Galen

Background and Early Life
Education
Gladiator School 157-161
Dissection
Medical Practices
Humoral Theory
Observation and Recording
Pulse
Experiments
Moves to Rome, 162
Flight from Rome 166-9
Royal Physician
Strengths
Writings
Medical
Other
Death
Posthumous Influence
Galenism’s Successes
Failures
Challenges to Galen

Background and Early Life

The Romans were excellent builders, soldiers and administrators, but they produced very few scientists, philosophers and doctors. (5) Not surprisingly, therefore, the most famous doctor in the Roman Empire was a Greek, (5) Aelius (1) Galenus (1,2) Greek Galenos (2) or Claudius (1,3) Galenus, (1) often Anglicized as Galen (1,2) and better known as Galen of Pergamon (1) [OR] Pergamum. (2,3) Galen was born in Pergamum (2,3) Mysia, Anatolia (2) (now Bergama) (2,7) Turkey. (2,3) [OR] Greece. (4) He was a Greek physician (1,2) writer (2) surgeon (1) and philosopher (1,2) in the Roman Empire. (1) He was born in 129 (2,8) [OR] 131 AD (6) of Greek parents. (3) His father was Aelius Nicon, (7,8) a wealthy (7) architect (7,8) and builder (8) with scholarly interests (7,8) in mathematics, logic, and astronomy and a fondness for exotic mathematical and literary recreations. (8) His mother, according to Galen himself, was a hot-tempered woman, always arguing with his father; Galen compared her to Socrates’ wife Xanthippe. (8) Like other wealthy people in those times, Galen’s family were slave owners, using slaves to do all the routine work. (10)

Education

He was a gifted intellect. (6) He received a comprehensive education that prepared him for a successful career as a physician and philosopher. (7) Perhaps while still in his teens, Galen became a therapeutes or ‘attendant’ of the healing god Asclepius, whose sanctuary was an important cultural center not only for Pergamum, but also for the entire Roman province of Asia. (8) The prestigious cult association of therapeutai included magistrates, senators, highly-placed members of the imperial civil service, and literary men from all over the province. (8) Nicon had planned for his son to study philosophy or politics, the traditional pursuits of the cultured governing class into which he had been born. (8) But in 144 or 145 Asclepius intervened. (8) In a dream, Galen says, the god told Nicon to allow his son to study medicine, and for the next four years Galen studied with the distinguished physicians who gathered at the sanctuary of Asclepius. (8) He studied medicine (3,4) in Greece, (3) in Alexandria (3,6) in Egypt, (3,4) and other parts of Asia Minor. (3) He was greatly influenced by the working methods of Hippocrates and other earlier Greek doctors. (4) In 148 or 149 Nicon died, and Galen at 19 found himself rich and independent. (8) He chose to travel and further his medical education at Smyrna (modern Izmir), Corinth, and Alexandria. (8) In 157 he returned to his native city and a prestigious appointment: physician to the gladiators. (8) Galen travelled extensively, exposing himself to a wide variety of medical theories and discoveries. (7)

Gladiator School 157-161

At the age of 28, (6) he returned home to Greece (3,5) in 157 (5,8) [OR] 158 (4) to become chief physician to the gladiators (3,5) of the High Priest of Asia (9) at the school in Pergamum. (3,4) From autumn 157 to autumn 161 (8) the traumatic injuries he regularly encountered gave Galen the perfect opportunity to extend his practical medical knowledge of the human body (4,5) and develop his interest in anatomy and skills as a surgeon. (5) He is said to have described the gladiator’s wounds as “windows into the body”. (9) The ‘windows’ proved to be very important to Galen’s increasingly sophisticated understanding of human anatomy, because dissection of human bodies was made illegal in the Roman Empire in the year 150 AD. (10) Only five gladiators died during his time as their appointed physician, a remarkable number when compared to the 60 deaths that occurred during the time his predecessor cared for them. (9) This was attributed to the meticulously painstaking wound care that he applied. (9) The (4,8) three (4) [OR] four (8) years he spent there (4,8) were a formative period in his life in medicine, (4) and he continued to pursue his studies in theoretical medicine and philosophy. (8)

