His life and works--His influence on Medicine.
Claudius Galenus, commonly known as Galen, has influenced the progress
of medical science by his writings probably more than any other medical
writer. His influence was paramount for fourteen centuries, and although
he made some original contributions, his works are noteworthy mainly as
an encyclopaedia of the medical knowledge of his time and as a review of
the work of his predecessors. There is a great deal of information in
his books about his own life. He was born at Pergamos in A.D. 130 in the
reign of Hadrian. His father was a scholar and his mother somewhat of a
shrew. Galen, in his boyhood, learned much from his father's example and
instruction, and at the age of 15 was taught by philosophers of the
Stoic, Platonist, Peripatetic, and Epicurean schools. He became
initiated, writes Dr. Moore, into "the idealism of Plato, the realism of
Aristotle, the scepticism of the Epicureans, and the materialism of the
Stoics." At the age of 17 he was destined for the profession of medicine
by his father in consequence of a dream. He studied under the most
eminent men of his day. He went to Smyrna to be a pupil of Pelops, the
physician, and Albinus the platonist; to Corinth to study under
Numesianus; to Alexandria for the lectures of Heraclianus; and to
Cilicia, Phoenicia, Palestine, Crete, and Cyprus. At the age of 29 Galen
returned from Alexandria to Pergamos (A.D. 158), and was appointed
doctor to the School of Gladiators, and gained much distinction.
He went to Rome for the first time in A.D. 163-4, and remained for four
years; and during this period he wrote on anatomy and on the teaching of
Hippocrates and Plato. He acquired great fame as a practitioner and, if
he had so desired, might have attended the Emperor; but it is probable
that Galen thought that the office of physician to the Emperor might
prevent him from leaving Rome if he wished to do so. He also gave public
lectures and disputations, and was called not only the "wonder-speaker"
but the "wonder-worker." His success gave rise to envy, and he was
afraid of being poisoned by his less successful rivals. The reason why
he left Rome is not certain, and the possible causes of his departure
are discussed by Dr. Greenhill in the "Dictionary of Greek and Roman
Biography and Mythology." A pestilence raged in Rome at this time, but
it is unlikely that Galen would have deserted his patients for that
reason. Probably he disliked Rome, and longed for his native place. He
had been in Pergamos only a very short time when he was summoned to
attend the Emperors Marcus Aurelius and L. Verus in Venetia. The latter
died of apoplexy on his way home to Rome, and Galen followed Marcus
Aurelius to the capital. The Emperor soon thereafter set out to
prosecute the war on the Danube, and Galen was allowed to remain in
Rome, as he had stated that such was the will of AEsculapius. The
Emperor's son Commodus was placed under the care of Galen during the
father's absence, and at this time also (A.D. 170) Galen prepared the
famous medicine theriaca for Marcus Aurelius, who took a small
quantity daily. The Emperor Septimius Severus employed the same
physician and the same medicine about thirty years afterwards. It is
recorded that the philosopher Eudemius was successfully treated by Galen
for a severe illness caused by an overdose of theriaca, and that the
treatment employed was the same drug in small doses.
Galen stayed several years in Rome, and wrote and practised as on his
former visit. He again returned to Pergamos, and probably was in Rome
again at the end of the second century. It is certain he was still alive
in the year 199, and probably lived in the reign of the Emperor
He was not only a great physician, but a man of wide culture in every
way. In matters of religion he was a Monotheist. There was persecution
of the Christians in his day, and it is likely that he came little into
contact with the disciples of the new religion, and heard distorted
accounts of it, but in one of his lost books, quoted by his Arabian
biographers, Galen praises highly the love of virtue of the Christians.
He no doubt found the practice of medicine lucrative when he had gained
pre-eminence, and it is recorded that he received L350 for curing the
wife of Boetius, the Consul.
