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Galen

Category: Genius

Pergamon

Aelius Galenus or Claudius Galenus (Greek: Κλαύδιος Γαληνός; AD 129 – c. 200/c. 216), better known as Galen of Pergamon was a prominent Greek physician, surgeon and philosopher.

Arguably the most accomplished of all medical researchers of antiquity, Galen influenced the development of anatomy, physiology, pathology, pharmacology, and neurology, as well as philosophy and logic. 

In his time, Galen's reputation as both physician and philosopher was legendary.  The Emperor Marcus Aurelius describing him as "Primum sane medicorum esse, philosophorum autem solum" (first among doctors and unique among philosophers Praen 14: 660). Galen's pre-eminence amongst the great thinkers of the millennium is exemplified by a 16th-century mural in the refectory of the Great Lavra of Mt Athos. It depicts pagan sages at the foot of the Tree of Jesse, with Galen between the Sibyl and Aristotle.

Pergamon siting in modern day Turkey

 Galen continued to exert an important influence over the theory and practice of medicine until the mid-17th century in the Byzantine and Arabic worlds, and for more than 1,300 years in the western world.  Yet the full importance of his contributions was not appreciated till long after his death.

Galen’s principal interest was in human anatomy, but Roman law prohibited the dissection of human cadavers.  So, Galen performed anatomical dissections on animals, mostly focusing on pigs and primates.  He clarified the anatomy of the trachea and was the first to demonstrate that the larynx generates the voice.  His anatomical reports remained uncontested until 1543, when printed descriptions and illustrations of human dissections were published.

Another of Galen’s major contributions to medicine was his work on the circulatory system. He was the first to recognize that there are distinct differences between venous (dark) and arterial (bright) blood. His anatomical experiments enabled him to describe the circulatory system, nervous system, respiratory system, and other structures.  In his work De motu musculorum, for example, Galen explained the difference between motor and sensory nerves, discussed the concept of muscle tone, and explained the difference between agonists and antagonists. Galen's theory of the physiology of the circulatory system endured until 1628, when William Harvey published his treatise entitled De motu cordis. Medical students continued to study Galen's writings until well into the 19th century.

 

Galen was a skilled surgeon, operating on human patients. Many of his procedures and techniques would not be used again for centuries, such as the procedures he performed on brains and eyes. To correct cataracts in patients, Galen performed an operation similar to a modern one.

Galen also conducted many nerve ligation experiments that supported the theory, which is still accepted today, that the brain controls all the motions of the muscles by means of the cranial and peripheral nervous systems.

Spiritual and philosophical beliefs

Galen saw himself as both a physician and a philosopher, as he wrote in his treatise entitled That the Best Physician is also a Philosopher.  To understand this statement we need to realise that a philosopher in those days was a seeker after wisdom – Philo-sophia and a traveller on the spiritual path.  In effect one achieved wisdom by spiritual enlightenment and to a certain extent being a philosopher was one of the highest levels of achievement spiritually.  Furthermore the ‘physician’, although involved in herbs, plants and physical interventions was actually a healer. 

Asclepius - Pergamon museum

The Asclepiea, equivalent in some senses with our hospitals of today, were the buildings designed to provide healing  and they were  dedicated to Asclepius, god of medicine, in effect a combined temple/hospital.  The healers were called  θεραπευτής (therapeutes) from where we get our word therapeutic – that which heals.  Asclepiea functioned as both spas and sanitoria as the healing power of water [removal of bacteria, viruses, warmth etc] was known and used.  The healers were also priests.  Thus there was really no distinction made in those days between spiritual healing and philosophy.  They all went together into one integrated understanding on the ‘power of spirit’.

Much of the healing of Galen’s day outside of the Asclepia, was achieved by little more than magic and a very extreme form of ritual using entrails and incantations.  Ritual can sometimes work to heal people via the placebo effect, but it is highly unlikely a person would get well by witnessing the decapitation and disembowelling of chickens!

Galen was in perpetual conflict with all the old essentially pseudo-shamanic doctors as he tried to combine genuine spiritual healing with what amounted to good science - the observation of symptoms and the classification of diseases.  Garcia-Ballester quotes Galen as saying: "In order to diagnose, one must observe and reason”.

