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Galen and his anatomic eponym: vein of Galen

Galen and his anatomic eponym: vein of Galen

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Published by BasicMedicine
Ustun C. Galen and his anatomic eponym: vein of Galen. Clin Anat 2004; 17 (6): 454-7.
Ustun C. Galen and his anatomic eponym: vein of Galen. Clin Anat 2004; 17 (6): 454-7.

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Published by: BasicMedicine on Nov 24, 2010
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Galen and His Anatomic Eponym: Vein of Galen
Cagatay Ustun
 Ege University, Faculty of Medicine, History of Medicine & Ethics Department, I ˙ zmir, Turkey
Galen or Galenus was born at Pergamum (now Bergama in Turkey) in 129 A.D., and died inthe year 200 A.D. He was a 2nd century Greek philosopher-physician who switched to themedical profession after his father dreamt of this calling for his son. Galen’s training andexperiences brought him to Alexandria and Rome and he rose quickly to fame with publicdemonstrations of anatomical and surgical skills. He became physician to emperor MarcusAurelius and the emperor’s ambitious son, Commodus. He wrote prodigiously and was ableto preserve his medical research in 22 volumes of printed text, representing half of all Greek medical literature that is available to us today. The structures, the great cerebral vein and thecommunicating branch of the internal laryngeal nerve, bear his eponym. Clin. Anat. 17:454–457, 2004.
2004 Wiley-Liss, Inc.
Key words: Galen, Vein of Galen
A Roman physician and philosopher of Greek ori-gin, Claudius Galen or Galenus (Cladius ClarissimusGalen, better known as Galen of Pergamum) was bornat Pergamum (now Bergama in Turkey) in 129 A.D.(Fig. 1). His father, Aelius Nicon, was an architect andbuilder with an interest in mathematics, logic, andastronomy and a fondness for exotic mathematical andliterary recreations. Nicon had planned for his son tostudy philosophy or politics, the traditional pursuits of the cultured governing class into which he had beenborn. But in 144 or 145 Asclepius intervened. In adream, Galen says, the god told Nicon to allow his sonto study medicine, and for the next four years Galenstudied with the distinguished physicians who gath-ered at the Pergamum sanctuary of Asclepius (Fig. 2).In 148 or 149 Nicon died, and Galen at age 19 foundhimself rich and independent. He chose to travel andfurther his medical education at Smyrna (today’sname: Izmir), Corinth, Crete, Cilicia, Cyprus, and Al-exandria. In 157 he returned to his native city and aprestigious appointment: physician to the gladiators.The need to keep these performers fit taught him theimportance of hygienic regimens and preventive mea-sures. Treating the severe injuries that were part of agladiator’s existence enabled him to observe livinghuman anatomy, particularly of bones, joints, andmuscles, and to develop skill in treating fractures aswell as brutal chest and abdominal wounds. Fromautumn 157 to autumn 161 he gained valuable prac-tical experience in trauma and sports medicine, and hecontinued to pursue his studies in theoretical medi-cine and philosophy. When civil unrest broke out in162, Galen left for Rome. The medical community inRome was competitive and corrupt. In Rome, Galen’sambition got the best of him and his high profilecreated powerful enemies who caused him to departsecretly in 166. After a couple of years in obscurity,Galen was recalled by the Roman Emperors MarcusAurelius and Lucius Verus to serve the army in theirwar against the Germans. When the plague hit Rome,Galen was made personal physician to Marcus Aure-lius and Aurelius’ son, Commodus. He died, probablyin the year 200 A.D. (or 201), in the reign of theEmperor Septimus Severus. Among other talents, hewas a great experimental physiologist. Although hefollowed the teachings of Hippocrates, he also madedeductions of his own (Shippen, 1957; Rosen, 1958;Hiatt and Hiatt, 1994; Cochrane, 1996; Po¨tzsch, 1996).
*Correspondence to: Cagatay Ustun MD, PhD, Ege U ¨ niversitesiTıp Faku¨ltesi, Tıp Tarihi Anabilim Dalı, Bornova I˙zmı˙r 35100Turkey. E-mail: custun@med.ege.edu.trReceived 9 March 2003; Revised 24 October 2003Published online in Wiley InterScience (www.interscience.wiley.com). DOI 10.1002/ca.20013
Clinical Anatomy 17:454–457 (2004)
2004 Wiley-Liss, Inc.
Galen’s works fall into two main categories: medi-cal and philosophical
His medical writings encompassnearly every aspect of medical theory and practice inhis era. A great many of Galen’s works have survived.The Ku¨hn edition of Galen (Greek with a Latin trans-lation) runs over 20,000 pages. There are other Ga-lenic works that only exist in Arabic translations. How-ever, many of Galen’s works are lost, e.g., many of histreatises on philosophy (logic, physics, and ethics)perished in a fire that consumed the Temple of Peacein 191 A.D.Claudius Galen carried out dissections and wrotenumerous treatises on human anatomy. He was con-sidered the authority on anatomy long after his deathby those who accepted his word rather than followinghis investigative methodology. Galen studied the bod-ies of animals to support his research. In particular, heused apes and swine that are very similar in manyaspects of anatomy to humans. This type of research,along with the dissection of human remains that heconducted in Alexandria, led to the development of his theory on the human body’s physiological system.This was a remarkable, if slightly incorrect, develop-ment that would allow physicians to clearly under-stand the effects of the treatments given. He said: “Aphysician needs to study anatomy, as an architectneeds to follow a plan.” He never understood thecirculation of the blood, but he distinguished betweenthe nerves that carry sense impressions to the brainand those that control movements. He also classifieddifferent variations of the pulse, distinguishing be-tween slow, fast, and irregular beats and trying todetermine their relation to the patient’s health.As an anatomist, Galen left many excellent descrip-tions, especially of the nervous and locomotor sys-tems, but his work was faulty and inaccurate, based
