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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 encyclopaedia of the medical knowledge of his time and as a review of
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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 AEsculapius. 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


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 L350 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."[23]

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.


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.


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.


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.


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."


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 AEgineta 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."[24]

"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."[25]

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.


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.[26]


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 encyclopaedic 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.