CHAPTER XV. Claudius Galen

CLAUDIUS GALEN

During the centuries immediately preceding the Christian era, Greek medicine was represented by a collection of treatises which had been written by Hippocrates and his followers on anatomical, physiological, pathological, therapeutical and ethical subjects, and which constituted a fairly complete but not always easily intelligible system. As time went on, however, and especially as new and useful facts were constantly being added to the existing stock of medical knowledge, the more thoughtful physicians began to feel that the system, which up to that day had proved acceptable, needed to be perfected in a number of respects; and accordingly, as a result of this feeling of dissatisfaction, and also as an expression of the prevailing desire for a more perfect knowledge of the truth, there developed, as has been stated in the preceding chapters, a number of different medical sects. When Galen first appeared in the field as a physician of unusual promise, these various sects were all still in a thriving condition. The Methodists, in particular, were very popular. Galen did not favor any special sect, but in his writings he made it manifest that he attached more importance to the teachings of Hippocrates than to those of any other author. “It was Hippocrates,” he said, “who laid the real foundations of the science of medicine.” It is therefore not surprising that Galen should have devoted so much time to the writing of elaborate commentaries on the works of Hippocrates. The service which he thus rendered to medicine, says Daremberg, was of very great value. But Galen, notwithstanding his great admiration for Hippocrates, did not hesitate to criticise a number of his teachings, and especially those which, as he believed, were not stated with sufficient clearness. Valuable as was the service rendered to medicine by the writing of these commentaries, there still remained an urgent need for a service of a different and much more difficult kind, viz., that of welding together into a single clearly written and easily intelligible system of medicine, all that was good in the Hippocratic writings and in the disconnected and at times antagonistic teachings of the sects. To accomplish this successfully required the services of a man endowed with mental gifts of a most exceptional character--complete knowledge of medicine in all its departments, a mind thoroughly trained in philosophy, the power to express his thoughts in simple language, and an independence and fairness of judgment which would render him indifferent to the petty interests of the sects. Claudius Galen, as subsequent events showed, possessed these very gifts in a high degree, and he devoted the better part of his reasonably long lifetime to the accomplishment of this much-needed work. How greatly it was needed at that particular period of time, nobody then knew or could even suspect. It soon appeared, however, that all the vaunted civilization of the Graeco-Roman world--much of it of the purest gold and a great deal of the basest alloy--was to be swept so completely off the face of the earth that, for thirteen hundred or more years, almost no thought whatever could possibly be given to the science and art of medicine. Fortunate, most fortunate it was, therefore, that, before this wave of destruction reached Rome, all the best part of Greek medical literature--for such it was in truth--had been gathered together and carefully systematized by Galen and stowed away in the recesses and chambers of remotely situated monasteries and churches by clear-sighted monks for the benefit of later generations of physicians.

Brief Biographical Sketch.--Claudius Galen was born in Pergamum, an important Greek city of Asia Minor, about the year 131 A. D., under the reign of the Emperor Hadrian. His father, whose name was Nicon, was a man of ample means, well informed in philosophy, astronomy and geometry, and most liberal in providing for the thorough education of his son in every branch of useful knowledge. In two or three places in his writings Galen speaks of his father in terms of affection. On the other hand, he does not hesitate to state in the plainest language possible that his mother was a veritable Xanthippe. In her moments of bad temper she would not only shout and scream in a violent manner, but would sometimes go so far as to bite her serving-maids. Pergamum, at the time of which I am writing, offered unusually good opportunities for studying disease. Its Asclepieion, which was built during Galen’s boyhood, had already become one of the famous temples of Asia Minor, and the sick and maimed flocked to it in large numbers. Then, in addition, the city was well equipped with able physicians, who appear, according to Neuburger, to have been on very friendly terms with the priests of the temple. It was under the guidance of such men that Galen--at the early age of seventeen, and after a careful training in philosophy, mathematics, etc.--began the study of medicine. He speaks with special interest and respect of one of his instructors, a certain Quintus, who had the reputation of being an excellent anatomist and at the same time one of the most distinguished practitioners of that day. Another anatomist, Styrus, was also one of Galen’s teachers.

