The Evolution of Modern Medicine: Chapter II - GALEN

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GALEN

PERGAMON has become little more than a name associated in our memory with the fulminations of St. John against the seven churches of Asia; and on hearing the chapter read, we wondered what was "Satan's seat" and who were the "Nicolaitanes" whose doctrine he so hated. Renewed interest has been aroused in the story of its growth and of its intellectual rivalry with Alexandria since the wonderful discoveries by German archaeologists which have enabled us actually to see this great Ionian capital, and even the "seat of Satan." The illustration here shown is of the famous city, in which you can see the Temple of Athena Polis on the rock, and the amphitheatre. Its interest for us is connected with the greatest name, after Hippocrates, in Greek medicine, that of Galen, born at Pergamon A. D. 130, in whom was united as never before—and indeed one may say, never since—the treble combination of observer, experimenter and philosopher. His father, Nikon, a prosperous architect, was urged in a dream to devote his son to the profession of medicine, upon which study the lad entered in his seventeenth year under Satyrus. In his writings, Galen gives many details of his life, mentioning the names of his teachers, and many incidents in his Wanderjahre, during which he studied at the best medical schools, including Alexandria. Returning to his native city he was put in charge of the gladiators, whose wounds he said he treated with wine. In the year 162, he paid his first visit to Rome, the scene of his greatest labors. Here he gave public lectures on anatomy, and became "the fashion." He mentions many of his successes; one of them is the well-worn story told also of Erasistratus and Stratonice, but Galen's story is worth telling, and it is figured as a miniature in the manuscripts of his works. Called to see a lady he found her suffering from general malaise without any fever or increased action of the pulse. He saw at once that her trouble was mental and, like a wise physician, engaged her in general conversation. Quite possibly he knew her story, for the name of a certain actor, Pylades, was mentioned, and he noticed that her pulse at once increased in rapidity and became irregular. On the next day he arranged that the name of another actor, Morphus, should be mentioned, and on the third day the experiment was repeated but without effect. Then on the fourth evening it was again mentioned that Pylades was dancing, and the pulse quickened and became irregular, so he concluded that she was in love with Pylades. He tells how he was first called to treat the Emperor Marcus Aurelius, who had a stomach-ache after eating too much cheese. He treated the case so successfully that the Emperor remarked, "I have but one physician, and he is a gentleman." He seems to have had good fees, as he received 400 aurei (about 2000) for a fortnight's attendance upon the wife of Boethus.

He left Rome for a time in 168 A. D. and returned to Pergamon, but was recalled to Rome by the Emperor, whom he accompanied on an expedition to Germany. There are records in his writings of many journeys, and busy with his practice in dissections and experiments he passed a long and energetic life, dying, according to most authorities, in the year 200 A.D.

A sketch of the state of medicine in Rome is given by Celsus in the first of his eight books, and he mentions the names of many of the leading practitioners, particularly Asclepiades, the Bithynian, a man of great ability, and a follower of the Alexandrians, who regarded all disease as due to a disturbed movement of the atoms. Diet, exercise, massage and bathing were his great remedies, and his motto—tuto, cito et jucunde—has been the emulation of all physicians. How important a role he and his successors played until the time of Galen may be gathered from the learned lectures of Sir Clifford Allbutt(32) on "Greek Medicine in Rome" and from Meyer-Steineg's "Theodorus Priscianus und die romische Medizin."(33) From certain lay writers we learn that it was the custom for popular physicians to be followed on their rounds by crowds of students. Martial's epigram (V, ix) is often referred to:

