Clinical Anatomy 17:454 – 457 (2004

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A GLIMPSE OF OUR PAST

Galen and His Anatomic Eponym: Vein of Galen
Cagatay Ustun*
˙ Ege University, Faculty of Medicine, History of Medicine & Ethics Department, Izmir, Turkey

Galen or Galenus was born at Pergamum (now Bergama in Turkey) in 129 A.D., and died in the year 200 A.D. He was a 2nd century Greek philosopher-physician who switched to the medical profession after his father dreamt of this calling for his son. Galen’s training and experiences brought him to Alexandria and Rome and he rose quickly to fame with public demonstrations of anatomical and surgical skills. He became physician to emperor Marcus Aurelius and the emperor’s ambitious son, Commodus. He wrote prodigiously and was able to 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 the communicating 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

GALEN’S LIFE
A Roman physician and philosopher of Greek origin, Claudius Galen or Galenus (Cladius Clarissimus Galen, better known as Galen of Pergamum) was born at Pergamum (now Bergama in Turkey) in 129 A.D. (Fig. 1). His father, Aelius Nicon, was an architect and builder with an interest in mathematics, logic, and astronomy and a fondness for exotic mathematical and literary recreations. Nicon had planned for his son to study philosophy or politics, the traditional pursuits of the cultured governing class into which he had been born. But in 144 or 145 Asclepius intervened. In a dream, Galen says, the god told Nicon to allow his son to study medicine, and for the next four years Galen studied with the distinguished physicians who gathered at the Pergamum sanctuary of Asclepius (Fig. 2). In 148 or 149 Nicon died, and Galen at age 19 found himself rich and independent. He chose to travel and further his medical education at Smyrna (today’s name: Izmir), Corinth, Crete, Cilicia, Cyprus, and Alexandria. In 157 he returned to his native city and a prestigious appointment: physician to the gladiators. The need to keep these performers fit taught him the importance of hygienic regimens and preventive measures. Treating the severe injuries that were part of a gladiator’s existence enabled him to observe living human anatomy, particularly of bones, joints, and
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muscles, and to develop skill in treating fractures as well as brutal chest and abdominal wounds. From autumn 157 to autumn 161 he gained valuable practical experience in trauma and sports medicine, and he continued to pursue his studies in theoretical medicine and philosophy. When civil unrest broke out in 162, Galen left for Rome. The medical community in Rome was competitive and corrupt. In Rome, Galen’s ambition got the best of him and his high profile created powerful enemies who caused him to depart secretly in 166. After a couple of years in obscurity, Galen was recalled by the Roman Emperors Marcus Aurelius and Lucius Verus to serve the army in their war against the Germans. When the plague hit Rome, Galen was made personal physician to Marcus Aurelius and Aurelius’ son, Commodus. He died, probably in the year 200 A.D. (or 201), in the reign of the Emperor Septimus Severus. Among other talents, he was a great experimental physiologist. Although he followed the teachings of Hippocrates, he also made deductions of his own (Shippen, 1957; Rosen, 1958; Hiatt and Hiatt, 1994; Cochrane, 1996; Potzsch, 1996). ¨
¨ *Correspondence to: Cagatay Ustun MD, PhD, Ege Universitesi ˙ ˙ Tıp Fakultesi, Tıp Tarihi Anabilim Dalı, Bornova Izmır 35100 ¨ Turkey. E-mail: custun@med.ege.edu.tr Received 9 March 2003; Revised 24 October 2003 Published online in Wiley InterScience (www.interscience.wiley. com). DOI 10.1002/ca.20013

2004 Wiley-Liss, Inc.

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Fig. 1. Galen.

GALEN’S WORKS
Galen’s works fall into two main categories: medical and philosophical. His medical writings encompass