Galen was influenced by earlier Greek and Roman thinkers, including Plato and Aristotle.  The combination of the two is actually quite key as will be evident if you read the entries for them, as the ideas they proposed are actually complementary to one another.  One of Galen’s major works, On the Doctrines of Hippocrates and Plato, also sought to demonstrate the unity of these two men and their views.

Asclepius curing  - Poynter

Galen used Aristotle’s philosophical notion of cause and effect.  He did not work backwards from the symptoms to identify the ultimate cause, as without all the pathological mechanisms we have today it was impossible, but for him to ‘to diagnose’, also meant following the cause effect chain through to produce a prognosis.  Prognosis was thus one of the most important objectives of Galenic diagnosis.   We need to understand how important this is in actually helping a doctor to heal.  The more cases one can document where the case is followed through, the more one learns about the disease itself and how it actually progresses in the body.  Where does it originate, where does it spread to.  One learns about the system of the disease – the function dependencies in the body.

Even today we have not established practises as advanced as Galen’s.  We know for example that the HPV can cause breast cancer, but the full chain – from the virus entering the body to its finally attacking the breast are not known.

a bust of Galen

One key belief that Galen shared with Plato is the tripartite soul – the immortal soul and the soul consisting of the conscious and the subconscious – a key to understanding how spiritual experience works.

He used what he knew to direct his medical practises, regarding medicine as an interdisciplinary field that combined theory, observation, experimentation, mind and soul, as well as spirit.  To heal the body you must also heal the soul. Interestingly, the arguments of the day were not around whether we had a soul, but where each part of the soul was ‘located’ – processed.   The Stoics like many of the far eastern religions believed the immortal soul to be in the heart.  Galen added to this the idea that the rational soul [Intellect Conscious self] was in the brain, the spiritual soul [Higher spirit] was in the heart, and the appetitive soul [subconscious] was in the liver.  

Galen, continued this same theory by  proposing that organs within the body [aggregates] were each  responsible for specific functions and these functions contributed to the functioning of the individual organism as a whole.  In effect, he applied the more general theory of aggregates to the body.

The humours

 

Galen's understanding of anatomy and medicine was principally influenced by the then-current theory of humorism, as advanced by ancient Greek physicians such as Hippocrates.

Under Hippocrates’ bodily humors theory, differences in human moods come as a consequence of imbalances in one of the four bodily fluids: blood, yellow bile, black bile, and phlegm. These days we laugh at such classifications because we believe them to be literal.  We are wrong. The naming is very unfortunate, bile is not bile and phlegm is not phlegm!   The Hippocratic system was closer to the Chinese system of meridians and the Indian system of nadis.  It certainly had nothing to do with the stuff produced when we cough or the contents of the gall bladder!

The types of energy were associated with the emotions.  In effect, the theory stated that  emotions govern the types of illness we may get, so heart break produces heart disease for example, and the type of personality we have in a general way may determine our predisposition to certain diseases.

Galen used this theory and the typology of human temperaments. An imbalance of humors produced disease.  The classification was thus

  • Blood – sanguine - Individuals with sanguine temperaments are extroverted and social
  • Black bile—melancholic - Melancholics are creative, kind, and considerate
  • Yellow bile—choleric - Choleric people have energy, passion, and charisma.
  • Phlegm—phlegmatic - Phlegmatic temperaments are characterized by dependability, kindness, and affection
Hygeia

According to the type of personality some diseases may be more prevalent than others and the treatment always depended on the Personality type.  Extroverts can take stronger medicine than the kindly quiet ones.  The ideas are eminently sensible and only now are being considered as a valid way of handling illness – especially mental illness.

Another one of Galen's major works, On the Diagnosis and Cure of the Soul’s Passion, contained how to approach and treat psychological problems.  His book contained directions on how to use what he called "talk therapy," or Psychotherapy, to help cure mental problems and thus by extension physical problems.  There is probably only one area where one might take issue with him today   “The therapist, had to be a male, preferably of an older, wiser, age, as well as free from the control of the passions.”  These passions, according to Galen, caused the psychological problems that people experienced in the first place – overload causes illness.

 

Life

We are lucky in that Galen provides an account of his own early life in On the affections of the mind. He was born in September 129 AD; his father, Aelius Nicon, was a wealthy patrician, an architect and builder, with eclectic interests including philosophy, mathematics, logic, astronomy, agriculture and literature. Galen describes his father as a "highly amiable, just, good and benevolent man".

