GALEN
I. _The Man and His Times_
Recent ignorance of Galen—His voluminous works—The manuscript
tradition of his works—His vivid personality—Birth and
parentage—Education in philosophy and medicine—First visit to
Rome—Relations with the emperors; later life—His unfavorable picture
of the learned world—Corruption of the medical profession—Lack of real
search for truth—Poor doctors and medical students—Medical discovery
in his time—The drug trade—The imperial stores—Galen’s private
supply of drugs—Mediterranean commerce—Frauds of dealers in wild
beasts—Galen’s ideal of anonymity—The ancient book trade—Falsification
and mistakes in manuscripts—Galen as a historical source—Ancient
slavery—Social life; food and wine—Allusions to Judaism and
Christianity—Galen’s monotheism—Christian readers of Galen.
II. _His Medicine and Experimental Science_
Four elements and four qualities—His criticism of atomism—Application
of the theory of four qualities in medicine—His therapeutics
obsolete—Some of his medical notions—Two of his cases—His power of
rapid observation and inference—His happy guesses—Tendency toward
scientific measurement—Psychological tests with the pulse—Galen’s
anatomy and physiology—Experiments in dissection—Did he ever dissect
human bodies?—Dissection of animals—Surgical operations—Galen’s
argument from design—Queries concerning the soul—No supernatural
force in medicine—Galen’s experimental instinct—His attitude
toward authorities—Adverse criticism of past writers—His estimate
of Dioscorides—Galen’s dogmatism; logic and experience—His
account of the Empirics—How the Empirics might have criticized
Galen—Galen’s standard of reason and experience—Simples knowable
only through experience—Experience and food science—Experience and
compounds—Suggestions of experimental method—Difficulty of medical
experiment—Empirical remedies—Galen’s influence upon medieval
experiment—His more general medieval influence.
III. _His Attitude Toward Magic_
Accusations of magic against Galen—His charges of magic against
others—Charms and wonder-workers—Animal substances inadmissible
in medicine—Nastiness of ancient medicine—Parts of animals—Some
scepticism—Doctrine of occult virtue—Virtue of the flesh of
vipers—Theriac—Magical compounds—Amulets—Incantations and
characters—Belief in magic dies hard—_On Easily Procurable
Remedies_—Specimens of its superstitious contents—External signs of
the temperaments of internal organs—Marvelous statements repeated
by Maimonides—Dreams—Absence of astrology in most of Galen’s
medicine—_The Prognostication of Disease by Astrology_—Critical
days—_On the History of Philosophy_—Divination and demons—Celestial
bodies.
ἀλλ’ εἴ τις καταγνῷ μου τόδε, ὁμολογῶ τὸ πάθος τοὐμὸν ὃ παρ’ ὅλον
ἐμαυτοῦ τὸν βίον ἔπαθον, οὐδενὶ πιστεύσας τῶν διηγουμένων τὰ τοιαῦτα,
πρὶν πειραθῆναι καὶ αὐτὸς ὧν δυνατὸν ἦν εἰς πεῖραν ἐλθεῖν με.
Kühn, IV, 513.
διὸ κᾂν μετ’ ἐμέ τις ὁμοίως ἐμοὶ φιλόπονός τε καὶ ξηλωτικὸς ἀληθείας
γένηται, μὴ προπετῶς ἐκ δυοῖν ἢ τριῶν χρήσεων ἀποφαινέσθω. πολλάκις
γὰρ αὐτῷ φανεῖται διὰ τῆς μακρᾶς πείρας ὥσπερ ἐφάνη κᾀμοὶ ...
Kühn, XIII, 96-1.
χρὴ γὰρ τὸν μέλλοντα γνώσεσθαί τι τῶν πολλῶν ἄμεινον εὐθὺς μὲν καὶ
τῇ φύσει καὶ τῇ πρώτῃ διδασκαλίᾳ πολὺ τῶν ἄλλων διενεγκεῖν ἐπειδὰν
δὲ γένηται μειράκιον ἀληθείας τινὸς ἔχειν ἐρωτικὴν μανίαν ὥσπερ
ἐνθουσιῶντα, καὶ μήθ’ ἡμέρας μήτε νυκτὸς διαλείπειν σπεύδοντά τε καὶ
συντεταμένον ἐκμαθεῖν, ὅσα τοῖς ἐνδοξοτάτοις εἴρηται τῶν παλαιῶν·
ἐπειδὰν δ’ ἐκμάθη, κρίνειν αὐτὰ καὶ βασανίζειν χρόνῳ παμπόλλῳ καὶ
σκοπεῖν πόσα μὲν ὁμολογεῖ τοῖς ἐναργῶς φαινομένοις πόσα δὲ διαφέρεται
καὶ οὕτως τὰ μὲν αἱρεῖσθαι τὰ δ’ ἀποστρέφεσθαι.
Kühn, II, 179.
“But if anyone charges me therewith, I confess my disease from which I
have suffered all my life long, to trust none of those who make such
statements until I have tested them for myself in so far as it has
been possible for me to put them to the test.”
“So if anyone after me becomes like me fond of work and zealous for
truth, let him not conclude hastily from two or three cases. For often
he will be enlightened through long experience, just as I have been.”
(It is remarkable that Ptolemy spoke similarly of his predecessor,
Hipparchus, as a “lover of toil and truth”—φιλόπονον καὶ φιλαλήθεα,
quoted by Orr (1913), 122.)
“For one who is to understand any matter better than most men do must
straightway differ much from other persons in his nature and earliest
education. And when he becomes a lad he must be madly in love with the
truth and carried away by enthusiasm for it, and not let up by day
or by night but press on and stretch every nerve to learn whatever
the ancients of most repute have said. But having learned it, he
must judge the same and put it to the test for a long, long time and
observe what agrees with visible phenomena and what disagrees, and so
accept the one and reject the other.”
I. _The Man and His Times_
[Sidenote: Recent ignorance of Galen.]
