08 - Galen: Influence for 45 Generations
Two great names- Hippocrates and Galen- stand out in the history of Greek medicine, towering over all other pinnacles of achievement surrounding them. Hippocrates dominated the beginning of a period of remarkable scientific creativity, which lasted more than seven hundred years, Galen, near the end of the period, both furthered scientific knowledge and crystallized it in an amazing volume of written works.
While next to nothing is known of Hippocrates as a person, many facts concerning Galen’s life are well documented; and the facets of his personality are interjected repeatedly into his voluminous writings.
Galen’s writings and teachings- marked by brilliant observation and wise therapeutic application as well as colossal error and insufferable dogmatism- dominated medical thinking and practice for fifteen hundred years- an occurrence unique in world experience. More than a few of Galen’s astute observations are in accord with modern medical beliefs. His errors were not seriously challenged in medical thought and teaching until the anatomist Vesalius, in 1543, and the physiologist Harvey, in 1628, courageously questioned the infallibility of Galenic authority and effectively substantiated their findings through demonstration.
Galen was born in 130 A.D., in the Greek city of Pergamon in Asia Minor (now Turkey), seat of one of the largest temples of Asclepius and also of one of the “seven churches which are in Asia,” addressed by the Christian Saint John (Revelation 2) in the first century. Galen was the only child of the architect, Nikon, a mild, just, and comparatively wealthy man who took a deep interest in the boy’s education. His mother, on the contrary, was a difficult woman, subject to fits of anger toward servants and ready to quarrel with her husband. Galen’s writings reveal scant regard for her; but her influence apparently was manifested in his temperament.
Named Galenos (meaning calm or serene), the boy’s education was supervised by his father on the family farm until he was 14; then he was taken to Pergamon to attend lectures in philosophy and in mathematics. To preserve a spirit of impartiality, his father directed him to attend courses given by representatives of the four leading philosophic systems of the day. Then, according to Galen’s own writings, Nikon had a dream, influenced by Asclepius, directing that his son study medicine.
Galen began the study of anatomy in Pergamon at about age 17, continuing there until his father’s death; this was followed by study at great centers of learning of the Greek world at Smyrna, Sorinth, and Alexandria, during which he added medical subjects to his growing store of knowledge. Nor was philosophy neglected. About the year 158, Galen, at age 28, returned to his home town of Pergamon. The head priest at the Asclepieon appointed him physician to the gladiators. This provided him a great opportunity to study not only practical applications of hygiene and medicine, but living anatomy, as revealed by terrible wounds suffered by contestants whom it was his duty to treat.
Four years later, the restless young physician departed for Rome, then capital of the world. There, despite numerous charlatans, competitors, and enemies, he soon acquired great fame through spectacular diagnoses and modes of treatment, public lectures, discussions, physiologic demonstrations, and writings. His reputation grew to the point where he was called to examine the Roman emperor was suffering from indigestion, as opposed to the complicated theories of other physicians on the scene, won him an appointment as court physician.
Galen frequently absented himself from Rome on lengthy research and study trips which took him throughout many lands. One of these came, very conveniently, during a “plague”- an attitude not regarded as unethical among physicians before the eighteenth century. However, he soon was recalled from Pergamon by Marcus Aurelius to a military camp at Aquileia; then shortly thereafter he was ordered to return to Rome to take over medical supervision of the emperor’s son, Commondus, whom he continued to serve as physician even when the latter succeeded his father as emperor. About 192 A.D., however, the Roman political climate became unhealthy for scholars and philosophers, and Galen returned to his home town of Pergamon. Presumably he continued to travel and to write until his death at 70, at the dawn of the third century.
The medicine and pathology Galen practiced, and about which he wrote, were based mainly on the speculative Hippocratic theories of the four humors, on critical days, and on fallacious theories regarding pulse and urine. These did not give way to more realistic approaches until the sixteenth, seventeenth and eighteenth centuries. Despite his mixture of rational science with philosophic speculation, Galen was a good observer and shrewd clinician. With pride he tells how he explained a patient’s puzzling sensory disturbances in the fourth and fifth fingers as due to infraction of a vertebra in the neck resulting from a fall from a horse, treatment of which cured the condition. He tried to differentiate between blood spitting and blood vomiting, between colic from kidney stone and colic from the intestines. He also understood well the psychosomatic element of illness. Called to treat a noble woman who was declining rapidly in a non-febrile melancholic condition, he observed sudden reddening of the cheeks and increase in pulse rate when the name of Pylades, an actor, was mentioned accidentally. After experimenting for a few days by having names of other actors mentioned in her presence, but never obtaining the change in pulse expect on mention of Pylades, he correctly diagnosed her case as an unsatisfied passion for the actor.
