Sir James Elliott

His life and works — His influence on Medicine.

Claudius Galenus, commonly known as Galen, has influenced the progress of medical science by his writings probably more than any other medical writer. His influence was paramount for fourteen centuries, and although he made some original contributions, his works are noteworthy mainly as an encyclopÆdia of the medical knowledge of his time and as a review of the work of his predecessors. There is a great deal of information in his books about his own life. He was born at Pergamos in A.D. 130 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 example and instruction, and at the age of 15 was taught by philosophers of the Stoic, Platonist, Peripatetic, and Epicurean schools. He became initiated, writes Dr. Moore, into "the idealism of Plato, the realism of Aristotle, the scepticism of the Epicureans, and the materialism of the Stoics." At the age of 17 he was destined for the profession of medicine by his father in consequence of a dream. He studied under the most eminent men of his day. He went to Smyrna to be a pupil of Pelops, the physician, and Albinus the platonist; to Corinth to study under Numesianus; to Alexandria for the lectures of Heraclianus; and to Cilicia, Phoenicia, Palestine, Crete, and Cyprus. At the age of 29 Galen returned from Alexandria to Pergamos (A.D. 158), and was appointed doctor to the School of Gladiators, and gained much distinction.

He went to Rome for the first time in A.D. 163-4, and remained for four years; and during this period he wrote on anatomy and on the teaching of Hippocrates and Plato. He acquired great fame as a practitioner and, if he had so desired, might have attended the Emperor; but it is probable that Galen thought that the office of physician to the Emperor might prevent him from leaving Rome if he wished to do so. He also gave public lectures and disputations, and was called not only the "wonder-speaker" but the "wonder-worker." His success gave rise to envy, and he was afraid of being poisoned by his less successful rivals. The reason why he left Rome is not certain, and the possible causes of his departure are discussed by Dr. Greenhill in the "Dictionary of Greek and Roman Biography and Mythology." A pestilence raged in Rome at this time, but it is unlikely that Galen would have deserted his patients for that reason. Probably he disliked Rome, and longed for his native place. He had been in Pergamos only a very short time when he was summoned to attend the Emperors Marcus Aurelius and L. Verus in Venetia. The latter died of apoplexy on his way home to Rome, and Galen followed Marcus Aurelius to the capital. The Emperor soon thereafter set out to prosecute the war on the Danube, and Galen was allowed to remain in Rome, as he had stated that such was the will of Æsculapius. The Emperor's son Commodus was placed under the care of Galen during the father's absence, and at this time also (A.D. 170) Galen prepared the famous medicine theriaca for Marcus Aurelius, who took a small quantity daily. The Emperor Septimius Severus employed the same physician and the same medicine about thirty years afterwards. It is recorded that the philosopher Eudemius was successfully treated by Galen for a severe illness caused by an overdose of theriaca, and that the treatment employed was the same drug in small doses.

Galen stayed several years in Rome, and wrote and practised as on his former visit. He again returned to Pergamos, and probably was in Rome again at the end of the second century. It is certain he was still alive in the year 199, and probably lived in the reign of the Emperor Caracalla.

He was not only a great physician, but a man of wide culture in every way. In matters of religion he was a Monotheist. There 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, quoted by his Arabian biographers, Galen praises highly the love of virtue of the Christians.

He no doubt found the practice of medicine lucrative when he had gained pre-eminence, and it is recorded that he received £350 for curing the wife of Boetius, the Consul.

Galen wrote no less than five hundred treatises, large and small, mostly on medical subjects, but also on ethics, logic, and grammar. His style is good but rather diffuse, and he delights in quoting the ancient Greek philosophers. Before his time, as we have seen, there were disputes between the various medical sects. The disciples of Dogmatism and of Empiricism had been opposed to each other for several centuries, and the Eclectics, Pneumatists, and Episynthetics had arisen shortly before his time. Galen wrote against slavish attachment to any sect, but "in his general principles he may be considered as belonging to the Dogmatic sect, for his method was to reduce all his knowledge, as acquired by the observation of facts, to general theoretical principles. These principles he, indeed, professed to deduce from experience and observation, and we have abundant proofs of his diligence in collecting experience, and his accuracy in making observations; but still in a certain sense at least, he regards individual facts and the details of experience as of little value, unconnected with the principles which he had laid down as the basis of all medical reasoning. In this fundamental point, therefore, the method pursued by Galen appears to have been directly the reverse of that which we now consider as the correct method of scientific investigation; and yet, such is the force of natural genius, that in most instances he attained the ultimate object in view, 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 expound his doctrines, and support them by new facts and observations. Yet, in reality, we have few writers whose works, both as to substance and manner, are more different from each other than those of Hippocrates and Galen, the simplicity of the former being strongly contrasted with the abstruseness and refinement of the latter."[1]

A list of the various editions of Galen's works is given in Dr. Smith's "Dictionary of Greek and Roman Biography and Mythology" (1890 edition, vol. ii, pp. 210-12), and also the titles of the treatises classified according to the branch of medical science with which they deal, and it is convenient to follow this classification.