At the close of the nineteenth century one English student of the
history of medicine said, “Galen is so inaccessible to English readers
that it is difficult to learn about him at first hand.”[517] Another
wrote, “There is, perhaps, no other instance of a man of equal
intellectual rank who has been so persistently misunderstood and even
misinterpreted.”[518] A third obstacle to the ready comprehension of
Galen has been that while more critical editions of some single works
have been published by Helmreich and others in recent times,[519] no
complete edition of his works has appeared since that of Kühn a century
ago,[520] which is now regarded as very faulty.[521] A fourth reason
for neglect or misunderstanding of Galen is probably that there is so
much by him to be read.
[Sidenote: His voluminous works.]
Athenaeus stated that Galen wrote more treatises than any other Greek,
and although many are now lost, more particularly of his logical and
philosophical writings, his collected extant works in Greek text and
Latin translation fill some twenty volumes averaging a thousand pages
each. When we add that often there are no chapter headings or other
brief clues to the contents,[522] which must be ploughed through slowly
and thoroughly, since some of the most valuable bits of information
come in quite incidentally or by way of unlooked-for digression; that
errors in the printed text, and the technical vocabulary with numerous
words not found in most classical dictionaries increase the reader’s
difficulties;[523] and that little if any of the text possesses any
present medical value, while much of it is dreary enough reading
even for one animated by historical interest, especially if one has
no technical knowledge of medicine and surgery:—when we consider all
these deterrents, we are not surprised that Galen is little known. “Few
physicians or even scholars in the present day,” continues the English
historian of medicine quoted above, “can claim to have read through
this vast collection; I certainly least of all. I can only pretend to
have touched the fringe, especially of the anatomical and physiological
works.”[524]
[Sidenote: The manuscript tradition of Galen’s works.]
Although the works of Galen are so voluminous, they have reached us
for the most part in comparatively late manuscripts,[525] and to some
extent perhaps only in their medieval form. The extant manuscripts
of the Greek text are mostly of the fifteenth century and represent
the enthusiasm of humanists who hoped by reviving the study of Galen
in the original to get something new and better out of him than the
schoolmen had. In this expectation they seem to have been for the most
part disappointed; the middle ages had already absorbed Galen too
thoroughly. If it be true, as Dr. Payne contends,[526] that the chief
original contributions to medical science of the Renaissance period
were the work of men trained in Greek scholarship, this was because,
when they failed to get any new ideas from the Greek texts, they turned
to the more promising path of experimental research which both Galen
and the middle ages had already advocated. The bulky medieval Latin
translations[527] of Galen are older than most of the extant Greek
texts; there are also versions in Arabic and Syriac.[528] For the last
five books of the _Anatomical Exercises_ the only extant text is an
Arabic manuscript not yet published.[529]
[Sidenote: Galen’s vivid personality.]
If so comparatively little is generally known about Galen, it is not
because he had an unattractive personality. Nor is it difficult to make
out the main events of his life. His works supply an unusual amount
of personal information, and throughout his writings, unless he is
merely transcribing past prescriptions, he talks like a living man,
detailing incidents of daily life and making upon the reader a vivid
and unaffected impression of reality. Daremberg asserts[530] that the
exuberance of his imagination and his vanity frequently make us smile.
It is true that his pharmacology and therapeutics often strike us as
ridiculous, but he did not imagine them, they were the medicine of his
age. It is true that he mentions cases which he has cured and those in
which other physicians have been at fault, but official war despatches
do the same with their own victories and the enemy’s defeats. _Vae
victis!_ In Galen’s case, at least, posterity long confirmed his own
verdict. And dull or obsolete as his medicine now is, his scholarly
and intellectual ideals and love of hard work at his art are still
a living force, while the reader of his pages often feels himself
carried back to the Roman world of the second century. Thus “the magic
of literature,” to quote a fine sentence by Payne, “brings together
thinkers widely separated in space and time.”[531]
[Sidenote: Birth and parentage.]
Galen—he does not seem to have been called Claudius until the time
of the Renaissance—was born about 129 A. D.[532] at Pergamum in Asia
Minor. His father, Nikon, was an architect and mathematician, trained
in arithmetic, geometry, and astronomy. Much of this education he
transmitted to his son, but even more valuable, in Galen’s opinion,
were his precepts to follow no one sect or party but to hear and judge
them all, to despise honor and glory, and to magnify truth alone. To
this teaching Galen attributes his own peaceful and painless passage
through life. He has never grieved over losses of property but managed
to get along somehow. He has not minded much when some have vituperated
him, thinking instead of those who praise him. In later life Galen
looked back with great affection upon his father and spoke of his own
great good fortune in having as a parent that gentlest, justest, most
honest and humane of men. On the other hand, the chief thing that he
learned from his mother was to avoid her failings of a sharp temper and
tongue, with which she made life miserable for their household slaves
and scolded his father worse than Xanthippe ever did Socrates.[533]
[Sidenote: Education in philosophy and medicine.]
In one of his works Galen speaks of the passionate love and enthusiasm
for truth which has possessed him since boyhood, so that he has not
stopped either by day or by night from quest of it.[534] He realized
that to become a true scholar required both high natural qualifications
and a superior type of education from the start. After his fourteenth
year he heard the lectures of various philosophers, Platonist and
Peripatetic, Stoic and Epicurean; but when about seventeen, warned by
a dream of his father,[535] he turned to the study of medicine. This
incident of the dream shows that neither Galen nor his father, despite
their education and intellectual standards, were free from the current
belief in occult influences, of which we shall find many more instances
in Galen’s works. Galen first studied medicine for four years under
Satyrus in his native city of Pergamum, then under Pelops at Smyrna,
later under Numisianus at Corinth and Alexandria.[536] This was about
the time that the great mathematician and astronomer, Ptolemy, was
completing his observations[537] in the neighborhood of Alexandria, but
Galen does not mention him, despite his own belief that a first-rate
physician should also know such subjects as geometry and astronomy,
music and rhetoric.[538] Galen’s interest in philosophy continued,
however, and he wrote many logical and philosophical treatises, most
of which are lost.[539] His father died when he was twenty, and it was
after this that he went to other cities to study.
