CHAPTER IX. GALEN.

His life and works His infuence on Medicine. Claudius Galenus, commonly
known as Galen, has infuenced the progress of medical science by his
writings probably more than any other medical writer. His infuence was
paramount for fourteen centuries, and although he made some original
contributions, his works are noteworthy mainly as an encyclopdia of the
medical knowledge of his time and as a reiew of the work of his
predecessors. !here is a great deal of information in his books about his own
life. He was born at "ergamos in #.$. %&' 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 e)ample and instruction, and at the age of %*
was taught by philosophers of the +toic, "latonist, "eripatetic, and ,picurean
schools. He became initiated, writes $r. Moore, into -the idealism of "lato, the
realism of #ristotle, the scepticism of the ,picureans, and the materialism of
the +toics.- #t the age of %. he was destined for the profession of medicine
by his father in conse/uence of a dream. He studied under the most eminent
men of his day. He went to +myrna to be a pupil of "elops, the physician, and
#lbinus the platonist0 to Corinth to study under 1umesianus0 to #le)andria for
the lectures of Heraclianus0 and to Cilicia, "h2nicia, "alestine, Crete, and
Cyprus. #t the age of 34 Galen returned from #le)andria to "ergamos 5#.$.
%*67, and was appointed doctor to the +chool of Gladiators, and gained much
distinction. He went to 8ome for the 9rst time in #.$. %:&;<, and remained for
four years0 and during this period he wrote on anatomy and on the teaching
of Hippocrates and "lato. He ac/uired great fame as a practitioner and, if he
had so desired, might hae attended the ,mperor0 but it is probable that
Galen thought that the o=ce of physician to the ,mperor might preent him
from leaing 8ome if he wished to do so. He also gae public lectures and
disputations, and was called not only the -wonder;speaker- but the -wonder;
worker.- His success gae rise to eny, and he was afraid of being poisoned
by his less successful rials. !he reason why he left 8ome is not certain, and
the possible causes of his departure are discussed by $r. Greenhill in the
-$ictionary of Greek and 8oman >iography and Mythology.- # pestilence
raged in 8ome at this time, but it is unlikely that Galen would hae deserted
his patients for that reason. "robably he disliked 8ome, and longed for his
natie place. He had been in "ergamos only a ery short time when he was
summoned to attend the ,mperors Marcus #urelius and ?. @erus in @enetia.
!he latter died of apople)y on his way home to 8ome, and Galen followed
Marcus #urelius to the capital. !he ,mperor soon thereafter set out to
prosecute the war on the $anube, and Galen was allowed to remain in 8ome,
as he had stated that such was the will of Asculapius. !he ,mperor(s son
Commodus was placed under the care of Galen during the father(s absence,
and at this time also 5#.$. %.'7 Galen prepared the famous medicine theriaca
for Marcus #urelius, who took a small /uantity daily. !he ,mperor +eptimius
+eerus employed the same physician and the same medicine about thirty
years afterwards. Bt is recorded that the philosopher ,udemius was
successfully treated by Galen for a seere illness caused by an oerdose of
theriaca, and that the treatment employed was the same drug in small doses.