Dissection

He considered dissection a key tool in understanding the human body, but was restricted by law to dissecting animals. (4) Throughout his life he dissected animals (3,5) in his quest to understand how the body functions. (3) Galen dissected pigs, goats and apes and applied what he had learnt to the human body. (5) For example he realised the importance of the spinal cord and how if it were cut there would be no movement from the part of the body below the cut. (5)

Medical Practices

Humoral Theory

Galen revived the methods favoured by Hippocrates and other Greek doctors who lived at the time of Hippocrates. (6,7) He followed them in promoting the humoral theory of the body, (4,5) (the theory that the body was made up of four liquids, (5) blood, phlegm, yellow bile and black bile). (5,6) Galen also accepted the view that disease was the result of an imbalance between these. (6) Galen also believed in the healing power of nature and (6) developed the balance idea by introducing the idea of using opposites to treat illnesses, (5,6) by restoring the balance of the four humours: if a man appeared to have a fever (6) it was believed to be the result of too much yellow bile in the body. (5) Galen therefore treated it with something cold, (5,6) suggesting that the patient drink lots of cool liquid and eat cold foods. (5) If a man appeared to have a cold, he would be treated with heat. (6) People who were weak were given hard physical exercises to do to build up their muscles. (6) People who had breathing problems due to a weak chest were given singing exercises. (6) Galen extended his knowledge of anatomy by dissecting pigs and apes and studying their bone structure and muscles. (6)

Observation and Recording

Like Hippocrates, Galen placed great importance on clinical observation through careful examination of patients and the recording of their symptoms. (4,6)
Pulse
To help with the diagnosis of patients, (5) Galen paid particular attention to an individual’s pulse, monitoring it for abnormalities and using it as a tool to diagnose disease and suggest possible treatments. (4) Feeling a patient’s pulse remains a standard diagnostic procedure to this day. (4,5)

Experiments

Galen was a radical and innovative experimenter (4) the originator of the experimental method in medical investigation. (3,4) He was arguably the most accomplished of all medical researchers of antiquity. (7) Galen was interested in human anatomy but there is no evidence that he dissected human bodies – though rumours persisted that he did. (6) In “On Anatomical Procedures”, Galen advised his students to dissect apes but take whatever opportunities that existed to study the human body. (6) Galen also studied how the body worked, concentrating on the movement of blood and the working of the nervous system. (6) For the latter, he experimented with the spinal cords of pigs. (6)

Moves to Rome, 162

By AD 161 Galen, now 32, may have realized that even a great and prosperous provincial city like Pergamum could not offer the opportunities his talents and ambition demanded. (8) In the early 160s (3,5) [OR] in 161 [OR] 162 AD Galen went to Rome (3,5) with the sole intention of seeking fame and fortune (6) [OR] to become a doctor to the Emperor Marcus Aurelius. (3,5) During his first stay at Rome Galen quickly became part of the intellectual life of the capital. (8) He served prominent members of Roman society. (7) He revived the ideas of Hippocrates and other Greek doctors. (6) The Romans had shown little interest in the work of Hippocrates and it took Galen to push it forward in Rome. (6) His public lectures and anatomical demonstrations brought him to the attention of the consular Flavius Boethius, and through him to the notice of the Emperor Marcus Aurelius. (8) In 166 AD the Antonine Plague struck Rome and Galen was present at the start of the outbreak. (9) Galen helped to treat those afflicted with the illness and his descriptions of the outbreak have led many historians to believe that it was an outbreak of smallpox. (9)