[Sidenote: First visit to Rome.]
Galen returned to Pergamum to practice and was, when but twenty-nine,
made the doctor for the gladiators by five successive pontiffs.[540]
During his thirties came his first residence at Rome.[541] The article
on Galen in Pauly-Wissowa states that he was driven away from Rome by
the plague, and in _De libris propriis_ he does say that, “when the
great plague broke out there, I hurriedly departed from the city for
my native land.”[542] But in _De prognosticatione ad Epigenem_ his
explanation is that he became disgusted with the malice of the envious
physicians of the capital, and determined to return home as soon as the
sedition there was over.[543] Meanwhile he stayed on and gained great
fame by his cures but their jealousy and opposition multiplied, so that
presently, when he learned that the sedition was over, he went back to
Pergamum.
[Sidenote: Relations with the emperors: later life.]
His fame, however, had come to the imperial ears and he was soon
summoned to Aquileia to meet the emperors on their way north against
the invading Germans. An outbreak of the plague there prevented their
proceeding with the campaign immediately,[544] and Galen states that
the emperors fled for Rome with a few troops, leaving the rest to
suffer from the plague and cold winter. On the way Lucius Verus died,
and when Marcus Aurelius finally returned to the front, he allowed
Galen to go back to Rome as court physician to Commodus.[545] The
prevalence of the plague at this time is illustrated by a third
encounter which Galen had with it in Asia, when he claims to have
saved himself and others by thorough venesection.[546] The war lasted
much longer than had been anticipated and meanwhile Galen was occupied
chiefly in literary labors, completing a number of works. In 192 some
of his writings and other treasures were lost in a fire which destroyed
the Temple of Peace on the Sacred Way. Of some of the works which thus
perished he had no other copy himself. In one of his works on compound
medicines he explains that some persons may possess the first two books
which had already been published, but that these had perished with
others in a shop on the Sacra Via when the whole shrine of peace and
the great libraries on the Palatine hill were consumed, and that his
friends, none of whom possessed copies, had besought him to begin the
work all over again.[547] Galen was still alive and writing during the
early years of the dynasty of the Severi, and probably died about 200.
[Sidenote: His unfavorable picture of the learned world.]
Although the envy of other physicians at Rome and their accusing him of
resort to magic arts and divination in his marvelous prognostications
and cures were perhaps neither the sole nor the true reason for Galen’s
temporary withdrawal from the capital, there probably is a great
deal of truth in the picture he paints of the medical profession and
learned world of his day. There are too many other ancient witnesses,
from the encyclopedist Pliny and the satirist Juvenal to the fourth
century lawyer and astrologer, Firmicus, who substantiate his charges
to permit us to explain them away as the product of personal bitterness
or pessimism. We feel that these men lived in an intellectual society
where faction and villainy, superstition and petty-mindedness and
personal enmity, were more manifest than in the quieter and, let
us hope, more tolerant learned world of our time. Selfishness and
pretense, personal likes and dislikes, undoubtedly still play their
part, but there is not passionate animosity and open war to the knife
on every hand. The _status belli_ may still be characteristic of
politics and the business world, but scholars seem able to live in
substantial peace. Perhaps it is because there is less prospect of
worldly gain for members of the learned professions than in Galen’s
day. Perhaps it is due to the growth of the impartial scientific
spirit, of unwritten codes of courtesy and ethics within the leading
learned professions, and of state laws concerning such matters as
patents, copyright, professional degrees, pure food, and pure drugs.
Perhaps, in the unsatisfactory relations between those who should have
been the best educated and most enlightened men of that time we may see
an important symptom of the intellectual and ethical decline of the
ancient world.
[Sidenote: Corruption of the medical profession.]
Galen states that many tire of the long struggle with crafty and wicked
men which they have tried to carry on, relying upon their erudition
and honest toil alone, and withdraw disgusted from the madding crowd
to save themselves in dignified retirement. He especially marvels at
the evil-mindedness of physicians of reputation at Rome. Though they
live in the city, they are a band of robbers as truly as the brigands
of the mountains. He is inclined to account for the roguery of Roman
physicians compared to those of a smaller city by the facts that
elsewhere men are not so tempted by the magnitude of possible gain
and that in a smaller town everyone is known by everyone else and
questionable practices cannot escape general notice. The rich men of
Rome fall easy prey to these unscrupulous practitioners who are ready
to flatter them and play up to their weaknesses. These rich men can see
the use of arithmetic and geometry, which enable them to keep their
books straight and to build houses for their domestic comfort, and of
divination and astrology, from which they seek to learn whose heirs
they will be, but they have no appreciation of pure philosophy apart
from rhetorical sophistry.[548]
[Sidenote: Lack of real search for truth.]
Galen more than once complains that there are no real seekers after
truth in his time, but that all are intent upon money, political power,
or pleasure. You know very well, he says to one of his friends in the
_De methodo medendi_, that not five men of all those whom we have met
prefer to be rather than to seem wise.[549] Many make a great outward
display and pretense in medicine and other arts who have no real
knowledge.[550] Galen several times expresses his scorn for those who
spend their mornings in going about saluting their friends, and their
evenings in drinking bouts or in dining with the rich and powerful.
Yet even his friends have reproached him for studying too much and not
going out more. But while they have wasted their hours thus, he has
spent his, first in learning all that the ancients have discovered
that is of value, then in testing and practicing the same.[551]
Moreover, now-a-days many are trying to teach others what they have
never accomplished themselves.[552] Thessalus not only toadied to the
rich but secured many pupils by offering to teach them medicine in
six months.[553] Hence it is that tailors and dyers and smiths are
abandoning their arts to become physicians. Thessalus himself, Galen
ungenerously taunts, was educated by a father who plucked wool badly
in the women’s apartments.[554] Indeed, Galen himself, by the violence
of his invective and the occasional passionateness of his animosity
in his controversies with other individuals or schools of medicine,
illustrates that state of war in the intellectual world of his age to
which we have adverted.
