Kassandra Jackson Miller
Ancient physicians were very concerned about timing. They recognized that the treatments they prescribed—whether medicines or meals, exercises or baths—would only achieve maximum effect if administered at the “right time,” a concept rendered in Greek by the word kairos. This and related terms already preoccupied the Hippocratics in the late Classical period. As Eskin has pointed out, “Two of the three major theoretical treatises by Hippocrates on the nature of medical science and methodology include in the first sentence kairos as a main term. Yet even in those texts which lack a literal use of kairos, timing and time-related issues are prevalent” (2002: 97).
In spite of this, however, scholars have devoted little attention to the question of how long different medical kairoi might last. In other words, when responding to changes in patient conditions, how much temporal leeway did the physician believe he had, and how precisely did he define these kairotic windows? The proposed paper will address these questions by considering two case studies from the Roman Imperial period, Galen of Pergamum’s On Crises and On Hygiene. The former considers kairoi in very sick patients suffering from periodic fevers, while the latter considers them in the context of maintaining health and warding off future disease. Both pieces were composed during a time when hourly timekeeping devices, like sundials and water-clocks, were prevalent in urban contexts, and it is constructive to observe when and why Galen chooses to express kairoi in terms of hours. The paper compares passages from On Crises and On Hygiene, and reveals how Galen’s interpretation of a kairos (and its relationship to hourly timekeeping) changes depending on whether the patient in question is sick, healthy, or of advanced age. If the patient is sick, Galen uses hourly timekeeping to track the progress of the disease and thereby to determine the kairoi at which the illness will transition from one stage to the next. If the patient is healthy, Galen still uses the time and duration of phenomena as indicators of kairoi, but he also considers the time of day and length of daylight as variables that can be manipulated to influence kairoi. If the patient is elderly, Galen considers him to fall in the middle of the spectrum between sickness and health, and therefore cautions against experimenting too much with that patient’s kairoi.
The proposed paper also demonstrates how, in discriminating between these different kinds of kairoi, Galen refines earlier Hippocratic conceptions, especially those articulated in Aphorisms, Precepts, and Diseases. Aphorisms famously opens with the declaration, “Life is short. The art [of medicine] is long. The right time is sharp (ὁ δὲ καιρὸς ὀξὺς)” (I.1.1-2 IV,458 Littré), and the Hippocratic author of Precepts describes a kairos as that “in which there is not much time (καιρὸς ἐν ᾧ χρόνος οὐ πολύς)” (I.1.2 IX,250 Littré). While Galen agrees that the kairotic aperture is narrow among the very sick and—to a lesser extent—among the elderly, he disagrees with this characterization in healthy patients. In health, Galen understands the kairotic window to be relatively wide, as deviations in environment and regimen are less problematic for the young and hearty than for the old and ailing. Thus, we see how Galen builds upon Hippocratic ideas in order to bring them into closer alignment with his own lived experiences.
The arguments presented in this paper shed light not only on the important concept of kairos, but also on the ways in which ancient physicians engaged with the temporal landscapes around them. Furthermore, it contributes to our understanding of where Galen positioned “old age” on the axis between “health” and “disease,” and lends support to Cockayne’s observation that Galen seems to recognize the elderly as a distinct medical class (2003: 39). In short, this paper seeks to promote productive discussion about the conceptual tools and categories upon which ancient physicians relied.