nearly every aspect of medical theory and practice in his era. A great many of Galen’s works have survived. The Kuhn edition of Galen (Greek with a Latin trans¨ lation) runs over 20,000 pages. There are other Galenic works that only exist in Arabic translations. However, many of Galen’s works are lost, e.g., many of his treatises on philosophy (logic, physics, and ethics) perished in a fire that consumed the Temple of Peace in 191 A.D. Claudius Galen carried out dissections and wrote numerous treatises on human anatomy. He was considered the authority on anatomy long after his death by those who accepted his word rather than following his investigative methodology. Galen studied the bodies of animals to support his research. In particular, he used apes and swine that are very similar in many aspects of anatomy to humans. This type of research, along with the dissection of human remains that he conducted in Alexandria, led to the development of his theory on the human body’s physiological system. This was a remarkable, if slightly incorrect, development that would allow physicians to clearly understand the effects of the treatments given. He said: “A physician needs to study anatomy, as an architect needs to follow a plan.” He never understood the circulation of the blood, but he distinguished between the nerves that carry sense impressions to the brain and those that control movements. He also classified different variations of the pulse, distinguishing between slow, fast, and irregular beats and trying to determine their relation to the patient’s health. As an anatomist, Galen left many excellent descriptions, especially of the nervous and locomotor systems, but his work was faulty and inaccurate, based

Fig. 2.

Treatment center (Pergamum Asclepion) with water channels and pipes.

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largely on the dissection of apes and swine. Galen made many mistakes, especially concerning the internal organs. For example, he incorrectly assumed that the rete mirable, a plexus of blood vessels at the base of the brain of ungulate animals, was also present in humans. In addition, he sometimes postulated the presence of structures not there to fit his theories. He studied osteology in the ape (Macacus ecaudatus) and from stray human skeletons, such as that of the robber he once found on a lonely mountainside. His myology was based mainly upon the study of the musculature of the Barbary ape (Macacus inuus), but he clearly understood the difference between origin and insertion and knew most of the muscles and their functions. Galen showed that arteries contain blood and gave the first description of the cranial nerves, the lymphatic system, and the phenomenon of paraplegia after division of the spinal cord. He believed the cerebellum to be the origin of the motor nerves and the spinal cord. The cerebellar vermis he considered to be a valve regulating the flow of animal spirits within the cerebral ventricles. The term “thalamus,” meaning chamber or anteroom, was applied by Galen to the organ to which he believed the optic nerves were connected, providing vital spirits for vision. He described the nervous system, the brain, spinal cord and nerves, as one functional unit. He observed loss of sensation and paralysis of all muscles supplied by nerves originating from the spinal cord after complete resection below that level. He distinguished the dura mater and pia mater, the corpus callosum, the third and 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, also the sympathetic ganglia, which he described as the reinforcers of the nerves. Galen also described a network of blood vessels surrounding the pituitary gland at the base of the brain and assumed this existed in man. Berangario da Carpi (1460 –1530) dissected 100 brains and failed to find it. He wrote “Galen imagined a rete but never saw it.” Galen was the author of some 500 papers and gave his name to the great cerebral vein (of Galen) and also to the nerve of Galen, the communicating branch of the internal laryngeal nerve with the recurrent laryngeal nerve. He studied the anatomy of the respiratory system and of the heart, arteries, and veins. He did not, however, discover the circulation of the blood throughout the body, and believed that blood passed from one side of the heart to the other through invisible pores in the dividing wall (Fielding Garrison, 1929; Nuland, 1995). A particular characteristic attached to the name of Galen was the large-scale use of medications. He

gathered medicinal plants and prepared his own prescriptions, out of mistrust for the rhizotomists and drug sellers. The many ingredients that he put together in a single preparation have sometimes been referred to as Galenicals, but the term has no precise meaning. He carried polypharmacy to an extreme, mixing and blending agents whose properties he classified according to the humors and their qualities of hot, cold, dry, and moist. For example, an illness categorized as hot required a drug that was in the cold category, a classification system founded on speculative doctrines (Lyons and Petrucelli, 1987; Tan, 2002). During his brilliant career Galen compiled more than 300 books, of which some 120 are still available for our study. It is small wonder that this medical colossus reigned like a dictator over the world of medical science for almost 1,500 years.

GALENISM
Galenism is a system of medicine that belongs to Galen. It is a blend of the humoral theory and Pythagorean number lore. If the work of Hippocrates can be taken as representing the foundation of Greek medicine, then the work of Galen, who lived 6 centuries later, is the apex of that tradition. Galen, for all his mistakes, remained the unchallenged authority for over 1,000 years. After he died in 200 (or 201) A.D., serious anatomical and physiological research ground to a halt because everything there was to be said on the subject had been said by Galen, who, it is reported, kept at least 20 scribes on staff to write down his every dictum. Although he was not a Christian, Galen’s writings reflect a belief in only one god, and he declared that the body was an instrument of the soul. This made him most acceptable to the fathers of the church and to Arab and Hebrew scholars. Galen’s mistakes perpetuated fundamental errors for nearly 1,500 years until Vesalius, the 16th century anatomist, although he regarded his predecessor with esteem, began to dispel Galen’s authority.