[Sidenote: Poor doctors and medical students.]
We suggested the possibility that learning compared to other
occupations was more remunerative in Galen’s day than in our own, but
there were poor physicians and medical students then, as well as those
greedy for gain or who associated with the rich. Many doctors could
not afford to use the rarer or stronger simples and limited themselves
to easily procured, inexpensive, and homely medicaments.[555] Many of
his fellow-students regarded as a counsel of perfection unattainable
by them Galen’s plan of hearing all the different medical sects and
comparing their merits and testing their validity.[556] They said
tearfully that this course was all very well for him with his acute
genius and his wealthy father behind him, but that they lacked the
money to pursue an advanced education, perhaps had already lost
valuable time under unsatisfactory teachers, or felt that they did not
possess the discrimination to select for themselves what was profitable
from several conflicting schools.
[Sidenote: Medical discovery in Galen’s time.]
Galen was, it has already been made apparent, an intellectual
aristocrat, and possessed little patience with those stupid men who
never learn anything for themselves, though they see a myriad cures
worked before their eyes. But that, apart from his own work, the
medical profession was not entirely stagnant in his time, he admits
when he asserts that many things are known to-day which had not been
discovered before, and when he mentions some curative methods recently
invented at Rome.[557]
[Sidenote: The drug trade.]
Galen supplies considerable information concerning the drug trade
in Rome itself and throughout the empire. He often complains of
adulteration and fraud. The physician must know the medicinal simples
and their properties himself and be able to detect adulterated
medicines, or the merchants, perfumers, and _herbarii_ will deceive
him.[558] Galen refuses to reveal the methods employed in adulterating
opobalsam, which he had investigated personally, lest the evil
practice spread further.[559] At Rome at least there were dealers in
unguents who corresponded roughly to our druggists. Galen says there
is not an unguent-dealer in Rome who is unacquainted with herbs from
Crete, but he asserts that there are equally good medicinal plants
growing in the very suburbs of Rome of which they are totally ignorant,
and he taxes even those who prepare drugs for the emperors with the
same oversight. He tells how the herbs from Crete come wrapped in
cartons with the name of the herb written on the outside and sometimes
the further statement that it is _campestris_.[560] These Roman drug
stores seem not to have kept open at night, for Galen in describing a
case speaks of the impossibility of procuring the medicines needed at
once because “the lamps were already lighted.”[561]
[Sidenote: The imperial stores.]
The emperors kept a special store of drugs of their own and had
botanists in Sicily, Crete, and Africa who supplied not only them
with medicinal herbs, but also the city of Rome as well, Galen says.
However, the emperors appear to have reserved a large supply of the
finest and rarest simples for their own use. Galen mentions a large
amount of Hymettus honey in the imperial stores—ἐν ταῖς αὐτοκρατορικαῖς
ἀποθήκαις,[562] whence our word “apothecary.”[563] He proves that
cinnamon[564] loses its potency with time by his own experience as
imperial physician. An assignment of the spice sent to Marcus Aurelius
from the land of the barbarians (ἐκ τῆς βαρβάρου) was superior to what
had stood stored in wooden jars from the reigns of Trajan, Hadrian,
and Antoninus Pius. Commodus exhausted all the recent supply, and when
Galen was forced to turn to what had been on hand in preparing an
antidote for Severus, he found it much weaker than before, although not
thirty years had elapsed. That cinnamon was a commodity little known to
the populace is indicated by Galen’s mentioning his loss in the fire of
192 of a few precious bits of bark he had stored away in a chest with
other treasures.[565] He praises the Severi, however, for permitting
others to use theriac, a noted medicine and antidote of which we
shall have more to say presently. Thus, he says, not only have they
as emperors received power from the gods, but in sharing their goods
freely they are like the gods, who rejoice the more, the more people
they save.[566]
[Sidenote: Galen’s private supply of drugs: _terra sigillata_.]
Galen himself, and apparently other physicians, were not content to
rely for medicines either upon the unguent-sellers or the bounty of
the imperial stores. Galen stored away oil and fat and left them
to age until he had enough to last for a hundred years, including
some from his father’s lifetime. He used some forty years old in one
prescription.[567] He also traveled to many parts of the Roman Empire
and procured rare drugs in the places where they were produced. Very
interesting is his account of going out of his way in journeying
back and forth between Rome and Pergamum in order to stop at Lemnos
and procure a supply of the famous _terra sigillata_, a reddish clay
stamped into pellets with the sacred seal of Diana.[568] On the way
to Rome, instead of journeying on foot through Thrace and Macedonia,
he took ship from the Troad to Thessalonica; but the vessel stopped
in Lemnos at Myrine on the wrong side of the island, which Galen had
not realized possessed more than one port, and the captain would not
delay the voyage long enough to enable him to cross the island to the
spot where the _terra sigillata_ was to be found. Upon his return from
Rome through Macedonia, however, he took pains to visit the right port,
and for the benefit of future travelers gives careful instructions
concerning the route to follow and the distances between stated points.
He describes the solemn procedure by which the priestess from the
neighboring city gathered the red earth from the hill where it was
found, sacrificing no animals, but wheat and barley to the earth. He
brought away with him some twenty thousand of the little discs or
seals which were supposed to cure even lethal poisons and the bite of
mad dogs. The inhabitants laughed, however, at the assertion which
Galen had read in Dioscorides that the seals were made by mixing the
blood of a goat with the earth. Berthelot, the historian of chemistry,
believed that this earth was “an oxide of iron more or less hydrated
and impure.”[569] In another passage Galen advises his readers,
if they are ever in Pamphylia, to lay in a good supply of the drug
_carpesium_.[570] In the ninth book of his work on medicinal simples he
tells of three strata of sory, chalcite, and misy, which he had seen
in a mine in Cyprus thirty years before and from which he had brought
away a supply, and of the surprising chemical change which the misy
underwent in the course of these years.[571]
[Sidenote: Mediterranean commerce.]