On the death of his father Galen left his home and devoted the succeeding nine years to visiting all the different cities in which he believed he might gain some additional knowledge in medicine and surgery. A large part of this long period was spent in Alexandria, which still retained much of its importance as a home of all the sciences. On attaining his twenty-eighth year he left that city and returned to Pergamum, evidently with the purpose of establishing himself there in the regular practice of his profession. Through the influence of the temple officials, and especially of the High Priest, Galen received the appointment of physician to the gladiators, a position which he held with credit for a period of four years, and which afforded him excellent opportunities for cultivating his knowledge of surgery. It was while he was serving in this capacity that he devised and put into practice a method of saturating the dressings (in cases of severe wounds) with red wine, for the purpose of preventing the development of inflammation in the parts affected; and the success which he thus obtained was so great that not one of the gladiators intrusted to his care died from his wounds. History does not state the precise manner in which Galen carried out his method of utilizing wine in the dressing of wounds, and we are therefore unable to determine just how much credit he was entitled to receive for this crude but apparently effective means of securing local antisepsis. It is clear, however, that Galen’s treatment could only have been a modification of a much older method, for Jesus, in his answer to a question put to him by a lawyer, said: “But a certain Samaritan, as he journeyed, came where he (the injured man) was: and when he saw him, he had compassion on him, and went to him, and bound up his wounds, pouring in oil and wine, and set him on his own beast, ...” (St. Luke x., 33, 34).

At the end of four years there broke out in Pergamum a riot which rendered residence there, at least for a certain length of time, undesirable. Accordingly Galen, who was now thirty-two years old, and who was probably glad of an excuse for leaving a place where a physician of his education and talents had so few opportunities for gaining distinction, decided to visit Rome, and--if circumstances appeared to favor the plan--to settle there. His first impressions after arriving in that metropolis were favorable to the plan of establishing himself there permanently, but at the end of a few years he became conscious of the growing hostility of those practitioners who had been for a longer time than he well established in that city. This hostility increased as he rose in favor and esteem with people of position and influence. He had treated skilfully and with success Eudemus, a peripatetic philosopher of great celebrity, for a quartan fever. He had also cured the wife of Boëthus (a patrician who belonged to the consular class) of a serious illness and had received as an expression of appreciation a gift of four hundred pieces of gold. He had won the friendship and esteem of such men as Sergius Paulus, the Praetor; of Barbaras, the uncle of the Emperor Lucius; and of Severus, who was at that time Consul, but who later became Emperor. These very influential men took an active interest in Galen’s scientific work, having been invited by him on more than one occasion to witness his dissections of apes,--dissections which he made for the particular purpose of demonstrating the organs of respiration and of the voice. All these facts soon became known to Galen’s rivals and probably helped to fan the spark of their envy into a flame; but it is very doubtful whether he was justified in saying that the ill feeling thus engendered threatened to end in some act of personal violence, for which reason he decided to leave Rome and return to Pergamum. His secret manner of departure, without taking leave of anybody, and the fact that the Plague was just at that time rapidly approaching Rome, justify the belief, says Neuburger, that it was not fear of personal violence at the hands of his jealous rivals that drove Galen away so mysteriously from the city in which, in the short space of four or five years, he had won so great professional success, but an unwillingness to face his duty, which was, to remain and aid in the approaching fight against the great destroyer--the Plague. If Galen had been a simple physician, one of the great body of medical practitioners in Rome, no one would be disposed to question the justice of the criticism which the distinguished Viennese historian makes of his decision to abandon that city at the moment of her distress and peril. But, as a matter of fact, Galen was not a practitioner of medicine in the full sense of that term. He treated cases of illness because in no other way would it be possible for him to acquire the necessary familiarity with disease; but, almost from the very beginning, he seems to have fully realized that he was destined to devote his time and his energies to a very different kind of professional work,--work which was urgently needed, which promised to be of very great value to medical science, and which probably no other physician then living was competent to do effectively. Furthermore, he was himself profoundly conscious that the work in question constituted the main object of his life. His own words (see his statement with reference to Archigenes, on page 174) show this plainly, and the huge mass of medical treatises which he wrote reveal in the most unmistakable manner with what untiring persistency he pursued the path which he believed it was his duty to follow. It being assumed, then, that such were the motives which actuated Galen, was it a mistake on his part to conclude that duty did not require him to remain in Rome? The question is a difficult one to answer, and I do not feel called upon to decide it. We do not, however, brand a general in the army a coward because he endeavors to protect himself as much as possible from danger during a battle, that he may be able, to the very end, to direct the soldiers under his command. Similarly, was not Galen justified in avoiding every risk which was likely to imperil the performance of duties which were of far greater value to medicine and to humanity at large than that of acting as a mere soldier in the ranks of medical men?

