Medical history is one of my favorite topics. As an undergrad I was fortunate to work with a second edition of Andreas Vesalius’s De Humani Corporis Fabrica Libri Septem, that revolutionary tome that contested and updated Galen’s anatomical observations from over a millennium earlier.

This shouldn’t be taken as a criticism of Galen. Unlike his far-removed successor, the Roman prohibition on human dissection forced guesswork on his part. If anything, the anatomists led remarkably parallel careers. Both challenged received wisdom, ran afoul of their period’s traditions, and eventually escaped into self-imposed exile. Where Vesalius drew fire by concluding that men didn’t have fewer ribs than women, a detail that clashed with the Catholic Church’s belief that Adam’s rib had formed Eve, Galen threaded an awkward middle ground between the dominant dogmatist and empiric schools of medicine, drawing ire and threats of poisoning when he spurned their guiding philosophies.

Galenus, designed by Harry-Pekka Kuusela, steps into the testy waters of Galen’s poison-laced Rome. It’s a fascinating setting. If only it provided more of a deep dive than a shallow wade.

Welcome to ancient Rome. People are often sick here.

One of the great difficulties in teaching history has nothing to do with imparting information. It’s about deprogramming myths and assumptions. The Middle Ages weren’t the Dark Ages, the Renaissance wasn’t an era of light, and ancient Rome was never staffed principally by English-accented patricians who waxed lyrical about putting principles above personal interests.

Galenus tosses its players straight into a relatively accurate image of second-century Rome. Diseases are rampant. The classes are sharply stratified. A trip to a nearby city consumes months rather than days or weeks. Most importantly, there are prevailing ideas about who can interact with whom. Curing a patrician of their uniquely upper-class diseases — gout, diabetes, pooping too much — increases your reputation. But seeing patients in your own home will draw some serious side-eye. The same goes for caring for injured gladiators in the arena. Don’t you know such people are infames? Ew. Don’t touch. And before you assume that it’s possible to win by tending to your reputation, too much renown brings its own downsides. Mostly in the form of regular poisonings that decrease your health. In fact, you need to work very hard to keep your reputation in that comfortable middle zone that will afford you the best jobs without getting you assassinated.

To be clear, even this portrayal is a shorthand. Galen was famously effective in his four-year post treating gladiators in Pergamon, and all those threats of poisoning and his temporary exile had more to do with clashes with the local schools than because he’d treated too many patricians. The same goes for the game’s portrayal of humorism, Hippocrates’ theory that diseases arose from an imbalance in the body’s natural “humors,” which remained prevalent in Galen’s day. The game divides its diseases into four classes, each with its own quirks. Sanguine diseases are those that stem from bloodloss, most commonly thanks to participation in the gladiatorial arena. Phlegmatic diseases tend to be contagious respiratory disorders, and are therefore both extremely common and diminish your doctor’s health as he treats them. Choleric diseases are the domain of the wealthy thanks to their opulent diets of meat and wine, and melancholic diseases are, um, boring. Both in the sense that they were ailments of the psyche and because Kuusela apparently couldn’t figure out a trait to go with them. Everything in the game is divided between these four classes: the patients you’ll treat, the skills you’ll develop, the publications you’ll pen, and the contests you’ll undertake. Roman medicine wasn’t quite so neatly parceled, but it’s an effective and streamlined way of thinking about what the game is asking you to administer.

Accepting patients in your own home diminishes your reputation.

That administering is principally a matter of carefully — even stoically! — managing your time. Worker placement isn’t quite as popular as it was a few years back, but Galenus leans hard into the system. Every year revolves around planning six blocks of time, each corresponding to roughly two months. The main demands on your time are rarely set in stone, changing year by year as diseases grow or diminish, plagues lash the plebes, or distant cities offer opportunities for learning. These are depicted via random cards, offering fresh crops of patients and new opportunities. Other pursuits are more stable: the arena, filled with lacerated young men; the baths, good for a healing soak or sucking up to the local medical sects; your own home, where you can publish your findings or embarrass yourself by treating patients.

The big twist is the annual medical contest. This is essentially a big round-ending auction where you’ll compete for Galen’s attention. Yes, that Galen. The big guy himself. Whenever somebody decides they’re done planning, they can deploy the rest of their time to the theater, switching from placing workers to using them. This provides much of the game’s tension. Unlike most worker placement games, you never earn a space’s produce right away. It isn’t until you’ve wrapped up your planning that you start moving your pieces into actual slots. This nests multiple bids into the placement round itself. Other players can see where you intend to claim patients and other bonuses, thus spurring them to make that switch before you do. It isn’t only a race, but multiple races tucked into one another.