Galen speaks of receiving other drugs from Great Syria, Palestine,
Egypt, Cappadocia, Pontus, Macedonia, Gaul, Spain, and Mauretania,
from the Celts, and even from India.[572] He names other places in
Greece and Asia Minor than Mount Hymettus where good honey may be
had, and states that much so-called Attic honey is really from the
Cyclades, although it is brought to Athens and there sold or reshipped.
Similarly, genuine Falernian wine is produced only in a small part of
Italy, but other wines like it are prepared by those who are skilled
in such knavery. As the best iris is that of Illyricum and the best
asphalt is from Judea, so the best _petroselinon_ is that of Macedonia,
and merchants export it to almost the entire world just as they do
Attic honey and Falernian wine. But the _petroselinon_ crop of Epirus
is sent to Thessalonica and there passed off for Macedonian. The best
turpentine is that of Chios but a good variety may be obtained from
Libya or Pontus. The manufacture of drugs has spread recently as well
as the commerce in them. The best form of unguent was formerly made
only in Laodicea, but now it is similarly compounded in many other
cities of Asia Minor.[573]
[Sidenote: Frauds of dealers in wild beasts.]
We are reminded that parts of animals as well as herbs and minerals
were important constituents in ancient pharmacy by Galen’s invective
against the frauds of hunters and dealers in wild beasts as well as
of unguent-sellers. They do not hunt them at the proper season for
securing their medicinal virtues, but when they are no longer in
their prime or just after their long period of hibernation, when they
are emaciated. Then they fatten them upon improper food, feed them
barley cakes to stuff up and dull their teeth, or force them to bite
frequently so that virus will run out of their mouths.[574]
[Sidenote: Galen’s ideal of anonymity.]
Besides the ancient drug trade, Galen gives us some interesting
glimpses of the publishing trade, if we may so term it, of his time.
Writing in old age in the _De methodo medendi_,[575] he says that he
has never attached his name to one of his works, never written for the
popular ear or for fame, but fired by zeal for science and truth, or
at the urgent request of friends, or as a useful exercise for himself,
or, as now, in order to forget his old age. Popular fame is only an
impediment to those who desire to live tranquilly and enjoy the fruits
of philosophy. He asks Eugenianus, whom he addresses in this passage,
not to praise him immoderately before men, as he has been wont to do,
and not to inscribe his name in his works. His friends nevertheless
prevailed upon him to write two treatises listing his works,[576] and
he also is free enough in many of his books in mentioning others which
are essential to read before perusing the present volume.[577] Perhaps
he felt differently at different times on the question of fame and
anonymity. He also objected to those who read his works, not to learn
anything from them, but only in order to calumniate them.[578]
[Sidenote: The ancient book trade.]
It was in a shop on the Sacra Via that most of the copies of some of
Galen’s works were stored when they, together with the great libraries
upon the Palatine, were consumed in the fire of 192. But in another
passage Galen states that the street of the Sandal-makers is where
most of the bookstores in Rome are located.[579] There he saw some men
disputing whether a certain treatise was his. It was duly inscribed
_Galenus medicus_ and one man, because the title was unfamiliar to him,
bought it as a new work by Galen. But another man who was something
of a philologer asked to see the introduction, and, after reading a
few lines, declared that the book was not one of Galen’s works. When
Galen was still young, he wrote three commentaries on the throat and
lungs for a fellow student who wished to have something to pass off
as his own work upon his return home. This friend died, however, and
the books got into circulation.[580] Galen also complains that notes
of his lectures which he has not intended for publication have got
abroad,[581] that his servants have stolen and published some of
his manuscripts, and that others have been altered, corrupted, and
mutilated by those into whose possession they have come, or have been
passed off by them in other lands as their own productions.[582] On the
other hand, some of his pupils keep his teachings to themselves and are
unwilling to give others the benefit of them, so that if they should
die suddenly, his doctrines would be lost.[583] But his own ideal has
always been to share his knowledge freely with those who sought it,
and if possible with all mankind. At least one of Galen’s works was
taken down from his dictation by short-hand writers, when, after his
convincing demonstration by dissection concerning respiration and the
voice, Boëthus asked him for commentaries on the subject and sent for
stenographers.[584] Although Galen in his travels often purchased and
carried home with him large quantities of drugs, when he made his first
trip to Rome he left all his books in Asia.[585]
[Sidenote: Falsification and mistakes in manuscripts.]
Galen dates the falsification of title pages and contents of books
back to the time when kings Ptolemy of Egypt and Attalus of Pergamum
were bidding against each other for volumes for their respective
libraries.[586] Works were often interpolated then in order to make
them larger and so bring a better price. Galen speaks more than once of
the deplorable ease with which numbers, signs, and other abbreviations
are altered in manuscripts.[587] A single stroke of the pen or slight
erasure will completely change the meaning of a medical prescription.
He thinks that such alterations are sometimes malicious and not mere
mistakes. So common were they that Menecrates composed a medical
work written out entirely in complete words and entitled _Autocrator
Hologrammatos_ because it was also dedicated to the emperor. Another
writer, Damocrates, from whom Galen often quotes long passages,
composed his book of medicaments in metrical form so that there might
be no mistake made even in complete words.
[Sidenote: Galen as a historical source.]
Galen’s works contain occasional historical information concerning many
other matters than books and drugs. Clinton in his _Fasti Romani_ made
much use of Galen for the chronology of the period in which he lived.