At that time Pergamon (modern-day Bergama, Turkey) was a major cultural and intellectual centre, noted for its library (Eumenes II), second only to that in Alexandria, and attracted both Stoic and Platonic philosophers, to whom Galen was exposed at age 14. His studies also took in each of the principal philosophical systems of the time, including Aristotelian and Epicurean.

His father had planned a traditional career for Galen in philosophy or politics, however, Galen states that in around 145 AD his father had a dream in which the god Asclepius (Aesculapius) appeared and commanded Nicon to send his son to study medicine. Again, no expense was spared, and following his earlier liberal education, at 16 he began studies at the prestigious local sanctuary or Asclepieum.

In 148, when he was 19, his father died, leaving him independently wealthy. He then followed the advice he found in Hippocrates' teaching and travelled and studied widely including such destinations as Smyrna (now Izmir), Corinth, Crete, Cilicia (now Çukurova), Cyprus, and finally the great medical school of Alexandria, exposing himself to the various schools of thought in medicine.

 

In 157, aged 28, he returned to Pergamon as physician to the gladiators of the High Priest of Asia, one of the most influential and wealthy men in Asia.  Over his four years there he learned the importance of diet, fitness, hygiene and preventive measures, as well as living anatomy, and the treatment of fractures and severe trauma, referring to their wounds as "windows into the body". Only five deaths among the gladiators occurred while he held the post, compared to sixty in his predecessor's time, a result that is in general ascribed to the attention he paid to their wounds. At the same time he pursued studies in theoretical medicine and philosophy.

Galen went to Rome in 162 and made his mark as a practicing physician. But his impatience with the lack of skill and understanding of the other doctors brought him into conflict with them and when the animosity with the Roman medical practitioners became serious, he left the city.

Rome engaged in foreign wars in 161. Marcus Aurelius and his colleague Lucius Verus were in the north fighting the Marcomanni. During the autumn of 169 when Roman troops were returning to Aquileia, a great plague broke out, and the emperor summoned Galen back to Rome. Galen had first-hand knowledge of the disease. He was in Rome when it struck in 166 AD, and was also present in the winter of 168–69 during an outbreak among troops stationed at Aquileia. He had experience with the epidemic, referring to it as very long lasting, and describes its symptoms and his treatment of it.

 

When Marcus and Verus went to Germany, Galen was left behind to act as physician to the imperial heir Commodus. It was here in court that Galen wrote extensively on medical subjects. Lucius Verus died in 169, and Marcus Aurelius himself died in 180, both victims of the plague.

Galen was the physician to Commodus for much of the emperor’s life and treated his common illnesses. According to Dio Cassius, in about 189, Commodus survived a similar plague that occurred which at its height killed 2,000 people a day in Rome.

The 11th-century Suda lexicon states that Galen died at the age of 70, which would place his death in about the year 199. However, there are also statements in Arabic sources that he died at age 87, after 17 years studying medicine and 70 practicing it, which would mean he died about 217.

References

Galen may have produced more work than any author in antiquity, rivaling the quantity of work issued from Augustine of Hippo.  Surviving texts represent nearly half of all the extant literature from ancient Greece. Although his surviving works amount to some 3 million words, this is thought to represent less than a third of his complete writings.  No single authoritative collection of his work exists, and controversy remains as to the authenticity of a number of works attributed to Galen. As a consequence, research on Galen's work is ‘fraught with hazard’.

  • Copies of his works translated by Robert M. Green are held at the National Library of Medicine in Bethesda, Maryland.
  • ‘Kitab ila Aglooqan fi Shifa al Amraz’, an Arabic translation of Galen is extant in the Library of Ibn Sina Academy of Medieval Medicine & Sciences, and is regarded as a ‘masterpiece of Galen's literary works’. It includes details of more than 150 single and compound formulations of both herbal and animal origin.
  • The most complete compendium of Galen's writings, surpassing even modern projects like the Corpus Medicorum Graecorum, is the one compiled and translated by Karl Gottlob Kühn of Leipzig between 1821 and 1833. This collection consists of 122 of Galen's treatises, translated from the original Greek into Latin (the text is presented in both languages).
  • Many of Galen's works are included in the Thesaurus Linguae Graecae, a digital library of Greek literature started in 1972.
  • Another useful modern source is the French Bibliothèque interuniversitaire de médicine (BIUM).