Galen wrote no less than five hundred treatises, large and small, mostly
on medical subjects, but also on ethics, logic, and grammar. His style
is good but rather diffuse, and he delights in quoting the ancient Greek
philosophers. Before his time, as we have seen, there were disputes
between the various medical sects. The disciples of Dogmatism and of
Empiricism had been opposed to each other for several centuries, and the
Eclectics, Pneumatists, and Episynthetics had arisen shortly before his
time. Galen wrote against slavish attachment to any sect, but "in his
general principles he may be considered as belonging to the Dogmatic
sect, for his method was to reduce all his knowledge, as acquired by the
observation of facts, to general theoretical principles. These
principles he, indeed, professed to deduce from experience and
observation, and we have abundant proofs of his diligence in collecting
experience, and his accuracy in making observations; but still in a
certain sense at least, he regards individual facts and the details of
experience as of little value, unconnected with the principles which he
had laid down as the basis of all medical reasoning. In this fundamental
point, therefore, the method pursued by Galen appears to have been
directly the reverse of that which we now consider as the correct method
of scientific investigation; and yet, such is the force of natural
genius, that in most instances he attained the ultimate object in view,
although by an indirect path. He was an admirer of Hippocrates, and
always speaks of him with the most profound respect, professing to act
upon his principles, and to do little more than expound his doctrines,
and support them by new facts and observations. Yet, in reality, we have
few writers whose works, both as to substance and manner, are more
different from each other than those of Hippocrates and Galen, the
simplicity of the former being strongly contrasted with the abstruseness
and refinement of the latter."
A list of the various editions of Galen's works is given in Dr. Smith's
"Dictionary of Greek and Roman Biography and Mythology" (1890 edition,
vol. ii, pp. 210-12), and also the titles of the treatises classified
according to the branch of medical science with which they deal, and it
is convenient to follow this classification.
I.--WORKS ON ANATOMY AND PHYSIOLOGY.
Galen insisted upon the study of anatomy as essential, and in this
respect was in conflict with the view held by the Methodists and the
Empirics who believed that a physician could understand diseases without
any knowledge of the exact structure of the body. His books on anatomy
were originally fifteen in number. The last six of these are now extant
only in an Arabic translation, two copies of which are preserved in the
Bodleian Library at Oxford.
The directions he gives for dissection show that he was a master of the
art. In dissecting out the portal vein and its ramifications, for
instance, he advises that a probe should be inserted into the vein, and
the point of the probe gradually advanced as the surrounding tissue is
cut away, so that finally the minute branches are exposed; and he
describes the use of the blowpipe, and other instruments used in
dissection. He carried out the experiment of tying the iliac and
axillary arteries in animals, and found that this procedure stopped the
pulse in the leg and arm, but caused no serious symptoms, and he found
that even the carotid arteries could be tied without causing death. He
also pointed out that tying the carotid artery did not cause loss of
voice, but that tying the artery carelessly so as to include the nerve
had this effect. He was the first to describe the ductus arteriosus, and
the three coats of the arteries.
It is highly improbable that Galen dissected human bodies in Rome,
though he dissected a great variety of the lower animals. He writes that
the doctors who attended Marcus Aurelius in the German wars dissected
the dead bodies of the barbarians. The chief mistakes made by Galen as
an anatomist were due to his assumption that what is true of the anatomy
of a lower animal is true also when applied to man.
Galen greatly assisted the advance of physiology by recognizing that
every part of the body exists for the purpose of performing a definite
function. Aristotle, like Plato, had taught that "Nature makes nothing
in vain," and Galen's philosophy was greatly influenced by the teaching
of Aristotle. Galen regarded his work as "a religious hymn in honour of
the Creator, who has given proof of His Omnipotence in creating
everything perfectly conformable to its destination."
He regarded the structure of various parts, such as the hand and the
membranes of the brain, as absolute perfection, although his idea of the
human hand was derived from a study of the ape's, and he had no
knowledge of the arachnoid membrane of the brain, but it would be unfair
to criticize his conclusions because of his failure to recognize a few
comparatively unimportant details. He discovered the function of the
motor nerves by cutting them experimentally, and so producing paralysis
of the muscles; the platysma, interossei, and popliteus muscles were
first described by him. He was the greatest authority on the pulse, and
he recognized that it consisted of a diastole (expansion) and a systole
(contraction) with an interval after the diastole, and another after the
systole. Aristotle thought that arteries contained air, but Galen taught
that they contained blood, for, when an artery was wounded, blood gushed
out. He was not far from the discovery of the circulation. He described
the heart as having the appearance of a muscle, and considered it the
source of natural heat, and the seat of violent passions. He knew well
the anatomy of the human skeleton, and advised students to go to
Alexandria where they might see and handle and properly study the bones.