His allusions to several of the emperors with whom he had personal
relations are valuable bits of source-material. Trajan was, of course,
before his time, but he testifies to the great improvement of the
roads in Italy which that emperor had effected.[588] Galen sheds a
little light on the vexed question of the population of the empire, if
Pergamum is the place he refers to in his estimate of forty thousand
citizens or one hundred and twenty thousand inhabitants, including
women and slaves but perhaps not children.[589]
[Sidenote: Ancient slavery.]
Galen illustrates for us the evils of ancient slavery in an incident
which he relates to show the inadvisability of giving way to one’s
passions, especially anger.[590] Returning from Rome, Galen fell in
with a traveler from Gortyna in Crete. When they reached Corinth,
the Cretan sent his baggage and slaves from Cenchrea[591] to Athens
by boat, but himself with a hired vehicle and two slaves went by
land with Galen through Megara, Eleusis, and Thriasa. On the way the
Cretan became so angry at the two slaves that he hit them with his
sheathed sword so hard that the sheath broke and they were badly
wounded. Fearing that they would die, he then made off to escape the
consequences of his act, leaving Galen to look after the wounded.
But later he rejoined Galen in penitent mood and insisted that Galen
administer a beating to him for his cruelty. Galen adds that he
himself, like his father, had never struck a slave with his own hand
and had reproved friends who had broken their slaves’ teeth with blows
of their fists. Others go farther and kick their slaves or gouge their
eyes out. The emperor Hadrian in a moment of anger is said to have
blinded a slave with a stylus which he had in his hand. He, too, was
sorry afterwards and offered the slave money, but the latter refused
it, telling the emperor that nothing could compensate him for the loss
of an eye. In another passage Galen discusses how many slaves and
“clothes” one really needs.[592]
[Sidenote: Social life: food and wine.]
Galen also depicts the easy-going, sociable, and pleasure-loving
society of his time. Not only physicians but men generally begin
the day with salutations and calls, then separate again, some to
the market-place and law courts, others to watch the dancers or
charioteers.[593] Others play at dice or pursue love affairs, or pass
the hours at the baths or in eating and drinking or some other bodily
pleasure. In the evening they all come together again at symposia which
bear no resemblance to the intellectual feasts of Socrates and Plato
but are mere drinking bouts. Galen had no objection, however, to the
use of wine in moderation and mentions the varieties from different
parts of the Mediterranean world which were especially noted for their
medicinal properties.[594] He believed that drinking wine discreetly
relieved the mind from all worry and melancholy and refreshed it. “For
we use it every day.”[595] He affirmed that taken in moderation wine
aided digestion and the blood.[596] He classed wine with such boons
to humanity as medicines, “a sober and decent mode of life,” and “the
study of literature and liberal disciplines.”[597] Galen’s treatise in
three books on food values (_De alimentorum facultatibus_) supplies
information concerning the ancient table and dietary science.
[Sidenote: Allusions to Judaism and Christianity.]
Galen’s allusions to Judaism and Christianity are of considerable
interest. He scarcely seems to have distinguished between them. In
two passages in his treatise on differences in the pulse he makes
incidental allusion to the followers of Moses and Christ, in both
cases speaking of them rather lightly, not to say contemptuously. In
criticizing Archigenes for using vague and unintelligible language
and not giving a sufficient explanation of the point in question,
Galen says that it is “as if one had come to a school of Moses and
Christ and had heard undemonstrated laws.”[598] And in criticizing
opposing sects for their obstinacy he remarks that it would be easier
to win over the followers of Moses and Christ.[599] Later we shall
speak more fully of a third passage in _De usu partium_[600] where
Galen criticizes the Mosaic view of the relation of God to nature,
representing it as the opposite extreme to the Epicurean doctrine of
a purely mechanistic and materialistic universe. This suggests that
Galen had read some of the Old Testament, but he might have learned
from other sources of the Dead Sea and of salts of Sodom, of which he
speaks in yet another context.[601] According to a thirteenth century
Arabian biographer of Galen, he spoke more favorably of Christians in
a lost commentary upon Plato’s _Republic_, admiring their morals and
admitting their miracles.[602] This last, as we shall see, is unlikely,
since Galen believed in a supreme Being who worked only through natural
law. “A confection of Ioachos, the martyr or metropolitan,” and “A
remedy for headache of the monk Barlama” occur in the third book of
the _De remediis parabilibus_ ascribed to Galen, but this third book
is greatly interpolated or entirely spurious, citing Galen himself as
well as Alexander of Tralles, the sixth century writer, and mentioning
the Saracens. Wellmann regards it as composed between the seventh and
eleventh centuries of our era.[603]
[Sidenote: Galen’s monotheism.]
Like most thoughtful men of his time, Galen tended to believe in one
supreme deity, but he appears to have derived this conception from
Greek rather than Hebraic sources. It was to philosophy and the Greek
mysteries that he turned for revelation of the deity, as we shall
see. Hopeless criminals were for him those whom neither the Muses
nor Socrates could reform.[604] It is Plato, not Christ, whom in
another treatise he cites as describing the first and greatest God as
ungenerated and good. “And we all naturally love Him, being such as He
is from eternity.”[605]
[Sidenote: Galen’s Christian readers.]
But while Galen’s monotheism cannot be regarded as of Christian or
Jewish origin, it is possible that his argument from design and
supporting theology by anatomy made him more acceptable to both
Mohammedan and Christian readers. At any rate he had Christian
readers at Rome at the opening of the third century, when a hostile
controversialist complains that some of them even worship Galen.[606]
These early Christian enthusiasts for natural science, who also devoted
much time to Aristotle and Euclid, were finally excommunicated; but
Aristotle, Euclid, and Galen were to return in triumph in medieval
learning.
II. _His Medicine and Experimental Science_
[Sidenote: Four elements and four qualities.]
Galen held as his fundamental theory of nature the view which was
to prevail through the middle ages, that all natural objects upon
this globe are composed of four elements, earth, air, fire, and
water,[607] and the cognate view, which he says Hippocrates first
introduced and Aristotle later demonstrated, that all natural objects
are characterized by four qualities, hot, cold, dry, and moist.