I.—Works on Anatomy and Physiology.

Galen insisted upon the study of anatomy as essential, and in this respect was in conflict with the view held by the Methodists and the Empirics who believed that a physician could understand diseases without any knowledge of the exact structure of the body. His books on anatomy were originally fifteen in number. The last six of these are now extant only in an Arabic translation, two copies of which are preserved in the Bodleian Library at Oxford.

The directions he gives for dissection show that he was a master of the art. In dissecting out the portal vein and its ramifications, for instance, he advises that a probe should be inserted into the vein, and the point of the probe gradually advanced as the surrounding tissue is cut away, so that finally the minute branches are exposed; and he describes the use of the blowpipe, and other instruments used in dissection. He carried out the experiment of tying the iliac and axillary 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 even the carotid arteries could be tied without causing death. He also pointed out that tying the carotid artery did not cause loss of voice, but that tying the artery carelessly so as to include the nerve had this effect. He was the first to describe the ductus arteriosus, and the three coats of the arteries.

It is highly improbable that Galen dissected human bodies in Rome, though he dissected a great variety of the lower animals. He writes that the doctors who attended Marcus Aurelius in the German wars dissected the dead bodies of the barbarians. The 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 advance of physiology by recognizing that every part of the body exists for the purpose of performing a definite function. Aristotle, like Plato, had taught that "Nature makes nothing in vain," and Galen's philosophy was greatly influenced by the teaching of Aristotle. Galen regarded his work as "a religious hymn in honour of the Creator, who has given proof of His Omnipotence in creating everything perfectly conformable to its destination."

He regarded the structure of various parts, such as the hand and the membranes of the brain, as absolute perfection, although his idea of the human hand was derived 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 criticize his conclusions because of his failure to recognize a few comparatively unimportant details. He discovered the function of the motor nerves by cutting them experimentally, and so producing paralysis of the muscles; the platysma, interossei, and popliteus muscles were first described by him. He was the greatest authority on the pulse, and he recognized that it consisted of a diastole (expansion) and a systole (contraction) with an interval after the diastole, and another after the systole. Aristotle 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 discovery of the circulation. He described the heart as having the appearance of a muscle, and considered it the source of natural heat, and the seat of violent passions. He knew well the anatomy of the human skeleton, and advised students to go to Alexandria where they might see and handle and properly study the bones. He recognized 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 off humours from the brain into the nose. But some of this air remained and combined with the vital spirits in the anterior ventricles of the brain, and finally exuded from the fourth ventricle, the residence of the soul. Aristotle had taught that the heart was the seat of the soul, and the brain relatively unimportant.

II.—Works on Dietetics and Hygiene.

Galen was a strong advocate of exercises and gymnastics, and eulogizes hunting specially. He recommends cold baths for people in the prime of life. As 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 required three meals a day, others two meals. He had a very 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 believed in the doctrine of the four elements, and his speculations led him into a belief in a further subdivision. "Fire is hot and dry; air is hot and moist; for the air is like a vapour; water is cold and moist, and earth is cold and dry." He held that there were three principles in man—spirits, solids, and humours—and eight temperaments ranging between health and disease and compatible with life. He retained a good deal of the teaching of the Pneumatic school, and believed that the pneuma was different from the soul, but the vehicle for the interaction of soul and body. From his theory of the action of the air through the nose on the contents of the ventricles of the brain is explained his use of sternutatories, and his belief in the efficacy of sneezing. Galen's classification of inflammations shows that his pathology was not nearly so accurate as his anatomy and physiology. He described (a) simple inflammation caused by excess of blood alone; (b) inflammation the result of excess of both pneuma and blood; (c) erysipelatous inflammation when yellow bile gains admission, and (d) scirrhous or cancerous when phlegm is present. He did good service by dividing the causes of disease into remote and proximate, the former subdivided into two classes—predisposing and exciting.

IV.—On Diagnosis.

He relied greatly on the doctrine of "critical days," which were thought to be influenced to some extent by the moon. His studies of the pulse were very useful to him in diagnosis. No doubt, he was an expert diagnostician mainly owing to his long, varied, and costly medical education, and his great natural powers of judgment. He asserted that with the help of the Deity he had never been wrong, but even his most ardent admirers would not be wanting in enthusiasm if they amended "never" into "hardly ever."