VEIN OF GALEN (GREAT CEREBRAL VEIN OF GALEN)
The single great cerebral vein (of Galen) receives the paired basal veins (of Rosenthal), the paired basal veins of Rosenthal, the paired occipital veins, and the posterior vein of the corpus callosum, and sometimes the superior cerebral vein. The paired occipital veins are superficial cerebral veins that drain the inferior and medial surfaces of the occip-

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REFERENCES
A chronology of significant historical developments in the biological sciences (http://www.biologie.uni-hamburg.de/b-online/ e01/geschichte.htm). Cochrane J. 1996. An illustrated history of medicine. London: Tiger Books International. p 18 –19. Dorland’s Illustrated Medical Dictionary. 1965. 24th Ed. Philadelphia: W.B. Saunders Co. p 1670. Fielding Garrison H. 1929. An introduction to the history of medicine, 4th Ed. Philadelphia: W.B Saunders Co. p 114 – 115. From Galen to Gutzmann—Hans von Leden (http://www. mh-hannover.de/service/uep/Region/Europe/Germany/ST/ Galen.htm). Galen (http://hsc.virginia.edu/hs-library/historical/antiqua/galen. htm). Galen, the Internet encyclopedia of philosophy (http://www. utm.edu/research/iep/g/galen.htm#Hellenistic Schools of Medicine). Glossary of histological and micro-anatomical terms (http:// anatomy.med.unsw.edu.au/teach/anat2200/2000/appen4.htm). Hiatt JR, Hiatt N. 1994. Galen–A father of medicine. J Am Coll Surg 178:410 – 416. Lyons AS, Petrucelli RJ. 1987. Medicine—An illustrated history. New York: Abradale Press-Harry N. Abrams, Inc., Publishers. p 257–258. Medicine in stamps. Galen (http://www.sma.org.sg/smj/4303/ 4303ms1.pdf). Nuland SB. 1995. Doctors—The biography of medicine. New York: Vintage Books. p 47–52. Pernkopf E. 1980. Atlas der topographischen und angewandten Anatomie des Menschen-I. Band, Kopf und Hals, Baltimore: Urban & Schwarzenberg. p 67– 68. Potzsch R. 1996. The pharmacy. Basel: Editiones Roche. p ¨ 23–24. Chronology of the Great Empires (http://www.b17.com/family/ lwp/chronology/empires.html). Rosen GA. 1958. History of public health. New York: MD Publications, Inc. p 46. http://www.ea.pvt.k12.pa.us/medant/galbio.htm Rouviere H, Delmas A. 1991. Anatomie Humaine, Tome 1. ` Tete et cou, Masson. p 228 –229. ˆ Shippen KB. 1957. Men of medicine. Dobson: Explorer Books Edition. p 43–50. Tan SY. 2002. Galen: history’s most enduring medic. Singapore Med J 43:116 –117. Who was Galen? A brief history of the Prince of Physicians (http://www.iapac.org/galenprince.asp).

Fig. 3. Sagittal, T1-weighted MR image shows a thrombosed vein of Galen malformation. Citation: R.N. Sener, O. Yalman, O. Kitis, S. Tamsel, C. Calli. 2000, Sep 11. Completely thrombosed aneurysm of the persistent, primitive prosencephalic vein of Markowski (http://www.eurorad.org/case.cfm?UID 643). Luxembourg: Euromultimedia.

ital lobe and adjacent parietal regions. The posterior vein of the corpus callosum drains the splenium of the corpus callosum and the adjacent surfaces of the brain. The great cerebral vein (of Galen) is a short vascular structure that passes caudally beneath the splenium of the corpus callosum and empties into the straight venous sinus (Fig. 3) (Pernkopf, 1980; Rouviere and Delmas, 1991). ` It is probable that Galen did not recognize that the vein he described drained the deep brain. In addition, no historical data is available on descriptions of any pathology related with the great cerebral vein (of Galen).

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