He recognized that inspiration is associated with enlargement of the
chest, and imagined that air passed inside the skull through the
cribriform plate of the ethmoid bone, and passed out by the same
channel, carrying off humours from the brain into the nose. But some of
this air remained and combined with the vital spirits in the anterior
ventricles of the brain, and finally exuded from the fourth ventricle,
the residence of the soul. Aristotle had taught that the heart was the
seat of the soul, and the brain relatively unimportant.
II.--WORKS ON DIETETICS AND HYGIENE.
Galen was a strong advocate of exercises and gymnastics, and eulogizes
hunting specially. He recommends cold baths for people in the prime of
life. As old age is "cold and dry," this is to be treated with hot baths
and the drinking of wine. He thought that wine was particularly suitable
for the aged, and that old people required three meals a day, others two
meals. He had a very high opinion of pork as an article of diet, and
said that the strength of athletes could not be maintained without this
form of food.
Galen believed in the doctrine of the four elements, and his
speculations led him into a belief in a further subdivision. "Fire is
hot and dry; air is hot and moist; for the air is like a vapour; water
is cold and moist, and earth is cold and dry." He held that there were
three principles in man--spirits, solids, and humours--and eight
temperaments ranging between health and disease and compatible with
life. He retained a good deal of the teaching of the Pneumatic school,
and believed that the pneuma was different from the soul, but the
vehicle for the interaction of soul and body. From his theory of the
action of the air through the nose on the contents of the ventricles of
the brain is explained his use of sternutatories, and his belief in the
efficacy of sneezing. Galen's classification of inflammations shows that
his pathology was not nearly so accurate as his anatomy and physiology.
He described (a) simple inflammation caused by excess of blood alone;
(b) inflammation the result of excess of both pneuma and blood; (c)
erysipelatous inflammation when yellow bile gains admission, and (d)
scirrhous or cancerous when phlegm is present. He did good service by
dividing the causes of disease into remote and proximate, the former
subdivided into two classes--predisposing and exciting.
He relied greatly on the doctrine of "critical days," which were thought
to be influenced to some extent by the moon. His studies of the pulse
were very useful to him in diagnosis. No doubt, he was an expert
diagnostician mainly owing to his long, varied, and costly medical
education, and his great natural powers of judgment. He asserted that
with the help of the Deity he had never been wrong, but even his most
ardent admirers would not be wanting in enthusiasm if they amended
"never" into "hardly ever."
V.--ON PHARMACY, MATERIA MEDICA, AND THERAPEUTICS.
In these subjects Galen was not as proficient as Dioscorides, whose
teaching he adopted with that of other medical authors. In Galen's works
there are lengthy lists of compound medicines, several medicines being
recommended for the same disease, and never with very marked
confidence. He paid high prices for various nostrums, and, sad to
relate, placed great faith in amulets, belief in which was general in
his time, and nowhere held more strongly than in superstitious Rome.
Medicines were classified by him according to their qualities, by which
he meant, not their therapeutic effects, but their inherent dryness or
moistness, coldness or heat. A medicine might be cold in the first
degree, and not in the second degree. Paulus AEgineta followed this
strange and foolish doctrine of Galen very closely, as the following
extracts from his book on Materia Medica will show:--
"Cistus (rock-rose).--It is an astringent shrub of gently cooling
powers. Its leaves and shoots are so desiccative as to agglutinate
wounds; but the flowers are of a more drying nature, being about the
second degree; and hence, when drunk, they cure dysenteries and all
kinds of fluxes."
"Ferrum (iron).--When frequently extinguished in water, it imparts a
considerable desiccative power to it. When drunk, therefore, it agrees
with affections of the spleen."