V.—On Pharmacy, Materia Medica, and Therapeutics.

In these subjects Galen was not as proficient as Dioscorides, whose teaching he adopted with that of other medical authors. In Galen's works there are lengthy lists of compound medicines, several medicines being recommended for the same disease, and never with very marked confidence. He paid high prices for various 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 Rome. Medicines were classified by him according to their qualities, by which he meant, not their therapeutic effects, but their inherent dryness or moistness, coldness or heat. A medicine might be cold in the first degree, and not in the second degree. Paulus Ægineta followed this strange and foolish doctrine of Galen very closely, as the following extracts from his book on Materia Medica will show:—

"Cistus (rock-rose).—It is an astringent shrub of gently cooling powers. Its leaves and shoots are so desiccative as to agglutinate wounds; but the flowers are of a more drying nature, being about the second degree; and hence, when drunk, they cure dysenteries and all kinds of fluxes."[2]

"Ferrum (iron).—When frequently extinguished in water, it imparts a considerable desiccative power to it. When drunk, therefore, it agrees with affections of the spleen."[3]

Many features, however, of Galen's teaching and practice of therapeutics are worthy of praise. He enunciated two fundamental principles: (1) That disease is something contrary to Nature, and is to be overcome by that which is contrary "to the disease itself"; and (2) that Nature is to be preserved by what has relation with Nature. He recognized that while the invading disease was to be repelled, the strength and constitution of the patient should be preserved, and that in all cases the cause of the disease was to be treated and not the symptoms. Strong remedies should not be used on weak patients.

VI.—Surgery.

Galen conformed to the custom of the physicians in Rome, and did not practise surgery to any extent, although he used the lancet in phlebotomy, and defended this practice against the followers of Erasistratus in Rome. He is said to have resected a portion of the sternum for caries, and also to have ligatured the temporal artery.[4]

VII.—GynÆcology.

Galen had little more than a superficial knowledge of this subject, and was quite ignorant of the surgery of diseases of women. He was not so well informed as Soranus was as to the anatomy of the uterus and its appendages, but deserves credit for having been better acquainted with the anatomy of the Fallopian tubes than his predecessors. He had erroneous views on the causation of displacements of the uterus. Several of the books inaccurately attributed to the authorship of Galen deal with the medical treatment of various 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 acquainted with other branches of knowledge besides medicine. As a philosopher he has been quoted in company with Plato and Aristotle, and his philosophical writings were greatly used by Arabic authors. In philosophy, as in medicine, he had studied the teachings of the various schools of thought, and did not bind himself to any sect in particular. He disagreed with the Sceptics in their belief that no such thing as certainty was attainable, and it was his custom in cases of extreme difficulty to suspend his judgment; for instance, in reference to the nature of the soul, he wrote that he had not been able to come to a definite opinion.

Galen mentions the discreditable conduct of physicians at consultations. Sometimes several doctors would hold a consultation, and, apparently forgetting the patient for the time, would hold violent disputations. Their main object was to display their dialectical skill, and their arguments sometimes led to blows. These discreditable exhibitions were rather frequent in Rome in his time.

With 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 wrote: "No one before me has given the true method of treating disease: Hippocrates, I confess, has heretofore shown the path, but as he was the first 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 very little of complicated diseases; in a word, he has only sketched what another was to complete; 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 extent.

It is a speculation of much interest how it was that Galen's views on Medicine received universal acceptance, and made him the dictator in this realm of knowledge for ages after his death. He was not precisely a genius, though a very remarkable man, and he established no sect of his own. The reason of his power lay in the fact that his writings supplied an encyclopÆdic knowledge of the medical art down to his own time, with commentaries and additions of his own, written with great assurance and conveying an impression of finality, for he asserted that he had finished what Hippocrates had begun. The world was tired of political and philosophical strife, and waiting for authority. The wars of Rome had resulted in placing political power in the hands of one man, the Emperor; the disputations and bickerings of philosophers and physicians produced a similar result, and Galen, in the medical world was invested with the purple.

The effect, therefore, of Galen's writings was, at first, to add to and consolidate medical knowledge, but his influence soon became an obstacle to progress. Even in the sixteenth and seventeenth centuries, Galenism held almost undisputed sway.

The house of Galen stood opposite the Temple of Romulus in the Roman Forum. This temple, in A.D. 530, was consecrated by Pope Felix IV to the honour of the saints, Cosma and Damiano, two Arabian anargyri (unpaid physicians) who suffered martyrdom under Diocletian.

The date of Galen's death is not exactly known, but was probably A.D. 200.