Search

Hippocratic authors frequently utilise silence, babbling, lisping and otherverbal signs to diagnose a variety of physical illnesses and predict theircourse. This chapter examines these 'voice pathologies' and evaluatestheir impact on the dialogue between patients and Hippocratic physicians. In short, Hippocratic authors treat patients' voices in two dissonant ways. On the one hand, physicians promote some form of discourse,implicitly relying on patients to report internal sensations resulting fromillnesses. On the other hand, they develop extensive techniques to diminish and downplay this reliance. As a result, Hippocratic authors treatpatients' mouths not so much as the loci of potential subjective expression, but as orifices secreting verbal discharges. They weaken the distinction between the (sonic) effluvia of the mouth and those of other bodilyoutlets, thus bringing verbal output into close conceptual proximity withother types of discharge. Words come to be scrutinised for their quantity,quality and consistency as though they were quasi-excreta of the mouth. (see text). Announce what has happened, discern what is happening and foretellwhat will happen; attend to these things. Practice two things concerningdiseases: help or do no harm. The art consists of three parts: the disease,the diseased and the physician; the physician is the servant of the art; thediseased fights against the disease with the physician (Hipp., Epid.1.5L. 2.634.6-636.4 = Kiülewein 189,24-190, 6).

Galen describes a syndrome he associates with an emotion called lypē, with specific symptoms and a course that may lead to humoral imbalance, disease, and death. Lypē is an emotion that encompasses distress at a loss, as the death of a close friend or the destruction of one's books by fire; but Galen also associates it with chronic worry about a future threat, and a physiology between the emotions of worry and fear (that is, 'anxiety'). Lypē can cause a progressive syndrome characterised by insomnia, fever, pallor, and weight loss that can kill patients or degenerate into psychotic illness. This syndrome can be described in modern terms as an anxiety disorder.

Instead of being self-evident depictions of sickness, ancient medical texts were narratives created from certain points of view and for intended purposes. As a guide for the physician travelling to an unfamiliar community of people, the treatise Airs, Waters, Places anticipated "communal" conditions resulting from seasonal changes, while admitting the possibility of "personal" sickness due to individual lifestyles. Even with its geographical situatedness, Epidemics 1 continued to prioritise population narratives, subsuming sickness within the experiences of the anonymous majority whenever possible. In both its constitutions and case histories, however, patients whose conditions deviated from majority expectations were identified for forensic purposes, so that case histories functioned as minority reports rather than exemplars of how sickness behaved. Such reports guarded against surprising deviations from the rules of prognosis, which could present a threat to the physician's credibility and livelihood as a consequence.

In the modern world, we are experiencing an epidemiological shift represented by the increasing prevalence of chronic diseases relative to that of acute diseases: more people are living longer, with more diseases, than ever before in human history. How are we to understand and to respond to this change? A study of provision of cancer treatment in Western Australia, especially among Indigenous populations, can illuminate ways in which healthcare providers and societies might better understand the treatment of chronic disease: healthcare providers should take care to appreciate patient perspectives and beliefs about disease aetiology and treatment. Consideration of treatment of disease in the ancient Graeco-Roman world supports the view that effective healing and maintenance of patient wellbeing occurs when healers communicate clearly with their patients about disease and treatment progression, and when healers are open-minded about patients' utilisation of multiple treatment modalities.

This paper examines the effects of the emergence of pulse measurement as an essential diagnosis and prognosis method used on Graeco-Roman patients. It argues that the introduction of this diagnostic tool brought about changes to the encounter between patients and their doctors and may have also increased intimacy and patients' forthcomingness during these encounters. The paper demonstrates that the popularity and conspicuity of the practical and theoretical engagement with the pulse afforded many opportunities for the transmission of professional knowledge from doctors to patients. It argues that this transmission of knowledge was often actively encouraged by doctors for the sake of self-promotion and promotion of the medical profession as a whole. At the same time, doctors also attempted to restrict this transmission of knowledge in order to use their exclusive competence in the pulse as means for establishing their authority and superiority over patients.

Compassion is considered an important quality for a successful physician today, but did ancient physicians display and value this emotion? How did they feel when faced with the pain and suffering of their patients? How did their patients' emotions affect their own? Many ancient physicians are not well-known for expressions of compassion in their writings; however, this seems to change in the second century AD. One medical writer who exemplifies this change is Soranus of Ephesus (c. 98-138 AD). In his Gynecology, there are a number of passages where compassion is addressed or expressed (such as the chapters on the qualities of the best midwife, the symptom of pica, childbirth, and superstition). The same points can be made of Soranus' On Chronic Diseases, preserved to some extent by the Latin version and adaptation by fifth century AD medical writer Caelius Aurelianus (see, for example, the chapters on chronic headache, mania and elephantiasis). Soranus and Caelius display compassion, understanding, and flexibility of approach when dealing with patient issues; they show themselves willing to change their medical technique when they see that it is doing more harm or discomfort than good. In Soranus and Caelius, we have an image of a physician who acknowledges and is aware of their patients' emotions, beliefs and attitudes, and who exhibits compassion for them.