In the fields of therapy and of pharmacy, Galen is remembered mainly for his schematism and extremely complex prescriptions, sometimes containing dozens of ingredients. Formulas of the type make up a class of pharmaceuticals still called “galenicals.” Yet he followed Hippocratic tradition by treating patients for numerous conditions by using diet and physiotherapy alone. He was extremely interested in hygiene and prevention of disease, the importance of which he put above treatment, and about which he wrote several books.
Galen was an able surgeon in his youth, but gave up surgery at Rome, since fashion regarded such manual activity as no longer proper for a learned physician. Though his followers learned from him the theory of laudable pus, he himself tried to heal wounds without suppuration.
Galen was a scientist as well as a practitioner. As a matter of fact, there is good evidence that medicine, which primarily was an art with Hippocrates, primarily was a science with Galen. Though he did not dissect humans, even in dissecting animals Galen cleared up a great number of basic anatomic problems; among them was the origin of blood vessels in the heart and of nerves in the central nervous system. His description of anatomy of bones and muscles is excellent, considering that it was gained from monkeys and pigs; and, even though its errors had to be cleared away by Vesalius, it helped to attain a basic understanding of human anatomy Harvey, some fourteen hundred years later, overthrew Galen’s physiologic ideas on the tidal ebb and flow of the blood. However, this cannot obscure the fact that Galen was the greatest experimental physiologist before Harvey. He demonstrated the nature of arteries, of ureters, of recurrent nerves, and of the spinal cord; he had ideas concerning function of motor and sensory nerves; and he appreciated states of tonus and of contraction.
Galen’s physiology was vitiated by his philosophic bent, and by his Aristotelian teleology; that is, by his conviction that the Creator had given to every organ a purpose, and that if he could figure out this purpose he would know how the organ functioned. But while Galen’s speculative, dogmatic, and dialectic inclinations, which endeared him to the Middle Ages, often irritate modern readers one cannot avoid being impressed by the acuteness of his mind. In taking up a problem, he thoroughly considered every possible implication and ramification. “Reason,” he wrote, “finds the answers most quickly, but experience confirms our confidence in them.”
Galen’s accomplishments were so manifold and his written works so numerous that they defy cataloguing. His subjects covered dietetics, pathology, therapeutics, pharmacy, anatomy and physiology, hygiene, medical philosophy, and Hippocratic commentaries- indeed a universe of thought. Written in Greek, this Galenic treasure did not reach the Latin western world except through an Arabic detour. Byzantine physicians built up Galen’s glory, and admiration of his teaching was transmitted to Oriental Christians and to Moslems. His works were translated from Greek into Syriac, and from Syriac into Arabic. Then, in the eleventh and twelfth centuries, Arabic versions and commentaries were translated into Latin. Some of Galen’s original treatises are completely lost; and some have been recovered only from these Arabic translations.
The Profession of medicine gained a wealth of facts and ideas from Galen. Despite confusion in influence of medical schools and of philosophic sects, he gave to the world a synthesis of medical thought and knowledge solid enough to last nearly fifteen hundred years. His mind was quick and well organized; he was well informed on many subjects. In the earlier period of his life, he continually insisted on experiments and on demonstrable proofs; but the open-minded young Galen later became one of the great dogmatists of all times. However, the magnitude of his dogmatism was increased by his followers and commentators. During the middle Ages, when thinking for one’s self was not fashionable, Galen was accepted and perpetuated as the infallible master. This, as George Sarton says, “Was a creation of the disciples, rather than of the master himself.” Blame for the slavish submission of later generations to his authority cannot be placed upon him.
Galen was a pillar of medicine; the last important pillar in the millennium of Greek domination of the medical world. He was a topflight scientist in his day.
Galen, whose teachings were accepted as dogma by medical men for fifteen hundred years, is pictured in a second-century Roman home applying cupping, a form of treatment which he advocated. Physician to emperors as well as commoners in the Roman Empire, the great Greek was a shrewd observer who gained much experience through experimentation. Hid accomplishments are recorded in his prolific writings.