Fig. 1.
Fig. 2.
Treatment center (Pergamum Asclepion) with water channels and pipes.
Galen 455
largely on the dissection of apes and swine. Galenmade many mistakes, especially concerning the inter-nal organs. For example, he incorrectly assumed thatthe rete mirable, a plexus of blood vessels at the baseof the brain of ungulate animals, was also present inhumans. In addition, he sometimes postulated thepresence of structures not there to fit his theories. Hestudied osteology in the ape (
 Macacus ecaudatus
) andfrom stray human skeletons, such as that of the robberhe once found on a lonely mountainside. His myologywas based mainly upon the study of the musculatureof the Barbary ape (
 Macacus inuus
), but he clearlyunderstood the difference between origin and inser-tion and knew most of the muscles and their func-tions. Galen showed that arteries contain blood andgave the first description of the cranial nerves, thelymphatic system, and the phenomenon of paraplegiaafter division of the spinal cord. He believed thecerebellum to be the origin of the motor nerves andthe spinal cord. The cerebellar vermis he consideredto be a valve regulating the flow of animal spiritswithin the cerebral ventricles. The term “thalamus,”meaning chamber or anteroom, was applied by Galento the organ to which he believed the optic nerveswere connected, providing vital spirits for vision. Hedescribed the nervous system, the brain, spinal cordand nerves, as one functional unit. He observed loss of sensation and paralysis of all muscles supplied bynerves originating from the spinal cord after completeresection below that level. He distinguished the duramater and pia mater, the corpus callosum, the thirdand fourth ventricles with the iter (Sylvian aqueduct)the fornix, corpora quadrigemina, vermiform process,calamus scriptorius, hypophysis, and infundibulum.Of the 12 cerebral nerves, he knew seven pairs, alsothe sympathetic ganglia, which he described as thereinforcers of the nerves. Galen also described a net-work of blood vessels surrounding the pituitary glandat the base of the brain and assumed this existed inman. Berangario da Carpi (1460–1530) dissected 100brains and failed to find it. He wrote “Galen imagineda rete but never saw it.” Galen was the author of some500 papers and gave his name to the great cerebralvein (of Galen) and also to the nerve of Galen, thecommunicating branch of the internal laryngeal nervewith the recurrent laryngeal nerve. He studied theanatomy of the respiratory system and of the heart,arteries, and veins. He did not, however, discover thecirculation of the blood throughout the body, andbelieved that blood passed from one side of the heartto the other through invisible pores in the dividingwall (Fielding Garrison, 1929; Nuland, 1995).A particular characteristic attached to the name of Galen was the large-scale use of medications. Hegathered medicinal plants and prepared his own pre-scriptions, out of mistrust for the rhizotomists anddrug sellers. The many ingredients that he put to-gether in a single preparation have sometimes beenreferred to as Galenicals, but the term has no precisemeaning. He carried polypharmacy to an extreme,mixing and blending agents whose properties he clas-sified according to the humors and their qualities of hot, cold, dry, and moist. For example, an illnesscategorized as hot required a drug that was in the coldcategory, a classification system founded on specula-tive doctrines (Lyons and Petrucelli, 1987; Tan, 2002).During his brilliant career Galen compiled morethan 300 books, of which some 120 are still availablefor our study. It is small wonder that this medicalcolossus reigned like a dictator over the world of medical science for almost 1,500 years.
Galenism is a system of medicine that belongs toGalen. It is a blend of the humoral theory andPythagorean number lore.If the work of Hippocrates can be taken as repre-senting the foundation of Greek medicine, then thework of Galen, who lived 6 centuries later, is the apexof that tradition. Galen, for all his mistakes, remainedthe unchallenged authority for over 1,000 years. Afterhe died in 200 (or 201) A.D., serious anatomical andphysiological research ground to a halt because every-thing there was to be said on the subject had been saidby Galen, who, it is reported, kept at least 20 scribeson staff to write down his every dictum. Although hewas not a Christian, Galen’s writings reflect a belief inonly one god, and he declared that the body was aninstrument of the soul. This made him most accept-able to the fathers of the church and to Arab andHebrew scholars. Galen’s mistakes perpetuated fun-damental errors for nearly 1,500 years until Vesalius,the 16th century anatomist, although he regarded hispredecessor with esteem, began to dispel Galen’s au-thority.
The single great cerebral vein (of Galen) receivesthe paired basal veins (of Rosenthal), the pairedbasal veins of Rosenthal, the paired occipital veins,and the posterior vein of the corpus callosum, andsometimes the superior cerebral vein. The pairedoccipital veins are superficial cerebral veins thatdrain the inferior and medial surfaces of the occip-
456 Ustun

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