It seems a great pity that one of the most inspiring figures in the history of medicine should be represented to posterity with such a blemish upon his character, and I have therefore ventured to suggest a possible defense of Galen’s action.

Not very long after he had returned to Pergamum, Galen was summoned by the Emperors Marcus Aurelius and Lucius Verus, who were then with the army at Aquileia, a few miles north of the present Trieste, to join them at that city; and he was, of course, obliged to obey. A fresh outbreak of the Plague had occurred and there had already been many fatal cases among the troops. It was therefore decided by the emperors, almost immediately after Galen’s arrival, to return to Rome with a part of the army. A start was accordingly made, and the company had already advanced some distance on their way, when Lucius Verus died. This unexpected event greatly increased the difficulties of the return journey, as it was deemed necessary to carry the remains of the deceased Emperor back to the imperial city. Thus Galen found himself once more settled in Rome, this time in the capacity of private physician to the Emperor Marcus Aurelius and his sons Commodus and Sextus. The position was extremely well adapted to the needs of Galen, who, from that time forward, for a period of several years, had at his disposal ample time for writing and for conducting his experimental work in anatomy and physiology, a privilege of which he appears to have made excellent use. He lived to be seventy years of age, his death occurring during the latter part of the reign of Severus, or at the beginning of that of Caracalla (about 201 A. D.).

All Galen’s critics agree that he possessed his full share of peculiarities,--not to call them by the harsher name of faults. He was constantly ready, for example, to praise his own doings and sayings, and he rarely lost an opportunity of holding up the physicians of Rome to ridicule and contempt. He was specially bitter in his criticisms of Methodism and its adherents--“the donkeys of Thessalus,” as he called them. At the same time, no other physician of ancient or modern times has manifested to an equal degree such extraordinary industry as a writer and original investigator in a great variety of departments of knowledge. Although many of his works have been lost, those which have come down to our time are still very numerous--“a sufficient number,” says Neuburger, “to constitute a library by themselves.” I give here a few of the titles of these works, in order that the reader may get at least some idea of the great variety of medical topics which Galen has discussed in his writings. The more complete list furnished by Daniel Le Clerc contains nearly two hundred titles, and yet even this is believed to fall short of the actual number.

SELECTED LIST OF THE WORKS OF GALEN RELATING TO MEDICINE. (FROM LE CLERC.)

Explanation of some of the Ancient Terms Employed by Hippocrates.

On the Establishment of the Art of Medicine.

Definitions of Medical Terms.

On the Different Sects in Medicine.

Discourse against the Empirics.

On the Importance, for a Physician, of a Thorough training in Philosophy.

The Physician; or Introduction to Medicine.

The Elements, as taught by Hippocrates. (2 books.)

The Different Temperaments. (3 books.)

On the Nature of Man; Commentaries on two Books of Hippocrates. (2 books.)

The Humors.

Do the Arteries Normally contain Blood?

On Black Bile.

On the Bones. (For Students in anatomy.)

Dissection of the Vocal Organs.

The Anatomy of the Eyes.

Dissection of the Veins and Arteries.

Dissection of the Nerves.

On the Utility of the Different parts of the Body. (17 books.)

On the Natural Faculties. (3 books.)

The Sentiments of Hippocrates and of Plato. (9 books.)

The Organ of Smell.

The Movements of the Muscles. (2 books.)

The Physiology of Respiration.

On Obesity.

On the Maintenance of Health. (6 books.)

The Characteristics of Different Foods. (3 books.)

Precepts regarding the Diet best suited to the Four Different Seasons and to Each of the Twelve Months of the Year.

On the Manner of Living best suited to those who Wish to Preserve their Health. (3 books.)

On Habit.

On the Differences between Diseases.

On the Causes of Diseases.

On Marasmus or Consumption.

