Friday, December 18, 2015


Demetrios Michaelides (ed.), Medicine and Healing in the Ancient Mediterranean World. Including the proceedings of the international conference with the same title, organised in the framework of the Research Project INTERREG IIIA: Greece/Cyprus 2000/2006, Joint Educational and Research Programmes in the History and Archaeology of Medicine, Palaeopathology, and Palaeoradiation, and the 1st International CAPP Symposium 'New Approaches to Archaeological Human Remains in Cyprus'. Oxford; Philadelphia: Oxbow, 2014. Pp. xix, 354. ISBN 9781782972358. $99.00.

Reviewed by Petros Bouras-Vallianatos, King's College London (

Version at BMCR home site


This book contains an interesting collection of forty-two papers arising from two events, both held in Nicosia, Cyprus, in 2008: a) an international conference "Medicine in the Ancient Mediterranean World" organised by Demetrios Michaelides, and b) the 1st International CAPP Symposium "New Approaches to Archaeological Human remains in Cyprus" organised by Kirsi Lorentz. The volume is edited by Demetrios Michaelides, who inter alia must be congratulated for his efforts in promoting the study of medicine in ancient and medieval Cyprus.1

The vast majority of the chapters are written in English; there are also six contributions in Modern Greek and two in French. Although a number of the papers are brief, presenting only preliminary results and taking the form of oral presentations, there are some well-researched and original studies. The volume is divided into nine thematic parts ranging from art and literature to history and archaeology: "Medicine and Archaeology," "Media," "The Aegean," "Medical Authors/Schools of Medicine," "Surgery," "Medicaments and Cures," "Skeletal Remains," "Asklepios and Incubation," "Byzantine, Arab and Medieval Sources". The chapters within each part are usually arranged in chronological order.

Given the length of this work, it is impossible to discuss all the contributions. (The table of contents is accessible via the Preview, above.) I will therefore concentrate on some of those which may raise interesting issues for further examination.

In Chapter 2 Georgia Karamitrou-Mentesidi and Kostas Moschakis provide an overview in the form of a catalogue listing a variety of artefacts (mostly dated to the second and third centuries AD) related to medicine (e.g. small sculptures of Asklepios and Hygieia, relief votive stelai, inscriptions referring to doctors) from the ancient city of Aiani (near Kozani in Western Macedonia, Greece) and the surrounding area. Although the authors make little attempt to contextualise these items in light of contemporary medical practice, the list contains some little-studied material. For example, there is a gravestone (cat. no. Ptol. 79) of a female physician, on which a large number of instruments, including cups, scissors, probes, scalpels, and hooks are depicted. In Chapter 4 Demetrios Michaelides gives a brief account of various anatomical votive offerings carved in limestone from the island of Cyprus, now dispersed in various local and overseas museums, which are dated to the Hellenistic and Roman periods. This account anticipates his forthcoming complete catalogue of all medical ex-votos of Cypriot origin, which medical historians and archaeologists will find extremely useful. The majority of the items originate from nineteenth-century excavations from which there are insufficient published records to allow archaeologists to date them properly and relate them to particular centres of healing. It is, however, extraordinary that all the items with a known provenance come from five neighbouring inland sites, viz. Chytroi, Voni, Arsos, Golgoi, and Mathiatis.

Part 3 opens with a chapter (6) by Robert Arnott on two Linear B tablets from Pylos, dated to around 1200 BC, in which he attempts to cast new light on Mycenaean medical practice. The endeavour involves both speculation and a number of conjectures, about which I have some reservations. For example, with regard to the first tablet (PY Eq 146), the word i-ja-te is translated as "physician", although this translation is debatable and is based only on the word's "phonetic resemblance" to the Archaic ia(/ē)tēr and iatros. The same applies to the next tablet, where — although the word pa-ma-ko (translated as "medicine") might relate to the Archaic term pharmakon — there is no other word on the tablet or any supplementary evidence to suggest a medical context. Nonetheless, in a number of places Arnott rightly points to the limitations involved in interpreting literary sources, and suggests that a better basis on which to make plausible assumptions about Mycenaean medical practice would be the interpretation of archaeological findings, an area in which he has indeed contributed some invaluable studies in the past.2