Flight from Rome 166-9

His medical teachings contradicted the methods of Rome’s established physicians, (10) which relied upon divination and mysticism. (11) Throughout his life Galen enjoyed nothing more than a good rant at anyone who practiced medicine in ways he disagreed with – the rants became a feature of his written work. (10) Galen described the Roman doctors as unscrupulous thieves, more interested in money than healing and truth. (10) He certainly achieved his fame but for some Romans this was too much. (6) They deeply resented him (10) [OR] as a Greek, many Romans viewed Galen with suspicion. (6) Fearing for his life, (10) in 166 AD, he was forced to flee the city (6,8) and return to Pergamum, (3,8) He was away for three years from 166 until sometime in 169 (8) [OR] 168. (6)

Royal Physician

In 168, Galen tells us, (8) Marcus (6,8) and his co-emperor, Lucius Verus, (8) invited him to return from Pergamum (6,8) and to join them at their headquarters in Aquileia, where they were engaged in military operations against the Quadi and Marcomanni, barbarian tribes threatening the Danubian frontier. (8) By the time Galen acted on the emperor’s invitation, however, an outbreak of plague had forced Marcus and his court to return to Rome. (8) There Galen joined them. (8) He became physician to the emperor Marcus Aurelius (3,5) and would later serve in the same role to several emperors (3,7) such as Aurelius’s successors, Commodus (3,8) who became Emperor in 180 AD, (10) and Septimius Severus. (3) Galen acted as Commodus’s physician all the way through his increasingly megalomaniacal reign, which ended with his murder in 192 AD. (10) Galen obviously impressed Rome’s political elite, because when Septimius Severus became Emperor in 193 AD after a period of political turmoil, the 64 year-old Galen continued as personal physician to the new Emperor. (10) With this protection, (6) Galen remained in the city (3,8) with the possible exception of a few journeys taken to investigate scientific phenomena, (8) until his death, (3,8) aged about 70, in 201 AD, (6) able to write, lecture, and practice medicine (6,8) free from his jealous rivals in Rome. (6)

Strengths

Some of his anatomical and physiological observations were accurate – for example, (3) he proved that urine was formed in the kidney (3,9) (as opposed to the bladder which was common belief). (3) His most important discovery was that arteries carry blood (3,9) although he did not discover circulation. (3,5) In the field of pharmacology, he created the system of Galenic degrees, which is the first recognized attempt to precisely gauge the effects of medicines. (9) As such he should be considered one of the earliest known clinical researchers. (9) He was one of the first clinicians to recognize the importance of the pulse. (9)

Writings

Medical

Galen believed that his knowledge should be shared. (4) He was a prolific writer, (3,4) with hundreds of treatises to his name: (3) about 20,000 pages of his work survive. (10) Galen’s works fall into three main categories: medical, philosophical, and philological. (8) His medical writings encompass nearly every aspect of medical theory and practice in his era. (8) In addition to summarizing the state of medicine at the height of the Roman Empire, he reports his own important advances in anatomy, physiology, and therapeutics. (8) Galen absorbed into his work (3,8) nearly all (8) [OR] all significant (3) preceding medical thought (3,8) and shaped the categories within which his successors thought about not only the history of medicine, but its practice as well. (8) In 191 a fire in the Temple of Peace, where he had deposited many of his manuscripts for safe-keeping, destroyed important parts of Galen’s work. (8) What remains, however, is enough to establish his reputation as the most prolific, cantankerous, and influential of ancient medical writers. (8) He lambasts his contemporaries for their ignorance, greed, and superficial knowledge of the art of medicine. (8) His extant works fill some twenty volumes in Greek. (8) Many of his works have been preserved and/or translated from the original Greek, although (7) many were destroyed (7,8) and some credited to him are believed to be spurious. (7) His writings ensured that Galen was widely known in his lifetime, (4) and his influence was great. (6) He became the most celebrated physician in the Roman Empire. (4) For many medical students, they were the primary source of information on medicine. (6)