It helps that the contest itself is both highly desirable and something of a red herring. Winning the contest provides “notable works,” the game’s all-important written proof of your mastery. Even better if you manage to spend enough of your resources to match Galen’s position, a feat that will net you yet another notable work. At the same time, becoming too popular is rather dangerous, and it’s possible to spend too much time — and a significant portion of your health — on contests when you might have been more effective seeing patients and publishing your findings. The entire game becomes one of priorities. Will you be the bombastic surgeon who presents every year in the theater? The doctor of the people? Will you take regular trips to other cities to hone your talents and philosophies? Will anybody at the table bother to specialize in the melancholic? (No.)

These questions make up the core of Galenus. Choosing what to study, who to cure, how to present your reputation, when to switch from planning your time to producing results — there are plenty of details to consider. It’s both strange and unfortunate, then, that they land so flatly.

I find this skill track humorous.

The first and most surface issue is that Galenus is an absolute eyesore. Or, rather, that its essential features are so small that even my 20/15 eyes found themselves dipping in close for a better look. The whole thing screams of digital playtesting, where features are readily magnified. Its tracks are tightly-packed, including a score track that’s prone to throw your accomplishments into disarray at the slightest breath. Worker placement slots are diminutive boxes smaller than the nail of my pinkie finger, so small that a friend with slight hand tremors couldn’t place his workers into their proper station. Don’t get me started on the event spaces, muddles of description and gameplay effects that are impossible to read from across the table. Even the year tracker is an oval of cardboard that’s smaller than a squirrel turd and which I initially assumed was an extra piece that could be thrown away or left unpunched. And that’s before we consider the rampant misspellings and the mistakes on event cards that have become the unfortunate hallmark of an Ion production. As much as I try not to be a grammatical prescriptivist, board games are a technical medium. The format calls for precision. That goes double for a publisher that wants to be taken seriously as a creator of historical and scientific examinations. I wanted to crack wise about how Galen wasn’t an ophthalmologist, except he performed cataract surgeries and developed collyria that can still be replicated to surprising effect as eye drops today. So much for that joke.

At a deeper level, Galenus lacks the in-depth exploration one might hope for from the publisher of the Pax series. Despite being spread across three social classes and corresponding stacks of cards, there’s precious little difference between one event and another. Each provides some sum of patients and an event, but these share trends rather than showing why medicine underwent such radical renovations in Galen’s day. There are no pushy emperors who force the most effective surgeons into their household. There are no exhausted armies limping back from wars on the frontier. There is no plague that kills half the empire. The Antonine Plague is even sometimes called the Plague of Galen! Apart from your vague reputation and three sect cards that can be earned for minor bonuses, there’s no clash between the newfangled practice of offering prognoses and the old guard’s insistence on divination.

On a technical level, quantities of patients don’t adjust according to player count, leaving higher-count sessions starved for people to treat while those with only two players may find it inordinately difficult to clear certain cards at all. The resulting landscape is oddly flat, not the rapidly changing and often precarious medical world of ancient Rome. This was an opportunity to show why second-century medicine was both vibrant and fraught. The game motions in that direction by offering a constant churn of new cards and worker slots, but even older and more plain-jane worker placement games like Lords of Waterdeep manage more distinction between their moveable components. Here, there’s little reason to note that one card represents “plague in army from Sarmatia” while another claims “tonsors fight for customers.” Apart from the fact that the latter card’s event is literally impossible to fully enact within the game’s rules, anyway.

Fun fact: togas made a national pastime of flashing.

This is a disappointing conclusion. As a setting, Galenus shows such promise. Ancient medicine is ready for the limelight, filled with new developments and clashing societies and philosophical disagreements. Modern doctors are mostly at risk of drug abuse, burnout, and exchanging passive-aggressive emails with their hospital’s surgery scheduler. A world where your medical practices could offend the local Platonists, get you poisoned, cause you to flee Rome under cover of darkness, and eventually press you into imperial service is one I’d love to explore. Galenus only motions dimly in that direction. Maybe somebody will gamify Vesalius to greater effect.

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A complimentary copy was provided.