One of the most interesting papers (Chapter 15) is in Part 4 and is written by Philip van der Eijk. He critically discusses W.H.S. Jones' (1876-1963) theory of "malaria". Jones, an influential twentieth-century classicist and translator of three volumes of Hippocratic works for the Loeb Classical Library, is well-known for his theory that malaria was first introduced to Greece in the mid-fifth century BC as a consequence of the Persian invasions. Van der Eijk's historiographical analysis of Jones' approach is thought-provoking, especially in that it alerts readers to the possibility of inconsistent results based on selective use of evidence. It also reflects on the risks involved in the interpretation of a mixed corpus of literary sources — consisting of medical texts, historiography, and tragedies — from a retrospective point of view, viz. use of modern terminology to refer to diseases and symptoms mentioned in ancient texts.

Ralph Jackson's paper (Chapter 18) is by far the most interesting and original contribution in Part 5 and focuses on surgery. The author presents a large number of intact scalpels (about seventy) dated to the Roman period from a variety of sites, including Pompeii, Rimini, and Bingen. In his interpretation he makes use of a variety of textual testimonies on the use of surgeon's knives written by medical authors such as Celsus, Galen, and Paul of Aegina. In this way Jackson shows how different kinds of scalpels can be connected with a variety of operations, ranging from simple bloodletting techniques to the cutting of stones in the urinary bladder. Readers looking for an exhaustive discussion on the topic can now consult the recent monograph on Greek and Roman surgical instruments by Lawrence Bliquez,3 but Jackson's paper serves as an excellent introduction to the topic for the non-expert or for undergraduates. Stefanos Geroulanos, Charalambos Panaretos, and Efterpi Lyberopoulou are the authors of Chapter 20 entitled "Surgery in Byzantium", which is an extended version of Geroulanos' earlier homonymous paper.4 The implied claims of the title exceed the substance of the chapter, which is limited to an otherwise useful, long list of operations and medical instruments from the works of three early Byzantine medical authors, i.e. Oribasios, Aetios of Amida, and Paul of Aegina. Unfortunately, a fully-fledged study of surgery in the Byzantine Empire remains a desideratum. Furthermore, the description of vast numbers of operations by the aforementioned medical authors does not necessarily mean that such invasive techniques were used throughout the Byzantine Empire. Another crucial point, which the authors may consider in a forthcoming study, is the total absence of any manual on surgery by any Byzantine physician after the late ninth/early tenth century, a terminus ante quem that roughly corresponds to the last Byzantine text of this kind, a work by Leo the physician.5

Alain Touwaide, the author of Chapter 23, provides a stimulating preliminary approach to the study of composite drugs in antiquity with special focus on the Hippocratic Corpus. Using evidence derived from modern studies on the chemistry of natural products, Touwaide argues that ancient compound drugs are based on a "well-designed strategy". For example, he does not consider the consistent use of incense (anti-inflammatory) and myrrh (antiseptic) in a large number of compound drugs for gynaecological affections coincidental, but thinks that they would have been included to help in the treatment of potential secondary infections. In my view, there are, at least, two major issues which need to be addressed in future studies of this sort: a) the accuracy of the procedure of retrospective identification of vegetal drugs mentioned in ancient texts, and b) the actual methods of preparation of composite drugs and, more importantly, extraction of active ingredients from plants in the ancient world in the absence of techniques of separation, such as distillation. The study is accompanied by a very useful appendix with a list of 255 names of ancient authorities, cited in the primary sources as authors of compound drugs.