Many features, however, of Galen's teaching and practice of therapeutics
are worthy of praise. He enunciated two fundamental principles: (1) That
disease is something contrary to Nature, and is to be overcome by that
which is contrary "to the disease itself"; and (2) that Nature is to be
preserved by what has relation with Nature. He recognized that while the
invading disease was to be repelled, the strength and constitution of
the patient should be preserved, and that in all cases the cause of the
disease was to be treated and not the symptoms. Strong remedies should
not be used on weak patients.
Galen conformed to the custom of the physicians in Rome, and did not
practise surgery to any extent, although he used the lancet in
phlebotomy, and defended this practice against the followers of
Erasistratus in Rome. He is said to have resected a portion of the
sternum for caries, and also to have ligatured the temporal artery.
Galen had little more than a superficial knowledge of this subject, and
was quite ignorant of the surgery of diseases of women. He was not so
well informed as Soranus was as to the anatomy of the uterus and its
appendages, but deserves credit for having been better acquainted with
the anatomy of the Fallopian tubes than his predecessors. He had
erroneous views on the causation of displacements of the uterus. Several
of the books inaccurately attributed to the authorship of Galen deal
with the medical treatment of various minor ailments of women.
Galen was a man of wide culture, and one of his essays is written for
the purpose of urging physicians to become acquainted with other
branches of knowledge besides medicine. As a philosopher he has been
quoted in company with Plato and Aristotle, and his philosophical
writings were greatly used by Arabic authors. In philosophy, as in
medicine, he had studied the teachings of the various schools of
thought, and did not bind himself to any sect in particular. He
disagreed with the Sceptics in their belief that no such thing as
certainty was attainable, and it was his custom in cases of extreme
difficulty to suspend his judgment; for instance, in reference to the
nature of the soul, he wrote that he had not been able to come to a
Galen mentions the discreditable conduct of physicians at consultations.
Sometimes several doctors would hold a consultation, and, apparently
forgetting the patient for the time, would hold violent disputations.
Their main object was to display their dialectical skill, and their
arguments sometimes led to blows. These discreditable exhibitions were
rather frequent in Rome in his time.
With Galen, as with Hippocrates, it is sometimes impossible to tell what
works are genuine, and what are spurious. He seemed to think that he was
the successor of Hippocrates, and wrote: "No one before me has given the
true method of treating disease: Hippocrates, I confess, has heretofore
shown the path, but as he was the first to enter it, he was not able to
go as far as he wished.... He has not made all the necessary
distinctions, and is often obscure, as is usually the case with ancients
when they attempt to be concise. He says very little of complicated
diseases; in a word, he has only sketched what another was to complete;
he has opened the path, but has left it for a successor to enlarge and
make it plain." Galen strictly followed Hippocrates in the latter's
humoral theory of pathology, and also in therapeutics to a great extent.
It is a speculation of much interest how it was that Galen's views on
Medicine received universal acceptance, and made him the dictator in
this realm of knowledge for ages after his death. He was not precisely a
genius, though a very remarkable man, and he established no sect of his
own. The reason of his power lay in the fact that his writings supplied
an encyclopaedic knowledge of the medical art down to his own time, with
commentaries and additions of his own, written with great assurance and
conveying an impression of finality, for he asserted that he had
finished what Hippocrates had begun. The world was tired of political
and philosophical strife, and waiting for authority. The wars of Rome
had resulted in placing political power in the hands of one man, the
Emperor; the disputations and bickerings of philosophers and physicians
produced a similar result, and Galen, in the medical world was invested
with the purple.
The effect, therefore, of Galen's writings was, at first, to add to and
consolidate medical knowledge, but his influence soon became an obstacle
to progress. Even in the sixteenth and seventeenth centuries, Galenism
held almost undisputed sway.
The house of Galen stood opposite the Temple of Romulus in the Roman
Forum. This temple, in A.D. 530, was consecrated by Pope Felix IV to the
honour of the saints, Cosma and Damiano, two Arabian anargyri (unpaid
physicians) who suffered martyrdom under Diocletian.
The date of Galen's death is not exactly known, but was probably A.D.