From the combinations of these four are produced various secondary
qualities.[608] Neither hypothesis was as yet universally accepted,
however, and Galen felt it incumbent upon him to argue against those
who contended that the human body and world of nature were made from
but one element.[609] There were others who ridiculed the four quality
hypothesis, saying that hot and cold were words for bath-keepers, not
for physicians to deal with.[610] Galen explains that philosophers
do not regard any particular variety of earth or any other mineral
substance as representing the pure element earth, which in the
philosophical sense is an extremely cold and dry substance to which
adamant and rocks make perhaps the closest approach. But the earths
that we see are all compound bodies.[611]
[Sidenote: Criticism of atomism.]
Galen rejected the atomism of Democritus and Epicurus, in which the
atoms were indivisible particles differing in shape and size, but not
differing in quality as chemical atoms are supposed to do. He credits
Democritus with the view that such qualities as color and taste are
sensed by us from the concourse of atoms, but do not reside in the
atoms themselves.[612] Galen also makes the criticism that the mere
regrouping of “impassive and immutable” atoms is not enough to account
for the new properties of the compound, which are often very different
from those of the constituents, as when “we alter the qualities of
medicines in artificial mixtures.”[613] Thus he virtually says that the
purely physical atomism of Democritus will not account for what to-day
we call chemical change. He also, as we shall see, rejected Epicurus’
theory of a world of nature ruled by blind chance.
[Sidenote: Application of the theory of four qualities in medicine.]
Galen of course thought that a dry medicine was good for a moist
disease, and that in a compound medicine, by mixing a very cold with
a slightly cold drug in varying proportions a medicine of any desired
degree of coldness might be obtained.[614] In general he regarded
solids like stones and metals as dry and cold, while he thought that
hot and moist objects tended to evaporate rapidly into air.[615] So he
declared that dryness of solid bodies was incurable, while he believed
that children’s bodies were more easily dissolved than adults’ because
moister and warmer.[616] The Stoics and many physicians believed that
heat prolonged life, but Asclepiades pointed out that the Ethiopians
are old at thirty because the hot sun dries up their bodies so, while
the inhabitants of Britain sometimes live to be one hundred and twenty
years old. This last, however, was regarded as probably due to the fact
that their thicker skins conserved their innate heat longer.[617]
[Sidenote: Galen’s therapeutics obsolete.]
As an offset to the evidence which will be presented later of the
traces of occult virtues, magic, and astrology in Galen’s therapeutics
I should like to be able to indicate the good points in it. But his
entire system, like the four quality theory upon which it is largely
based, seems now obsolete, and what evidenced his superiority to other
physicians in his own day would probably strike the modern reader
only as a token of his distinct inferiority to present practice.
Eighty odd years of modern medical progress since have added further
emphasis to Daremberg’s declaration that we have had to throw overboard
“much of his physiology, nearly all of his pathology and general
therapeutics.”[618]
[Sidenote: Some of his medical notions.]
Nevertheless, we may note a few specimens which perhaps represent
his ordinary theory and practice as distinguished from passages in
which the influence of magic enters. He holds that bleeding and
cold drink are the two chief remedies for fever.[619] He notes that
children occasionally resemble their grandparents rather than their
parents.[620] He disputes the assertion of Epicurus—one by which some
of his followers failed to be guided—that there is no benefit to health
in Aphrodite, and contends that at certain intervals and in certain
individuals and circumstances sexual intercourse is beneficial.[621]
His discussion of anodynes and stupor or sleep-producing medicines
shows that the ancients had anaesthetics of a sort.[622] He recognized
the importance of breathing plenty of fresh, invigorating, and
unpolluted air, free from any intermixture of impurity from mines,
pits, or ovens, or of putridity from decaying vegetable or animal
matter, or of noxious vapors from stagnant water, swamps, and
rivers.[623] As was usual in ancient and medieval times, he attributes
plagues to the corruption of the air, which poisons men breathing
it, and tells how Hippocrates tried to allay a plague at Athens by
purifying the air by fumigation with fires, odors, and unguents.[624]
[Sidenote: Two of Galen’s cases.]
Two specimens may be given of Galen’s accounts of his own cases. In
the first, some cheese, which he had told his servants to take away as
too sharp, when mixed with boiled salt pork and applied to the joints,
proved very helpful to a gouty patient and to several others whom he
induced to try it.[625] In the second case Galen administered the
following heroic treatment to a woman at Rome who was afflicted with
catarrh to the point of throwing up blood.[626] He did not deem it wise
to bleed her, since for four days past she had gone almost without
food. Instead he ordered a sharp clyster, rubbed and bound her hands
and feet with a hot drug, shaved her head and put on it a medicament
made of doves’ dung. After three hours she was bathed, care being taken
that nothing oily touched her head, which was then covered up. At first
he fed her only gruel, afterwards some bitter autumn fruit, and as she
was about to go to sleep he administered a medicament made from vipers
four months before. On the second day came more rubbing and binding
except the head, and at evening a somewhat smaller dose of the viper
remedy. Again she slept well and in the morning he gave her a large
dose of cooked honey. Again her body was well rubbed and she was given
barley water and a little bread to eat. On the fourth day an older and
therefore stronger variety of viper-remedy was administered and her
head was covered with the same medicament as before. Its properties,
Galen explains, are vehemently drying and heating. Again she was given
a bath and a little food. On the fifth day Galen ventured to purge her
lungs, but he returned at intervals to the imposition upon her head.
Meanwhile he continued the process of rubbing, bathing, and dieting,
until finally the patient was well again,—a truly remarkable cure!
[Sidenote: His power of rapid observation and inference.]