Galen stayed seeral years in 8ome, and wrote and practised as on his
former isit. He again returned to "ergamos, and probably was in 8ome again
at the end of the second century. Bt is certain he was still alie in the year
%44, and probably lied in the reign of the ,mperor Caracalla. He was not
only a great physician, but a man of wide culture in eery way. Bn matters of
religion he was a Monotheist. !here 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,
/uoted by his #rabian biographers, Galen praises highly the loe of irtue of
the Christians. He no doubt found the practice of medicine lucratie when he
had gained pre;eminence, and it is recorded that he receied C&*' for curing
the wife of >oetius, the Consul. Galen wrote no less than 9e hundred
treatises, large and small, mostly on medical subDects, but also on ethics,
logic, and grammar. His style is good but rather diEuse, and he delights in
/uoting the ancient Greek philosophers. >efore his time, as we hae seen,
there were disputes between the arious medical sects. !he disciples of
$ogmatism and of ,mpiricism had been opposed to each other for seeral
centuries, and the ,clectics, "neumatists, and ,pisynthetics had arisen
shortly before his time. Galen wrote against slaish attachment to any sect,
but -in his general principles he may be considered as belonging to the
$ogmatic sect, for his method was to reduce all his knowledge, as ac/uired
by the obseration of facts, to general theoretical principles. !hese principles
he, indeed, professed to deduce from e)perience and obseration, and we
hae abundant proofs of his diligence in collecting e)perience, and his
accuracy in making obserations0 but still in a certain sense at least, he
regards indiidual facts and the details of e)perience as of little alue,
unconnected with the principles which he had laid down as the basis of all
medical reasoning. Bn this fundamental point, therefore, the method pursued
by Galen appears to hae been directly the reerse of that which we now
consider as the correct method of scienti9c inestigation0 and yet, such is the
force of natural genius, that in most instances he attained the ultimate obDect
in iew, 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 e)pound his doctrines, and support
them by new facts and obserations. Fet, in reality, we hae few writers
whose works, both as to substance and manner, are more diEerent from each
other than those of Hippocrates and Galen, the simplicity of the former being
strongly contrasted with the abstruseness and re9nement of the latter.-G%H #
list of the arious editions of Galen(s works is gien in $r. +mith(s -$ictionary
of Greek and 8oman >iography and Mythology- 5%64' edition, ol. ii, pp. 3%';
%37, and also the titles of the treatises classi9ed according to the branch of
medical science with which they deal, and it is conenient to follow this
classi9cation.
I.WORKS ON ANATOMY AND PHYSIOLOGY.
Galen insisted upon the study of anatomy as essential, and in this respect
was in confict with the iew held by the Methodists and the ,mpirics who
belieed that a physician could understand diseases without any knowledge
of the e)act structure of the body. His books on anatomy were originally
9fteen in number. !he last si) of these are now e)tant only in an #rabic
translation, two copies of which are presered in the >odleian ?ibrary at
I)ford. !he directions he gies for dissection show that he was a master of
the art. Bn dissecting out the portal ein and its rami9cations, for instance, he
adises that a probe should be inserted into the ein, and the point of the
probe gradually adanced as the surrounding tissue is cut away, so that
9nally the minute branches are e)posed0 and he describes the use of the
blowpipe, and other instruments used in dissection. He carried out the
e)periment of tying the iliac and a)illary 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 een the carotid arteries could be tied without
causing death. He also pointed out that tying the carotid artery did not cause
loss of oice, but that tying the artery carelessly so as to include the nere
had this eEect. He was the 9rst to describe the ductus arteriosus, and the
three coats of the arteries. Bt is highly improbable that Galen dissected
human bodies in 8ome, though he dissected a great ariety of the lower
animals. He writes that the doctors who attended Marcus #urelius in the
German wars dissected the dead bodies of the barbarians. !he 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 adance of physiology by recogniJing that eery part of
the body e)ists for the purpose of performing a de9nite function. #ristotle,
like "lato, had taught that -1ature makes nothing in ain,- and Galen(s
philosophy was greatly infuenced by the teaching of #ristotle. Galen
regarded his work as -a religious hymn in honour of the Creator, who has
gien proof of His Imnipotence in creating eerything perfectly conformable
to its destination.- He regarded the structure of arious parts, such as the
hand and the membranes of the brain, as absolute perfection, although his
idea of the human hand was deried 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
criticiJe his conclusions because of his failure to recogniJe a few
comparatiely unimportant details. He discoered the function of the motor
neres by cutting them e)perimentally, and so producing paralysis of the
muscles0 the platysma, interossei, and popliteus muscles were 9rst described
by him. He was the greatest authority on the pulse, and he recogniJed that it
consisted of a diastole 5e)pansion7 and a systole 5contraction7 with an
interal after the diastole, and another after the systole. #ristotle 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
discoery of the circulation. He described the heart as haing the appearance
of a muscle, and considered it the source of natural heat, and the seat of
iolent passions. He knew well the anatomy of the human skeleton, and
adised students to go to #le)andria where they might see and handle and
properly study the bones. He recogniJed 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 oE humours from the brain into the nose. >ut some of
this air remained and combined with the ital spirits in the anterior entricles
of the brain, and 9nally e)uded from the fourth entricle, the residence of the
soul. #ristotle had taught that the heart was the seat of the soul, and the
brain relatiely unimportant.
