Book Xii. to the Neck and the Rest of the Spinal Column (46 Pages);

Book XIII. to the shoulder and the structure of the spinal column in detail (40 pages); Books XIV. and XV. to the genital organs and the parts in which the foetus develops (70 pages); Book XVI. to the nerves, arteries and veins (43 pages); and Book XVII. Epilogue (11 pages).

There are very few modern text books in which the author treats the subject in as exhaustive a manner as Galen has done in these seventeen books. As may readily be imagined from the great number and length of his writings, he often wanders off into side issues and thus lays himself open to the charge of being a diffuse writer. At the same time he cannot be accused of dullness, for in reading Daremberg’s version one is seldom tempted to omit any of the text, and his style is interesting. The following brief extracts, to which should be added that given on a previous page, may be taken as fair samples of his manner of treating questions in the department of physiology:--

Reasons why the Alae Nasi are Cartilaginous and why they may be Moved by Voluntary Muscular Action.--We have already explained in some measure the reasons why the alae nasi should be composed of cartilage and why it should be possible for the animal to move them at will. It is an established fact that the movements of these parts are competent to aid in no small degree the somewhat forcible inspirations and expirations. This is the reason why the alae are constructed in such a manner as to be easily movable. They are made of cartilage because this substance is hard to fracture or to tear apart. The placing of these alar movements under the control of the will, and not under that of some other bodily force (like the arterial impulse, for example), is certainly an excellent arrangement; and, if one does not appreciate this without any further explanation, it must be because my previous reasonings about such matters have fallen upon inattentive ears.

(Translated from Book XI., Chapter XVII., of Daremberg’s French version of Galen’s works.)

Another brief extract may be given here. It forms a part of the chapter relating to the action of the sigmoid valves of the pulmonary artery, etc., and merits special attention because it furnishes additional evidence of the correctness of Daremberg’s statement that Galen was the leader of the most advanced school of experimentation:--

The more strongly the thorax, in its exertion of a compressing force, tends to drive the blood (out of the heart), the more tightly do these membranes (the sigmoid valves) close the opening. Invested in a circular manner from within outward, extending throughout the entire circumference of the interior of the vessel, these membranous valves are, each one of them, so accurately patterned and so perfectly fitted that when they are put upon the stretch by the column of blood, they constitute a single large membrane which closes (watertight) the orifice. Pushed back by the return flow of the blood, they fall back against the inner surface of the vein, and permit an easy passage of the blood through the amply dilated orifice (which they, an instant before, closed so perfectly).

(Translated from Book VI., Chapter XI., of Daremberg’s French version of the works of Galen.)

In his comments upon the account of the sigmoid valves which I have just quoted, Daremberg says that the description of these structures given by Erasistratus at least four hundred years earlier is admitted by Galen to be so correct that it would scarcely be possible to furnish a better one.

Galen’s Remarks upon the Subject of Diagnosis.--In the treatise entitled “On the parts of the Body Affected” (Book II., Chapter X.) Galen gives the following advice with regard to the method which it is desirable to adopt when one wishes to ascertain which part or organ is affected, what is the nature of the disease there located, and whether it is primary in its nature or secondary to some affection of earlier development:--

It should have been the special duty of Archigenes, who appeared on the scene next in order after a series of the most illustrious physicians, to infuse more light into medical teaching. Unfortunately, he did the very opposite; for we who have grown old in the exercise of the art (and should therefore find it easy to comprehend what is written about medicine), are at times unable to understand what he says. Such being the true state of affairs, I now propose to undertake what Archigenes failed to accomplish. I shall commence by indicating in a general way what is the proper method to adopt when one wishes to ascertain in what part or organ the disease is located and how one should proceed when it is proposed to teach the method to others. This method may be stated in the following terms:--

In the first place, the part should be carefully examined in order that we may ascertain whether it presents any signs of special value as indicating the nature of the disease. In the next place, it is important in such an examination to know beforehand what are the particular signs which belong to each of the diseases that may affect the part or organ in question, and also whether these signs vary according to the particular section of the organ involved. In inflammation of the lung, for example, there are: difficulty in breathing (dyspnoea) and great general distress (malaise), the patient being obliged to remain in a sitting posture (orthopnoea)--all of which are signs indicating the possibility of suffocation. Furthermore, the air expired from the infected lung is sensibly hot, especially if the inflammation is of the erysipelatous variety, and, as a consequence, the patient shows a disposition to draw long breaths, knowing that the cold air which he thus draws into his lungs will afford him some measure of relief. The sputa expectorated when he coughs are differently colored; some being red, yellowish, or of a rusty appearance, while others are almost black, livid, or frothy. The patient also often experiences the sensation of a heavy weight in his chest, together with more or less pain, which seems to be located deep down in that region and which shoots backward into his spinal column or forward toward the sternum. Add to these manifestations a high fever and a pulse such as we have already described on another page, and you will have....

(Translated from Daremberg’s French version of Galen’s works.)

It has been said that Galen possessed more than the ordinary share of vanity with regard to his cleverness as a diagnostician; and certainly some of the accounts which he gives, in his clinical and scientific treatises, of his own experiences, seem to bear out this accusation. One hesitates to expose the weak spots in the character of one of the really great men of antiquity lest such exposure may convey a wrong impression; at the same time it would be an error to represent him as a man entirely free from the foibles common to humanity,--even to the best and wisest of men. I therefore repeat here Galen’s own account of a professional visit which he made to a brother physician whose malady presented to himself and to his friends many obscure features.