And in the "Apollonius of Tyana" by Philostratus, when Apollonius wishes to prove an alibi, he calls to witness the physicians of his sick friend, Seleucus and Straloctes, who were accompanied by their clinical class to the number of about thirty students.(34) But for a first-hand sketch of the condition of the profession we must go to Pliny, whose account in the twenty-ninth book of the "Natural History" is one of the most interesting and amusing chapters in that delightful work. He quotes Cato's tirade against Greek physicians,—corrupters of the race, whom he would have banished from the city,—then he sketches the career of some of the more famous of the physicians under the Empire, some of whom must have had incomes never approached at any other period in the history of medicine. The chapter gives a good picture of the stage on which Galen (practically a contemporary of Pliny) was to play so important a role. Pliny seems himself to have been rather disgusted with the devious paths of the doctors of his day, and there is no one who has touched with stronger language upon the weak points of the art of physic. In one place he says that it alone has this peculiar art and privilege, "That whosoever professeth himself a physician, is straightwaies beleeved, say what he will: and yet to speake a truth, there are no lies dearer sold or more daungerous than those which proceed out of a Physician's mouth. Howbeit, we never once regard or look to that, so blind we are in our deepe persuasion of them, and feed our selves each one in a sweet hope and plausible conceit of our health by them. Moreover, this mischief there is besides, That there is no law or statute to punish the ignorance of blind Physicians, though a man lost his life by them: neither was there ever any man knowne, who had revenge of recompence for the evill intreating or misusage under their hands. They learne their skill by endaungering our lives: and to make proofe and experiments of their medicines, they care not to kill us."(35) He says it is hard that, while the judges are carefully chosen and selected, physicians are practically their own judges, and that of the men who may give us a quick despatch and send us to Heaven or Hell, no enquiry or examination is made of their quality and worthiness. It is interesting to read so early a bitter criticism of the famous "Theriaca," a great compound medicine invented by Antiochus III, which had a vogue for fifteen hundred years.

But we must return to Galen and his works, which comprise the most voluminous body of writings left by any of the ancients. The great edition is that in twenty-two volumes by Kuhn (1821-1833). The most useful editions are the "Juntines" of Venice, which were issued in thirteen editions. In the fourth and subsequent editions a very useful index by Brassavola is included. A critical study of the writings is at present being made by German scholars for the Prussian Academy, which will issue a definitive edition of his works.

Galen had an eclectic mind and could not identify himself with any of the prevailing schools, but regarded himself as a disciple of Hippocrates. For our purpose, both his philosophy and his practice are of minor interest in comparison with his great labors in anatomy and physiology.

In anatomy, he was a pupil of the Alexandrians to whom he constantly refers. Times must have changed since the days of Herophilus, as Galen does not seem ever to have had an opportunity of dissecting the human body, and he laments the prejudice which prevents it. In the study of osteology, he urges the student to be on the lookout for an occasional human bone exposed in a graveyard, and on one occasion he tells of finding the carcass of a robber with the bones picked bare by birds and beasts. Failing this source, he advises the student to go to Alexandria, where there were still two skeletons. He himself dissected chiefly apes and pigs. His osteology was admirable, and his little tractate "De Ossibus" could, with very few changes, be used today by a hygiene class as a manual. His description of the muscles and of the organs is very full, covering, of course, many sins of omission and of commission, but it was the culmination of the study of the subject by Greek physicians.

His work as a physiologist was even more important, for, so far as we know, he was the first to carry out experiments on a large scale. In the first place, he was within an ace of discovering the circulation of the blood. You may remember that through the errors of Praxagoras and Erasistratus, the arteries were believed to contain air and got their name on that account: Galen showed by experiment that the arteries contain blood and not air. He studied particularly the movements of the heart, the action of the valves, and the pulsatile forces in the arteries. Of the two kinds of blood, the one, contained in the venous system, was dark and thick and rich in grosser elements, and served for the general nutrition of the body. This system took its origin, as is clearly shown in the figure, in the liver, the central organ of nutrition and of sanguification. From the portal system were absorbed, through the stomach and intestines, the products of digestion. From the liver extend the venae cavae, one to supply the head and arms, the other the lower extremities: extending from the right heart was a branch, corresponding to the pulmonary artery, the arterial vein which distributed blood to the lungs. This was the closed venous system. The arterial system, shown, as you see, quite separate in Figure 31, was full of a thinner, brighter, warmer blood, characterized by the presence of an abundance of the vital spirits. Warmed in the ventricle, it distributed vital heat to all parts of the body. The two systems were closed and communicated with each other only through certain pores or perforations in the septum separating the ventricles. At the periphery, however, Galen recognized (as had been done already by the Alexandrians) that the arteries anastomose with the veins, ". . . and they mutually receive from each other blood and spirits through certain invisible and extremely small vessels."