Effie Photos-Jones' and Allan Hall's contribution (Chapter 24) focuses on the extremely popular mineral drug known as "Lemnian Earth", which was extracted from an area in the North-Eastern part of the Aegean island of Lemnos and is said by a large number of medical authors from Galen to the early Modern period to be an extremely effective antidote to snake bites, inflammation of the eye, and ulcers. Basing themselves on literary accounts, the authors suggest that the medicine was produced by enriching the raw material with the water of local streams, which most probably had a high alum content. Consequently, the widespread effectiveness of the drug might be explained by the astringent and bactericide properties of the alum, which seems to have been its active ingredient. It is worth noting that the authors have not so far encountered alum in samples recovered from the area of the spring concerned on Lemnos, but their ongoing project will hopefully provide results that will permit a more convincing evaluation of the written accounts in the future.

Sherry Fox, Ioanna Moutafi, Eleanna Prevedorou, and Despina Pilides are the authors of a study analysing trauma patterns in 82 individuals from four sites in early Christian Cyprus, including one urban, inland site (the Hill of Agios Georgios) and three rural sites near the south coast (Kalavasos-Kopetra, Alassa-Ayia Mavri, and Maroni-Petrera). According to their results, of the 24 adults recovered from the inland site, 16 (67%) show some kind of pathological lesion, while the remaining 8 (33%) present evidence of single trauma. On the other hand, of the 21 adults from the south coast, 9 (43%) show some sort of pathological lesion and only 4 (19%) display evidence of single or multiple trauma. According to the authors, the higher proportions in the case of the inland site could be explained by demographic differences between the two groups of samples. These preliminary results show how palaeopathological findings could potentially fuel future microhistorical studies.

Georgia Petridou's paper (Chapter 36) is arguably the most interesting in Part 8. It discusses divine epiphanies as diagnostic and therapeutic tools in the ancient cult of Asclepius. Firstly the author provides some very useful background material on the introduction of Asclepius' cult to Athens before proceeding with a discussion of a representative number of examples of the god's various manifestations, including anthropomorphic and zoomorphic ones (the latter in the form of the god's sacred snakes). Incubation was the preeminent means of acquiring healing epiphanies; in some examples, although there is a miraculous healing outcome, we can see patterns of rational medicine applied, such as surgery or administration of drugs on the patient's skin. Ultimately, Petridou shows that Asclepius' epiphanies bear the special signs of divine revelation and thus an effective contextualisation of the healing process should always take into consideration his twofold profile as both god and healer.

The lack of a useful index and the preliminary nature of the majority of the studies detract from the value of this book. 6 It is noteworthy that in the archaeology-related chapters, there is abundant use of photographic material, which is indeed very useful for the reader. In short, this volume raises a number of important questions and constitutes a useful source of information on various aspects of medicine and health in the ancient and medieval Mediterranean world. It could appeal to a variety of audiences from historians of medicine to palaeopathologists and philologists to art historians.


1.   For example, D. Michaelides, "Ιατροί και Ιατρική στην Αρχαία Κύπρο," M. Vryonidou-Giankou (ed.), Η Ιατρική στην Κύπρο: Από την Αρχαιότητα μέχρι την Ανεξαρτησία, Nicosia 2006, 12-68.
2.   For example, R. Arnott, "Surgical Practice in the Prehistoric Aegean," Medizinhistorisches Journal 32 (1997), 249-78.
3.   L. Bliquez, The Tools of Asclepius: Surgical Instruments in Greek and Roman Times, Leiden 2015, 72-107. See BMCR 2015.12.14.
4.   S. Geroulanos, "Surgery in Byzantium," M. Grünbart et al (eds.), Material Culture and Well-Being in Byzantium (400-1453), Vienna 2007, 129-34.
5.   F. Z. Ermerins (ed.), Anecdota Medica Graeca. Leipzig 1840, 79-221 passim.
6.   There are only a few typos, e.g. "Παπαδόπουλλος" for "Παπαδόπουλος" (37), "Dekomedes" for "Demokedes" (70).

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