Other

His philosophical writings cannot be easily separated from his medical thought. (8) Other works survive only in Arabic or medieval Latin translations. (8) Throughout his treatises on knowledge and semantics he is concerned to argue that medicine, understood correctly, can have the same epistemological certainty, linguistic clarity, and intellectual status that philosophy enjoyed. (8) Likewise his treatises on the language of medicine and his commentaries on Hippocratic texts form part of his project to recover authentic medical knowledge from the accretions of mistaken doctrine. (8) From this consistent intellectual and scholarly program emerges a consistent personality. (8) Galen tells us more about himself, his opinions, and his life than any other ancient medical author. (8) In his fiery, polemic quest for intellectual and rhetorical supremacy, Galen belongs among the great public intellectuals of the Second Sophistic period. (8)

Death

He died sometime after AD 210 (2,8) in about 216 (2) [OR] in 216 AD. (9) Although there is some debate over the date of his death, he was no younger than seventy when he died. (7) Arabic sources state that he died aged 87 in Sicily. (9)

Posthumous Influence

Galen influenced the development of various scientific disciplines, including anatomy, physiology, pathology, pharmacology, and neurology, as well as philosophy and logic. (7) He saw himself as both a physician and a philosopher, as he wrote in his treatise entitled That the Best Physician Is Also a Philosopher. (7) Galen was very interested in the debate between the rationalist and empiricist medical sects, and his use of direct observation, dissection and vivisection represents a complex middle ground between the extremes of those two viewpoints. (7) However, because of the collapse of the Roman Empire in the West they suffered greatly from stasis and intellectual stagnation. (7) He exercised a dominant influence on medical theory and practice in Europe (2,3) for 15 (3) [OR] 13 (7) centuries after his death, (3,4) [OR] until the Middle Ages. (6) [OR] until modern times. (8) Although Galen believed Asclepius came to his aid, he also came to believe there was only one God. (10) This made the later Christian and Muslim worlds much more receptive to his work. (10) In the Abbasid (7,11) period (11) [OR] Caliphate (7) (after AD 750) Arab Muslims began to be interested in Greek scientific and medical texts for the first time, and had some of Galen’s texts translated into Arabic, often by Syrian Christian scholars. (11) Thus in both the Eastern Roman Empire and the Islamic world his writings continued to be studied and followed. (7) Galen’s ideas dominated medicine throughout the Middle Ages. (2,5) His prolonged influence owed much to the (4) Byzantine and (2) Islamic scholars who absorbed, reproduced and added to his body of work (3,4) in the early medieval period. (4) From the 11th century onwards, Latin translations of Islamic medical texts began to appear in the West, alongside the Salerno school of thought, and were soon incorporated into the curriculum at the universities of Naples and Montpellier. (11) Practitioners in Arab countries and Persia noticed problems with aspects of Galen’s work. (7,11) Galen’s theory of the physiology of the circulatory system remained unchallenged until c. 1242, when Ibn al-Nafis published his book (7,11) Sharh tashrih al-qanun li’ Ibn Sina (Commentary on Anatomy in Avicenna’s Canon), in which he reported his discovery of the pulmonary circulation, (7) showing that Galen was incorrect, (11) but nobody had the authority to completely overturn what had been the final word in medicine for so many centuries. (10) Subsequently his works were retranslated in the West, where they effectively remained beyond criticism (4) until the Renaissance. (3,4) Medical students studied his descriptions of operations, including a tracheotomy to cure breathing difficulties, long after his death. (5) Galen’s books were used at training schools for doctors. (5) His drawing of the heart was studied by doctors until the 16th century. (5) Even though some doctors questioned his theories, the Catholic Church prevented Galen being challenged in this period, as his theories of anatomy fitted in with their belief in a system ordained by nature. (5) His errors therefore exercised a ‘pernicious influence’ on medicine. Medicine entered its own dark age, and far from making progress, medical practices actually went backward until the Renaissance revived interest in progress again. (10) Galen’s ideas were further challenged in the mid-17th century. (2) [OR] during the Renaissance. (3,5) when many of his ideas were refuted. (3) Medical teachers and students at Bologna began to open human bodies, and Mondino de Luzzi (c. 1275–1326) produced the first known anatomy textbook based on human dissection. (7) Galen’s original Greek texts gained renewed prominence during the early modern period. (7) In the 1530s, Belgian anatomist and physician Andreas Vesalius, who was greatly influenced by Galen, took on a project to translate many of Galen’s Greek texts into Latin. (7) Galen’s anatomical reports, based mainly on dissection of monkeys, especially the Barbary macaque, and pigs, remained uncontested until 1543, when printed descriptions and illustrations of human dissections were published in the seminal work De humani corporis fabrica by Andreas Vesalius where Galen’s physiological theory was accommodated to these new observations. (7) [OR] Andreas Vesalius and William Harvey in the 1500s and 1600s finally exposed flaws in Galen’s understanding of human anatomy and blood circulation. (10) By the time that Harvey began to study medicine, western medical beliefs and theories about blood and circulation had advanced little since Galen wrote his medical textbooks in Rome 1400 years earlier. Even as late as 1833, the index to Karl-Gottlob Kühn’s edition (still the only nearly complete collection of Galen’s Greek works) could be designed for working medical practitioners as well as for classical scholars. (8) The influence of Galen’s writings, including humorism, remains strong in modern Unani medicine, now closely identified with Islamic culture, and widely practiced from India (where it is officially recognized) to Morocco. (11)