On the Different Kinds of Fevers. (2 books.)

On Thirst.

On the Parts of the Body Affected. (6 books.)

The Diseases of Women.

The Different Kinds of Pulse. (16 books.)

The Different Kinds of Urine.

On Critical Days. (3 books.)

Commentaries on the Treatises of Hippocrates. (39 books.)

On the Manner of Treating Different Maladies. (17 books.)

On Venesection. (3 books.)

On the Use of Cups, Leeches and Scarifications.

On Purgatives. (3 books.)

On Colic.

On Jaundice.

On Gout.

On Stone in the Bladder.

Etc.

The numerous works of Galen, says Pagel, constitute a complete and very satisfactory encyclopaedia of medicine. The most available edition of his works in Greek is that of Karl Gottlob Kühn of Leipzig (1821–1828; 22 Vols. of about 1000 pages each). There is scarcely a department which this great physician has not treated quite fully. But, unfortunately, the translations into modern languages are relatively few, and they cover only small portions of the entire work. That of Daremberg, entitled “Oeuvres anatomiques, physiologiques et médicales de Galien, etc.” (Paris, 1854–1857; 2 Vols.), is in every way most satisfactory, and it is from this source that I have made a few extracts--just sufficient to give the reader some idea of Galen’s style of writing and of his competency to deal with such subjects as human anatomy and physiology. To attempt anything like a complete exposition of his views regarding pathology, therapeutics, hygiene, etc., would necessitate my devoting more space to this part of the history of medicine than I can afford to give. To those who desire to obtain more ample information about Galen’s views regarding pathology and therapeutics I would recommend a study of Daremberg’s admirable work and a perusal of the careful analysis made by Neuburger of certain portions of Galen’s text.

Galen’s Contributions to Anatomy and Physiology.--At the period of time about which I am now writing, and for many centuries afterward, there existed among all classes of the community a very strong prejudice against dissecting human corpses. And even Galen himself appears to have shared this prejudice, for, in spite of his intense eagerness to gain a more perfect knowledge of human anatomy, he apparently did not dare to undertake any such investigation, even when a favorable opportunity for so doing presented itself, as it did on the occasion to which he refers in the following brief extract taken from one of his treatises:--

A carelessly constructed sepulchre on the banks of a river had been undermined during a season of flood, and the corpse thus set free had floated down stream a short distance, until it finally lodged on the shore of a small cove. Passing near by I had the opportunity of inspecting this corpse. The fleshy parts had already disappeared to a great extent through the process of decomposition, but the bones were still held together by their fibrous connections. The picture presented to the eye was that of a human skeleton specially prepared for the instruction of young physicians. On another occasion, a few steps from the main road, I came across the dead body of a robber who had been killed by the traveler whose money he had attempted to steal. The peasants of that neighborhood were not willing to bury the corpse of such a bad man, and they accordingly allowed it to remain at the spot where it was first discovered. In the course of the following two days, as might be expected, the vultures removed every particle of flesh from the bones, so that, when I saw what remained of the body, the only thing visible was a nicely cleaned skeleton. (Le Clerc: Histoire de la Médecine, p. 711.)

Here were two excellent opportunities for gaining the additional knowledge of human anatomy which Galen so much desired, but he evidently was not at all disposed to avail himself of them--doubtless because his mind was deeply imbued with the feeling that any such interference on his part would be a sacrilegious act. Under the circumstances, therefore, there was nothing left for him to do but to utilize animals for purposes of dissection, and more particularly apes, whose anatomy very closely resembles that of the human being. Several of Galen’s books on anatomy have come down to our time, but quite a number of others have been lost. From those which we possess, and especially from the one entitled “Anatomical Administrations,” it is permissible to conclude that he was a most skilful dissector and an extremely close and careful observer, and that he was very particular to set down the results of his observations in admirably clear language. Indeed, Le Clerc assures us that Vesalius, the great Flemish anatomist of the sixteenth century, bestowed high praise upon Galen’s anatomical descriptions; and that, too, notwithstanding the fact that the latter sometimes erred in his statements regarding the similarity between certain parts observed in dissections of an animal and the corresponding parts in man. In one of his treatises Galen states distinctly that the arteries contain blood. In another he gives a remarkably full and accurate description of the nervous system, including the brain, spinal cord, and many of the nerves.

