the highly intimate
relationship between these two "characters" is evident in Galen's
narratives, and, unlike the medical narratives of Hippocrates or those
of the modern physician, the patient himself is able to provide his own
perspective in many of Galen's narratives, through the means of
indirect discourse.  There is even evidence for a modicum of
patient-physician negotiation, as revealed in narratives in which the
patient's and Galen's voices alternate with one another.  Galen's
patients were no doubt drawn from the entire spectrum of society, but
Mattern demonstrates that Galen places marked emphasis upon the adult,
urban male of the leisure class, particularly one with a warm, dry
temperament, setting this patient up as the archetypal patient (and
even seeing himself, she argues, in this ideal patient).  Mattern
argues for a correlation between this ideal Galenic patient and the
Greek conception of a citizen.  She notes that Greco-Roman regimens of
health held both moral and social significance as much as they held
medical meaning; she points, for example, to the psychological
connection between gymnastic exercise, an activity vigorously promoted
by Galen as part of a healthy lifestyle for men, and Greek civic life,
in the competitive, masculine, and highly public nature inherent in
both.

Galen's characterization of his patients, which could include aspects
of their emotional temperaments, is dealt with in the fourth chapter;
the final chapter examines his self-representation as a physician.
Mattern discusses Galen's narrative emphasis on his own ability to
"read" his patients, sometimes "at a glance."  She also highlights the
intriguing manner in which Galen depicts his interactions with fever,
which was considered by ancient physicians as a disease in its own
right and not merely a symptom, noting his use of military metaphors
but also persuasively suggesting that Galen on many occasions depicts
fever as an animal whose movements the physician must track and outwit.
It is Mattern's exploration of the delicacy of the physician's power
and status in relation to the patient, however, which is of particular
note.  Medical therapies require intimate physical contact with a
patient: bathing, drying, massaging, feeding.  Galenic theory,
moreover, demanded a thorough inspection of the bodily wastes produced
by the patient.  Galen's narratives are strangely ambiguous about who
in fact is performing these chores: whether he undertook these
essentially servile tasks himself or delegated these tasks to slaves
(his own or those belonging to the household) is seldom clear.  Galen
further portrays himself frequently acting in concert with household
slaves, gaining from them "inside" information about the family which
helps determine his diagnosis and therapeutic response.  This close
connection with servility, therefore, prompts a clear power struggle in
many of the narratives, in which he strives not to overcome competitive
rivals, but rather to assert his power over the patient and the
household.  The ancient physician seems to have walked a fine line
between servility and authority, at least when dealing with members of
the ruling classes.

Mattern's work is well-organized, well-argued, and clearly presented,
with minimal editorial problems (only four typographical errors were
spotted).  The book will appeal equally to historians, whether of
ancient medicine in particular or of the social history of the time
period, and to the general reading public; Mattern clearly aspires to
attract some of the latter, particularly physicians, whom she hopes
will "see through what must seem the absurdity of [Galen's] doctrines
and the outrageousness of his arrogance to the ancient human drama at
the heart of medicine" (162).

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Notes:


1.   Vivian Nutton, Ancient Medicine (London 2004): 390 n. 22.