Aelius Aristides, one of the most renowned orators of the so-called second sophistic, has often been thought of as the paradigmatic patient who surrendered his physical and psychological health to Asclepius, and spent a large part of his life in the temple of the god at Pergamum blindly following divine orders on diet and regimen. This study looks at the Hieroi Logoi as an illness narrative and argues against such a simplistic view and in favour of a more complex picture: Aristides is a far cry far from the submissive patient, who idly resided in the Pergamene Asclepieion relying exclusively on the therapeutic powers of the god and his human helpers. In fact, through a close reading of a selection of passages from the Hieroi Logoi a whole new image of Aristides emerges: the informed patient who is not only in possession of the basics of the medical discourse but who also functions as a physician of sorts, taking both his own life and the lives of others into his hands. This new type of patient, the knowledgeable patient, who is well-versed in medical matters and envisages himself as an active agent of the healing process and an equally important partner in the medical encounter, ties well with other testimonies we have about knowledgeable patients mostly to be found amongst the members of the socio-political elite of the time.

This paper provides the first analysis of case histories in the Byzantine period as they feature in the On Urines of John Zacharias Aktouarios (ca. 1275-ca. 1330). This group of clinical accounts is of special importance in that they have no counterpart in the Greek-speaking world since Galen. This study aims to illustrate various factors determining the patient's response to the physician's advice through close examination of John's clinical narratives. The first part deals with the terminology that John uses to indicate the patient's gender, age, social status, and clinical condition. The second part explores the significance of John's acquaintance with the patients, the patient's socio-economic background, and also the patient's experience in connection with the physician's professional expertise.

This paper focuses on the mental patients in Arabo-Islamic Middle Ages. Patients suffering from mental illnesses generated a lot of interest for Arabo-Islamic physicians. The first objective of this study is to identify who were the mentally infirm and to compare the Arab physicians' typologies of mental patients to that of their Greek predecessors. The second part of this paper shifts the focus from theoretical descriptions to case histories and biographical sources, in order to understand how the physicians treated their mental patients, and to find out what was the social impact of this medical approach. Finally, because the special provision for the insane is a distinctive feature of the Islamic hospital, the third part of my paper examines whether the main purpose of these hospitals was the patients' confinement or their treatment.

Ideally in Galen's model of preventive medicine, the patient does not become a patient at all but remains a healthy person able to maintain his or her health without need of either medicines or other therapies. This chapter is divided into four sections, Galen's ideal patient; less than ideal patients; patients in old age; and patients whose nature is inclined to a bad mixture of humours, and so in need of medication. In all four categories, even those where medical recommendations such as blood-letting are recommended, Galen offers an option based on hygieine, or the art of maintaining good health. Galen's aim in de sanitate tuenda is to ensure that a well-educated person can lead a healthy life by learning what does harm and what benefits him or her. The chapter explores the extent to which the patient can really be independent of the doctor, and the interesting balance between nature and urban life which constitutes good health in Galenic thought.

Despite advocating perpetual virginity and viewing childbirth as inherently injurious to female health, Soranus' attitude towards the infant in Book 2 of the Gynaecia is remarkably positive. In fact, it is only towards the infant that Soranus displays such consistently positive attitude. This compassionate approach is evident both in the content and the language employed, which is characterised by a striking occurrence of diminutives. His preference here for authorities such as Thracians and Scythians rather than illustrious ones, along with his 'language of the nursery', points to an oral, rather than literary, tradition. Soranus seems to have been the first to write so extensively on childcare; freed from the influence of any earlier tradition, he engaged in a more nuanced vision of childhood, seeing it as a 'blank slate' both physically and mentally, untouched by the faults of adulthood. While the content of Book 2 has been mined for information concerning the practicalities of child-care, it has not been evaluated in terms of its differences from the rest of the Gynaecia, which are significant.

This paper analyses gender as an aspect of the role of touch in the relationship between doctors and patients, as represented in the Hippocratic Corpus. Touch is an essential aspect of the ancient doctor's art, but one potentially fraught with concerns over gender: while seeing, hearing, and smelling are also central to the medical encounter, touching is the act that places the greatest demands on the privacy and bodily integrity of the patient. This paper shows--perhaps counterintuitively--that, despite the multiple assertions of gender differences put forward by the authors of the Hippocratic Corpus, these authors make little distinction between touching male and female patients. At the same time, the paper argues that ancient physicians were anxious to avoid the charge that they were harming their patients when they touched them. It demonstrates that male doctors, sensitive as they were to the problems posed by their interactions with female patients, were challenged in different ways when engaging in intimate contact with male patients.

The brief collection of deontological guidelines entitled Praecepta is one of the most important literary evidence regarding the fee of the ancient physician. This chapter focuses on three passages from the Praecepta, which offer us a wealth of information on this topic. Some technical terms used in the text, such as the term μiσθápiov, show clearly that the author intends both to provide guidelines for the ideal bedside manners and to defend the repute of the physicians from the widespread charge of greed. In some regards, the author of the Praecepta depicts medicine as a 'liberal' art: the good physician disdains monetary gain as the main goal of his service, and aims to safeguard the social status and reputation of the medical profession. On the other hand, the author of the Praecepta enlightens his readers on the bad behaviour of both charlatan physicians and bad-mannered patients.