Upon the occasion of my first visit to Rome I completely won the admiration of the philosopher Glaucon by the diagnosis which I made in the case of one of his friends. Meeting me one day in the street he shook hands with me and said: “I have just come from the house of a sick man, and I wish that you would visit him with me. He is a Sicilian physician, the same person with whom I was walking when you met me the other day.” “What is the matter with him?” I asked. Then coming nearer to me he said, in the frankest manner possible: “Gorgias and Apelas told me yesterday that you had made some diagnoses and prognoses which looked to them more like acts of divination than products of the medical art pure and simple. I would therefore like very much to see some proof, not of your knowledge but of this extraordinary art which you are said to possess.” At this very moment we reached the entrance of the patient’s house, and so, to my regret, I was prevented from having any further conversation with him on the subject and from explaining to him how the element of good luck often renders it possible for a physician to give, as it were off-hand, diagnoses and prognoses of this exceptional character. Just as we were approaching the first door, after entering the house, we met a servant who had in his hand a basin which he had brought from the sick room and which he was on his way to empty upon the dung heap. As we passed him I appeared not to pay any attention to the contents of the basin, but at a mere glance I perceived that they consisted of a thin sanio-sanguinolent fluid, in which floated excrementitious masses that resembled shreds of flesh--an unmistakable evidence of disease of the liver. Glaucon and I, not a word having been spoken by either of us, passed on into the patient’s room. When I put out my hand to feel of the latter’s pulse, he called my attention to the fact that he had just had a stool, and that, owing to the circumstance of his having gotten out of bed, his pulse might be accelerated. It was in fact somewhat more rapid than it should be, but I attributed this to the existence of an inflammation. Then, observing upon the window sill a vessel containing a mixture of hyssop and honey and water, I made up my mind that the patient, who was himself a physician, believed that the malady from which he was suffering was a pleurisy; the pain which he experienced on the right side in the region of the false ribs (and which is also associated with inflammation of the liver) confirming him in this belief, and thus inducing him to order for the relief of the slight accompanying cough the mixture to which I have just called attention. It was then that the idea came into my mind that, as fortune had thrown the opportunity in my way, I would avail myself of it to enhance my reputation in Glaucon’s estimation. Accordingly, placing my hand on the patient’s right side over the false rib, I remarked: “This is the spot where the disease is located.” He, supposing that I must have gained this knowledge by simply feeling his pulse, replied with a look which plainly expressed admiration mingled with astonishment, that I was entirely right. “And”--I added simply to increase his astonishment--“you will doubtless admit that at long intervals you feel impelled to indulge in a shallow, dry cough, unaccompanied by any expectoration.” As luck would have it, he coughed in just this manner almost before I had got the words out of my mouth. At this Glaucon, who had hitherto not spoken a word, broke out into a volley of praises. “Do not imagine,” I replied, “that what you have observed represents the utmost of which medical art is capable in the matter of fathoming the mysteries of disease in a living person. There still remain one or two other symptoms to which I will direct your attention.” Turning then to the patient I remarked: “When you draw a longer breath you feel a more marked pain, do you not, in the region which I indicated; and with this pain there is associated a sense of weight in the hypochondrium?” At these words the patient expressed his astonishment and admiration in the strongest possible terms. I wanted to go a step farther and announce to my audience still another symptom which is sometimes observed in the more serious maladies of the liver (scirrhus, for example), but I was afraid that I might compromise the laudation which had been bestowed upon me. It then occurred to me that I might safely make the announcement if I put it somewhat in the form of a prognosis. So I remarked to the patient: “You will probably soon experience, if you have not already done so, a sensation of something pulling upon the right clavicle.” He admitted that he had already noticed this symptom. “Then I will give just one more evidence of this power of divination which you believe that I possess. You, yourself, before I arrived on the scene, had made up your mind that your ailment was an attack of pleurisy, etc.”

Glaucon’s confidence in me and in the medical art, after this episode, was unbounded.

Thirty or forty years elapsed after Galen’s death before the Profession began to realize how great an authority he had become in all matters relating to medicine; not perhaps among the majority of physicians, but among the better educated and those more given to reasoning about the various problems in physiology and pathology. Then came the invasion of Rome by the Barbarians, and with it the scattering of nearly all those who were at the time practicing medicine in that great city. This was the beginning of the long period known as the Middle Ages, a period during which, so far as Italy and Gaul were concerned, the science of medicine made no advance whatever. The physicians living in a precarious manner in the towns, and the monks who practiced medicine in the country districts, took very little interest, as may readily be imagined, in the achievements of Galen. Through all those years they clung to the doctrines of the Methodists, as revealed to them in the work of Caelius Aurelianus, the favorite medical treatise of that period. It was only during the latter part of the Middle Ages that Galen’s teachings began once more to be appreciated at their true value; and, as time went on, they gained a stronger and stronger hold on the minds of medical men, until finally they held undisputed sway. Friedlaender, speaking of medicine in those dark times, uses these words: “Galen’s colossal personality loomed up throughout that long night as a brilliant guiding star to light the intricate pathways of medicine.”