Galen

Courtesy: National Library of Medicine.

Succeeding Hippocrates, the honor of most illustrious historical figure in rational Western medicine goes to Galen, born to a wealthy family in the prosperous city of Pergamum in Asia Minor (now Bergama in Turkey) ca. 130 CE, almost 600 years after the birth of Hippocrates of Cos. Galen regarded himself as the intellectual heir of Hippocrates, and like Hippocrates took as fundamental the idea that understanding disease required understanding the workings of the human body. He performed experiments, dissected animals, and gave many popular public lectures and demonstrations of animal dissections.

Galen taught us much of what we know about Hippocrates and he advanced knowledge of the formation and excretion of urine, of the mechanisms of speech and respiration, and of the action of nerves and muscles. He left posterity 22 volumes of work.

Galen had no deficiency of hubris. He boasted that his voluminous writings contained all one needed ever to know about medicine.

Interestingly, Galen was also a philosopher, and his works repeatedly stress that to be the best physician, one should also be a philosopher.

He remained a highly influential figure for the next 1400 years, to such an extent as to stifle further advances in the discovery of anatomy, physiology and the pathogenesis of disease during that period. His ideas influenced medical thinking even until the 20th century. "At least until the 16th and 17th centuries, to know medicine was to know it as Galen wrote about it in the 2nd century." Medical historian, Vivian Nutton writes:

....many of his [Galen's] views were not unique to him, but the forceful way in which he developed them and decried others, his frequent claims for the superiority of this or that technique or intellectual methodology, and the sheer power and prolixity of his writings impressed a Galenic stamp on subsequent medicine in Byzantium, the Middle East and the mediaeval West.

That produced something of a set-back in the development of Western rational medicine, the remedy beginning with the father of 'modern' human anatomy, Andreas Vesalius.

The classicist and Greek-to-English translator of many of Galen’s writings, Peter Singer, cautions us against blaming Galen as if he was "....endowed with the capacity posthumously to bully his posterity, for the uncritical attitude towards him of his successors." One can appreciate Singer’s caution best in context:

If the name of Galen is mentioned at all today, it is seldom in tones of respect. His medical system is an outdated curiosity; his was the terrible dogmatism that held up the course of scientific research for centuries....But such judgements....are based upon a misconception as well as a fallacy: the former, to confuse Galenism—the regimented system of thought solidified in the Schools—with Galen; the latter, to blame Galen, as if endowed with the capacity posthumously to bully his posterity, for the uncritical attitude towards him of his successors. Galen lived in a period of public debate and conflict, of an almost chaotic intellectual diversity; a period as far removed from medieval systematization as from the scientific orthodoxy of our own time and, considered within that period, emerges as one of the most philosophically intriguing, and not just historically important, figures of antiquity.

Galen’s reputation during his lifetime spread throughout the Roman Empire. He eventually became the personal physician of the Roman Emperor, Marcus Aurelius (b. 121 CE, d. 180 CE; r. 161-180 CE).

The early Galen

Galen entered the world in Pergamon, a provincial city, extant in present day Turkey. Pergamon had existed before the time of Alexander the Great, and became a center of culture. It had a famous library containing some 200,000 books. Galen’s father, a wealthy architect, steered his son into a career in medicine following a ‘Hippocratic’ dream so advising him. He sent Galen to the Hippocratic school in Pergamon, a part of the Roman Empire. Galen’s interests, attested to in his own writings, included mathematics and philosophy, which he maintained and incorporated in his work throughout his career, as well as the writings of the Hippocratic physicians and of the history of medicine from before and after Hippocrates. Afterwards, in 152 CE, in his early 20s, Galen continued to study medicine in Alexandria, returning six years later, to become surgeon to the gladiators in the amphitheater at Pergamon. There he treated gladiators with all kinds of open wounds, of the head, chest, abdomen, muscles, and bones. Glimpsing the various parts of the interior of the body, he began to wonder how they worked and how they worked together — musing about function, or physiology.

Later influence

Galen, along with Hippocrates, is one of the most prominent names in early medicine. After Galen's death, his works were widely disseminated in the Greek-speaking parts of the Roman empire, and the works of Galen were a touchstone for medical researchers in Constantinople and Alexandria.

In the eighth and ninth centuries, scholars working under the Abbasid caliphate began to translate the works of Galen into Syriac and then Arabic. The physicians and philosophers under the caliphate had access to the full range of Galen's works (including some which have not survived). Under the caliphs, Galen came to be regarded as foremost among medical writers but unremarkable as a philosopher. Though some of this may have been because Galen was a pagan who, for example, expressed doubts about the immortality of the soul, most of this can be attributed to the greater prestige of Aristotle.

In the Latin West during the medieval period, most of Galen's output was never very widely known. With the rise of medicine in the schools and universities of the high and late medieval period, Galen did become a prominent figure in medical scholarship. One of his treatises became part of the Articella, the standard medical textbook in the high and late middle ages.

In the Renaissance, in the 14th and 15th centuries, the study and practice of medicine were greatly influenced by the prominence of humanist study. A wider range of Galen's works became available, and in the original Greek. Galen and Hippocrates both became revered as classical authors, and to some extent, educated Renaissance physicians were more preoccupied with textual study than with medical practice.

In the course of the 16th and 17th centuries, Galen's star began to wane. Galen had only dissected Barbary Macaques, and his inferences about human anatomy began to be proven wrong. Interestingly, the Hippocratic corpus did not fall out of fashion: "Apart from pulse theory, Galen could not compete with the richness of Hippocratic clinical observations with their appearance of being less tied to theory."