Pain might be a powerful diagnostic tool, but it is at the same time an intensely private and subjective experience that represents a formidable problem in the communication between physician and patient. Galen addresses (principally in De locis affectis) the problem of constructing a consistent and univocal terminology for different pain sensations, rejecting the system proposed earlier by Archigenes on the grounds that he relies on metaphorical descriptors which indiscriminately incorporate terms belonging to information generated by all the senses, fails to conform to patient testimony, and refers to ambiguous concepts. Galen sets himself the task of developing a system of proper or literal (kyrios) terms for pain sensations, even despite the apparent ineffability of certain sensations and laymen's imprecise self-analysis and description of their suffering. His pain vocabulary, developed through a combination of consensus between patients and physicians' expert descriptions of their own pain, promises to link terminology univocally to sensation, turning patients' testimony about their subjective experience of pain into universally applicable diagnostic guidance.

This chapter looks from an early modernist's perspective at some of the major questions and methodological issues that writing the history of patients in the ancient world shares with similar work on Patientengeschichte in medieval and early modern Europe. It addresses, in particular, the problem of finding adequate sources that give access to the patients' experience of illness and medicine and highlights the potential as well as the limitations of using physicians' case histories for that purpose. It discusses the doctor-patient relationship as it emerges from these sources, and the impact of the patient's point of view on learned medical theory and practice. In conclusion, it pleads for a cautious and nuanced approach to the controversial issue of retrospective diagnosis, 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.

This chapter looks at the patient cases of the Epidemics as testimonies to the interaction between the physician and the patient. My corpus of reference is the patient cases in fifth- and early fourth-century medical texts, mostly the more elaborated examples offered by Epidemics 1 and 3. A patient case collects information from various sources: the patient's observable behavior and state; his or her account of her disease, its history and the patient's lifestyle; the contribution given by relatives and friends; and, of course, the physician with his judgment, his agenda, his terminology and didactic aims. What remains elusive and hidden is the viewpoint of the patient and his personal experience within, or under the authoritative report compiled by the physician. In this chapter, I survey key stylistic features of these reports, which I see as significant to the reconstruction of the point of view of the ill in his or her encounter with the doctor. My main aim is to extract from these texts as much as possible information about the experience of suffering and patienthood in antiquity. In my analysis I look at the text not only, and not primarily as a definitive pronouncement stemming from the physician's legislating mind, and from the material author's 'pen', nor observations from by-standers and helpers in the sick room, nor even as the plaintive cries from suffering patient, but as a composition in which all the principal actors in the drama of a sickness must contribute.

Using the casebooks of the Ghent homoeopathic physician Gustave van den Berghe (born Zwevegem, 1836; died Ghent, 1902), this essay reconstructs patients' experience with sexuality and venereal disease during the late 19th century. Van den Berghe's records are uncharacteristic in that they do not translate the patient's descriptions into medical terms. The casebooks therefore represent an opportunity to hear about the disease and its social context in the patient's own words. Reading these case reports carefully, we can begin to understand not only what it meant to suffer from venereal disease, but also what motivated people to seek homoeopathy in general and this healer in particular.

While the perspectives of patients are generally included in the social history of medicine during the early modern period, patients' accounts are largely overlooked in the study of earlier periods. For students of antiquity the task is particularly arduous, since meaningful, self-reflexive legacies that could be used to examine the dimensions of patient history are rare. For instance, patient accounts from the period of the Roman Empire are scarce, and rather problematic primary sources. Devotions to the healing god Asklepios, his cult and his medicine incorporate patients' perspectives, but in most cases little useful information is gained from them. An additional source is the hieroi logi of P. Aelius Aristides, who was the patient of Asklepios in Pergamon for many years. These testaments have a fictional element that presents a methodological challenge to the historian. Nevertheless, as this article shows, answers to many questions relating to patient history can be extrapolated from Aristides' testaments.

This article develops a fragmentary history of early homeopathic treatment of children. It begins with an outline of Samuel Hahnemann's perception and treatment of children during the "Medical Enlightenment". This is followed by an investigation of attitudes towards children in early homeopathic literature, in comparison to those of mainstream medicine of the period. The central part of the article is the ensuing analysis of letters sent to Hahnemann by parents seeking advice on how to treat their children's illness; this correspondence includes detailed descriptions of diseases and therapies, and also sheds light on parental feelings about children and family life. The correspondence leads us to conclude that there was no proper model of healing children at the beginning of homeopathic medicine. During the 19th century and perhaps later, homeopathy was based on medical theories prevalent in 18th century medicine. The adults writing these letters came from the upper classes and were always convinced adherents of homeopathy. In response to Hahnemann's queries, many letters contain exact description of somatic and psychic symptoms. Unlike Hahnemann's brief style, many of the parents delve into each detail of the child's condition, and also express themselves emotionally on subjects such as their children, fears of sickness and death. It is also apparent that women, who bore the main responsibility for family life, had a good deal of authority over the course of treatment, as well as the choice of physician.