It is difficult to understand how Galen missed the circulation of the blood. He knew that the valves of the heart determined the direction of the blood that entered and left the organ, but he did not appreciate that it was a pump for distributing the blood, regarding it rather as a fireplace from which the innate heat of the body was derived. He knew that the pulsatile force was resident in the walls of the heart and in the arteries, and he knew that the expansion, or diastole, drew blood into its cavities, and that the systole forced blood out. Apparently his view was that there was a sort of ebb and flow in both systems—and yet, he uses language just such as we would, speaking of the venous system as ". . . a conduit full of blood with a multitude of canals large and small running out from it and distributing blood to all parts of the body." He compares the mode of nutrition to irrigating canals and gardens, with a wonderful dispensation by nature that they should "neither lack a sufficient quantity of blood for absorption nor be overloaded at any time with excessive supply." The function of respiration was the introduction of the pneuma, the spirits which passed from the lungs to the heart through the pulmonary vessels. Galen went a good deal beyond the idea of Aristotle, reaching our modern conception that the function is to maintain the animal heat, and that the smoky matters derived from combustion of the blood are discharged by expiration.

I have dwelt on these points in Galen's physiology, as they are fundamental in the history of the circulation; and they are sufficient to illustrate his position. Among his other brilliant experiments were the demonstration of the function of the laryngeal nerves, of the motor and sensory functions of the spinal nerve roots, of the effect of transverse incision of the spinal cord, and of the effect of hemisection. Altogether there is no ancient physician in whose writings are contained so many indications of modern methods of research.

Galen's views of disease in general are those of Hippocrates, but he introduces many refinements and subdivisions according to the predominance of the four humors, the harmonious combination of which means health, or eucrasia, while their perversion or improper combination leads to dyscrasia, or ill health. In treatment he had not the simplicity of Hippocrates: he had great faith in drugs and collected plants from all parts of the known world, for the sale of which he is said to have had a shop in the neighborhood of the Forum. As I mentioned, he was an eclectic, held himself aloof from the various schools of the day, calling no man master save Hippocrates. He might be called a rational empiricist. He made war on the theoretical practitioners of the day, particularly the Methodists, who, like some of their modern followers, held that their business was with the disease and not with the conditions out of which it arose.

No other physician has ever occupied the commanding position of "Clarissimus" Galenus. For fifteen centuries he dominated medical thought as powerfully as did Aristotle in the schools. Not until the Renaissance did daring spirits begin to question the infallibility of this medical pope. But here we must part with the last and, in many ways, the greatest of the Greeks—a man very much of our own type, who, could he visit this country today, might teach us many lessons. He would smile in scorn at the water supply of many of our cities, thinking of the magnificent aqueducts of Rome and of many of the colonial towns—some still in use—which in lightness of structure and in durability testify to the astonishing skill of their engineers. There are country districts in which he would find imperfect drainage and could tell of the wonderful system by which Rome was kept sweet and clean. Nothing would delight him more than a visit to Panama to see what the organization of knowledge has been able to accomplish. Everywhere he could tour the country as a sanitary expert, preaching the gospel of good water supply and good drainage, two of the great elements in civilization, in which in many places we have not yet reached the Roman standard.

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Osler, William. 2006. The Evolution of Modern Medicine. Urbana, Illinois: Project Gutenberg. Retrieved April 2022 from https://www.gutenberg.org/files/1566/1566-h/1566-h.htm#link2H_4_0015

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