II.WORKS ON DIETETICS AND HYGIENE.
Galen was a strong adocate of e)ercises and gymnastics, and eulogiJes
hunting specially. He recommends cold baths for people in the prime of life.
#s 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 re/uired three meals a day, others two meals. He had a
ery 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.
III.ON PATHOLOGY.
Galen belieed in the doctrine of the four elements, and his speculations led
him into a belief in a further subdiision. -Kire is hot and dry0 air is hot and
moist0 for the air is like a apour0 water is cold and moist, and earth is cold
and dry.- He held that there were three principles in manspirits, solids, and
humoursand eight temperaments ranging between health and disease and
compatible with life. He retained a good deal of the teaching of the
"neumatic school, and belieed that the pneuma was diEerent from the soul,
but the ehicle for the interaction of soul and body. Krom his theory of the
action of the air through the nose on the contents of the entricles of the
brain is e)plained his use of sternutatories, and his belief in the e=cacy of
sneeJing. Galen(s classi9cation of infammations shows that his pathology
was not nearly so accurate as his anatomy and physiology. He described 5a7
simple infammation caused by e)cess of blood alone0 5b7 infammation the
result of e)cess of both pneuma and blood0 5c7 erysipelatous infammation
when yellow bile gains admission, and 5d7 scirrhous or cancerous when
phlegm is present. He did good serice by diiding the causes of disease into
remote and pro)imate, the former subdiided into two classespredisposing
and e)citing.
IV.ON DIAGNOSIS.
He relied greatly on the doctrine of -critical days,- which were thought to be
infuenced to some e)tent by the moon. His studies of the pulse were ery
useful to him in diagnosis. 1o doubt, he was an e)pert diagnostician mainly
owing to his long, aried, and costly medical education, and his great natural
powers of Dudgment. He asserted that with the help of the $eity he had neer
been wrong, but een his most ardent admirers would not be wanting in
enthusiasm if they amended -neer- into -hardly eer.-
V.ON PHARMACY, MATERIA MEDICA, AND THERAPEUTICS.
Bn these subDects Galen was not as pro9cient as $ioscorides, whose teaching
he adopted with that of other medical authors. Bn Galen(s works there are
lengthy lists of compound medicines, seeral medicines being recommended
for the same disease, and neer with ery marked con9dence. He paid high
prices for arious 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 8ome. Medicines were classi9ed by him according to their
/ualities, by which he meant, not their therapeutic eEects, but their inherent
dryness or moistness, coldness or heat. # medicine might be cold in the 9rst
degree, and not in the second degree. "aulus Agineta followed this strange
and foolish doctrine of Galen ery closely, as the following e)tracts from his
book on Materia Medica will showL -Cistus 5rock;rose7.Bt is an astringent
shrub of gently cooling powers. Bts leaes and shoots are so desiccatie as to
agglutinate wounds0 but the fowers are of a more drying nature, being about
the second degree0 and hence, when drunk, they cure dysenteries and all
kinds of fu)es.-G3H -Kerrum 5iron7.Mhen fre/uently e)tinguished in water, it
imparts a considerable desiccatie power to it. Mhen drunk, therefore, it
agrees with aEections of the spleen.-G&H Many features, howeer, of Galen(s
teaching and practice of therapeutics are worthy of praise. He enunciated two
fundamental principlesL 5%7 !hat disease is something contrary to 1ature, and
is to be oercome by that which is contrary -to the disease itself-0 and 537
that 1ature is to be presered by what has relation with 1ature. He
recogniJed that while the inading disease was to be repelled, the strength
and constitution of the patient should be presered, and that in all cases the
cause of the disease was to be treated and not the symptoms. +trong
remedies should not be used on weak patients.