He describes the optic nerve, the oculo-motorius and trochlearis, the different ramifications of the trigeminus, the acusticus and facialis, the vagus and glossopharyngeus, the nerves of the pharynx and larynx, the sympatheticus (with the accompanying ganglia), and the radial, ulnar, median, crural and ischiatic nerves. (Puschmann.)

Although it is true that certain important anatomical and physiological facts are found recorded for the first time in the works of Galen, this must not be accepted as evidence that Galen himself is the real discoverer of these facts. The most that can be claimed for him is that he is the first writer to bring the facts in question to the knowledge of us moderns. When the ancient books that have been lost are once more brought to light, as they very well may be at any time, we shall be able, perhaps, to give credit where credit is due. But there is one department in which Galen did experimental work of an entirely original character and for which he deserves unstinted praise. I refer to the experiments which he made concerning the physiology of the brain and spinal cord. They are related in the following extract, which has been translated from the account given by Neuburger (op. cit., Vol. I., p. 380):--

The brain itself is not sensitive; it expands and contracts synchronously with the respiratory movements, the purpose of which action is to drive the pneuma from the cavities of that organ into the nerves. The function of the meninges is to hold the parts firmly together and to unite the blood-vessels. Pressure upon the brain causes stupor. An injury of the tissues surrounding the fourth ventricle or of those which constitute the beginning of the spinal cord produces death. The seat of the soul is in the substance of the brain, and not in its membranes. The spinal cord serves as a conductor of sensation and of motor impulses, and it also plays the part of a brain for those structures of the body which lie below the head. It gives off nerves like streamlets. Division of the spinal cord longitudinally in its median axis does not give rise to paralysis. Transverse division, on the other hand, causes symmetrical paralyses. If the cord is divided between the third and fourth cervical vertebrae, respiration is arrested, and if the division is made between the cervical and the thoracic portions of the spinal column, the animal breathes with the aid only of its diaphragm and of the upper muscles of the trunk of the body. Division of the recurrent nerves produces aphonia; if the fifth cervical nerve is divided, the scapular muscles on the corresponding side will be paralyzed. Galen considers the ganglia to be organs for reinforcing the energy of the nerves. The fact that both cerebral and spinal-cord nerve-filaments enter into the composition of the sympathetic nerve explains the extraordinary sensitiveness of the abdominal organs.

When we consider that these experiments are the first of their kind of which history makes mention, that they were carried out nearly seventeen hundred years ago, and that--so far as we know--they sprang entirely from the brain of the experimenter, we may well express unlimited admiration for Claudius Galen.

Daniel Le Clerc says that Galen’s principal treatise on human physiology, entitled “Utility of the Different Parts of the Human Body,” constitutes a chef-d’oeuvre which has challenged the admiration of physicians and philosophers in all ages. Christians, however, he adds, are particularly gratified to learn from this work that “Galen, although classed as a Pagan, unhesitatingly recognizes that it was an all-wise, an all-powerful, an all-good God who created man and all the other animals.” Further on, Le Clerc refers to another statement which was made by Galen and which will be found on page 261 of Daremberg’s version. It reads as follows:--

If I were to spend any more time in talking about such brutes--by which term he designates men who cannot appreciate the wisdom of God in distributing the different parts of the body in the manner in which He has done this--I should justly incur the blame of sensible persons. They would accuse me of desecrating the account which I am writing, an account which is intended as a hymn of sincere praise of the Creator of man. I believe that true piety consists, not in sacrificing numberless hecatombs nor in burning unlimited quantities of incense and a thousand perfumes, but in first searching out and then making known to my fellow men how great are the wisdom, the power, and the goodness of the Creator.

Galen’s work on “The Utility of the Different Parts of the Human Body” is composed of seventeen books, all of which exist to-day in a complete state. Taken together they form, as may be seen by the following list of contents, a remarkably complete treatise on physiology. Books I. and II. are devoted to the hand, forearm and arm (105 pages); Book III. to the thigh, leg and foot (62 pages); Books IV. and V. to the alimentary organs and their accessories (101 pages); Book VI. to the respiratory organs (78 pages); Book VII. to the organs of the voice (67 pages);