Galenism’s Successes

Diagnosis of disease by careful attention to the patient’s pulse.
Diagnosis of disease by careful attention to the patient’s urine. (10)
Removal of cataracts from patients’ eyes. (10)
Diagnosis of physical symptoms caused by psychological disturbance. (10)
Proof that urine forms in kidneys, not the bladder. (10)
Discovery that arteries carry liquid blood rather than, as previously thought, gaseous air. (10)
Identification of 7 of the 12 cranial nerves – such as the optic nerve and acoustic nerve. (10)
Identification of two types of blood – bright red and dark red. (10)
Discovery that the heart has four valves and they allow blood to flow in only one direction. (10)
Discovery of the anatomy of the trachea and that the larynx generates the voice. (11)

Failures:

Some of Galen’s ideas were incorrect, as he did not dissect a human body. (7) Greek and Roman taboos (7) [OR] Rome’s ban (10,11) had prohibited the dissection of human cadavers since about 150 BC, (11) and so human dissection was usually banned in ancient times. (7,10) His anatomical research had to be carried out on animals; he dissected Barbary apes and pigs, both living and dead. (7,10) He therefore had to make the assumption that what he found in pigs and primates applied to humans. (10) With hindsight, we know he was wrong to make this assumption. (10)
Belief that diseases are caused by bad air from rotting animal and plant matter.
Belief that dark blood in the veins is manufactured in the liver to be consumed by the body as food.
Belief that brightly coloured arterial blood is made by the heart to deliver ‘vital spirits’ to the body.
Routine use of bloodletting as a therapy. It was still being used in 19th century Europe. In 1852 Ada Lovelace, who was dying of uterine cancer, was treated with bloodletting. The treatment probably killed her faster than the cancer alone would have.
Belief that arteries are linked to veins by fine blood vessels through which blood and air pass.
Belief that microscopic pores in the heart’s septum connect the left and right sides of that organ.
Use of Hippocrates system of ‘humours’. Hippocrates thought imbalances in the humors of black bile, blood, phlegm, and yellow bile caused disease.Galen added his own contribution of four temperaments, one for each humor:
Black bile matched melancholic, which meant depressed and despondent.
Blood matched sanguine, which meant passionate and optimistic.
Phlegm matched a phlegmatic, which meant unemotional and apathetic.
Yellow bile matched choleric, which meant quick tempered and stubborn.

Bibliography

AlmoravidsBibliography

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