VI.SURGERY.
Galen conformed to the custom of the physicians in 8ome, and did not
practise surgery to any e)tent, although he used the lancet in phlebotomy,
and defended this practice against the followers of ,rasistratus in 8ome. He
is said to hae resected a portion of the sternum for caries, and also to hae
ligatured the temporal artery.G<H
VII.GYNCOLOGY.
Galen had little more than a super9cial knowledge of this subDect, and was
/uite ignorant of the surgery of diseases of women. He was not so well
informed as +oranus was as to the anatomy of the uterus and its
appendages, but deseres credit for haing been better ac/uainted with the
anatomy of the Kallopian tubes than his predecessors. He had erroneous
iews on the causation of displacements of the uterus. +eeral of the books
inaccurately attributed to the authorship of Galen deal with the medical
treatment of arious 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 ac/uainted with other branches of knowledge besides medicine.
#s a philosopher he has been /uoted in company with "lato and #ristotle, and
his philosophical writings were greatly used by #rabic authors. Bn philosophy,
as in medicine, he had studied the teachings of the arious schools of
thought, and did not bind himself to any sect in particular. He disagreed with
the +ceptics in their belief that no such thing as certainty was attainable, and
it was his custom in cases of e)treme di=culty to suspend his Dudgment0 for
instance, in reference to the nature of the soul, he wrote that he had not
been able to come to a de9nite opinion. Galen mentions the discreditable
conduct of physicians at consultations. +ometimes seeral doctors would hold
a consultation, and, apparently forgetting the patient for the time, would hold
iolent disputations. !heir main obDect was to display their dialectical skill,
and their arguments sometimes led to blows. !hese discreditable e)hibitions
were rather fre/uent in 8ome in his time. Mith 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
wroteL -1o one before me has gien the true method of treating diseaseL
Hippocrates, B confess, has heretofore shown the path, but as he was the 9rst
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 ery little of complicated
diseases0 in a word, he has only sketched what another was to complete0 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 e)tent. Bt is a speculation of
much interest how it was that Galen(s iews on Medicine receied uniersal
acceptance, and made him the dictator in this realm of knowledge for ages
after his death. He was not precisely a genius, though a ery remarkable
man, and he established no sect of his own. !he reason of his power lay in
the fact that his writings supplied an encyclopdic knowledge of the medical
art down to his own time, with commentaries and additions of his own,
written with great assurance and coneying an impression of 9nality, for he
asserted that he had 9nished what Hippocrates had begun. !he world was
tired of political and philosophical strife, and waiting for authority. !he wars of
8ome had resulted in placing political power in the hands of one man, the
,mperor0 the disputations and bickerings of philosophers and physicians
produced a similar result, and Galen, in the medical world was inested with
the purple. !he eEect, therefore, of Galen(s writings was, at 9rst, to add to
and consolidate medical knowledge, but his infuence soon became an
obstacle to progress. ,en in the si)teenth and seenteenth centuries,
Galenism held almost undisputed sway. !he house of Galen stood opposite
the !emple of 8omulus in the 8oman Korum. !his temple, in #.$. *&', was
consecrated by "ope Keli) B@ to the honour of the saints, Cosma and
$amiano, two #rabian anargyri 5unpaid physicians7 who suEered martyrdom
under $iocletian. !he date of Galen(s death is not e)actly known, but was
probably #.$. 3''.
FOOTNOTES
$r. >ostock(s -History of Medicine.-
-"aulus Agineta,- ol. iii, p. .<.
Bbid., p. 3<3.
-,ncyl. >rit.,- +urgery.