These two cases, however, do not give us a just comprehension of
Galen’s abilities at their best. In his medical practice he could be as
quick and comprehensive an observer and as shrewd in drawing inferences
from what he observed as the famous Sherlock Holmes, so that some of
his slower-witted contemporaries accused him of possessing the gift
of divination. His immediate diagnosis of the case of the Sicilian
physician by noting as he entered the house the excrements in a vessel
which a servant was carrying out to the dungheap, and as he entered the
sick-room a medicine set on the window-sill which the patient-physician
had been preparing for himself, amazed the patient and the philosopher
Glaucon[627] more than, let us hope in this case in view of his
profession, they would have amazed the estimable Dr. Watson.
[Sidenote: His happy guesses.]
Puschmann has pointed out that Galen employs certain expressions
which seem happy guesses at later discoveries. He writes: “Galen was
supported in his researches by an extremely happy imaginative faculty
which put the proper word in his mouth even in cases where he could not
possibly arrive at a full understanding of the matter,—where he could
only conjecture the truth. When, for instance, he declares that sound
is carried ‘like a wave’ (Kühn, III, 644), or expresses the conjecture
that the constituent of the atmosphere which is important for breathing
also acts by burning (IV, 687), he expresses thoughts which startle us,
for it was only possible nearly two thousand years later to understand
their full significance.”[628]
[Sidenote: Tendency towards scientific measurement.]
Galen was keenly alive to the need of exactness in weights and
measurements. He often criticizes past writers for not stating
precisely what ailment the medicament recommended is good for, and in
what proportions the ingredients are to be mixed. He also frequently
complains because they do not specify whether they are using the
Greek or Roman system of weights, or the Attic, Alexandrine, or
Ephesian variety of a certain measure.[629] Moreover, he saw the
desirability of more accurate means of measuring the passage of
time.[630] When he states that even some illustrious physicians of his
acquaintance mistake the speed of the pulse and are unable to tell
whether it is slow, fast, or normal, we begin to realize something
of the difficulties under which medical practice and any sort of
experimentation labored before watches were invented, and how much
depended upon the accuracy of human machinery and judgment. Yet Galen
estimates that the chief progress made in medical prognostication since
Hippocrates is the gradual development of the art of inferring from the
pulse.[631] Galen tried to improve the time-pieces in use in his age.
He states that in any city the inhabitants want to know the time of
day accurately, not merely conjecturally; and he gives directions how
to divide the day into twelve hours by a combination of a sun-dial and
a _clepsydra_, and how on the water clock to mark the duration of the
longest, shortest, and equinoctial days of the year.[632]
[Sidenote: Psychological tests with the pulse.]
Delicate and difficult as was the task of measuring the pulse in
Galen’s time, he was clever enough to anticipate by seventeen centuries
some of the tests which modern psychologists have urged should be
applied in criminal trials. He detected the fact that a female patient
was not ill but in love by the quickening of her pulse when someone
came in from the theater and announced that he had just seen Pylades
dance. When she came again the next day, Galen had purposely arranged
that someone should enter and say that he had seen Morphus dancing.
This and a similar test on the third day produced no perceptible
quickening in the woman’s pulse. But it bounded again when on the
fourth day Pylades’ name was again spoken. After recounting another
analogous incident where he had been able to read the patient’s mind,
Galen asks why former physicians have never availed themselves of
these methods. He thinks that they must have had no conception of
how the bodily health in general and the pulse in particular can be
affected by the “psyche’s” suffering.[633] We might then call Galen the
first experimental psychologist as well as the first to elaborate the
physiology of the nervous system.
[Sidenote: Galen’s anatomy and physiology.]
It would scarcely be fair to discuss Galen’s science at all without
saying something of his remarkable work in anatomy and physiology.
Daremberg went so far as to hold that all there is good or bad in his
writings comes from good or bad physiology, and regarded his discussion
of the bones and muscles as especially good.[634] He is generally
considered the greatest anatomist of antiquity, but it is barely
possible that he may have owed more to predecessors and contemporaries
and less to personal research than is apparent from his own writings,
which are the most complete anatomical treatises that have reached us
from antiquity. Herophilus, for example, who was born at Chalcedon in
the closing fourth century B. C. and flourished at Alexandria under
the first Ptolemy, discovered the nerves and distinguished them from
the sinews, and thought the brain the center of the nervous system, so
that it is perhaps questionable whether Payne is justified in calling
Galen “the founder of the physiology of the nervous system,” and in
declaring that “in physiological diagnosis he stands alone among the
ancients.”[635] However, if Galen owed something to Herophilus, we owe
much of our knowledge of the earlier physiologist to Galen.[636]
[Sidenote: Experiments in dissection.]
Aristotle had held that the heart was the seat of the sensitive
soul[637] and the source of nervous action, “while the brain was of
secondary importance, being the coldest part of the body, devoid of
blood, and having for its chief or only function to cool the heart.”
Galen attacked this theory by showing experimentally that “all the
nerves originated in the brain, either directly or by means of the
spinal cord, which he thought to be a conducting organ merely, not
a center.” “A thousand times,” he says, “I have demonstrated by
dissection that the cords in the heart called nerves by Aristotle
are not nerves and have no connection with nerves.” He found that
sensation and movement were stopped and even the voice and breathing
were affected by injuries to the brain, and that an injury to one
side of the brain affected the opposite side of the body. His
public demonstration by dissection, performed in the presence of
various philosophers and medical men, of the connection between
the brain and voice and respiration and the commentaries which he
immediately afterwards dictated on this point were so convincing,
he tells us fifteen years later, that no one has ventured openly to
dispute them.[638] His “experimental investigation of the spinal
cord by sections at different levels and by half sections was still
more remarkable.”[639] Galen opposed these experimental proofs to
such unscientific arguments on the part of the Stoic philosopher,
Chrysippus, and others, as that the heart must be the chief organ
because it is in the center of the body, or because one lays one’s
hand on one’s heart to indicate oneself, or because the lips are
moved in a certain way in saying “I” (ἐγώ).[640] Another noteworthy
experiment by Galen was that in which, by binding up a section of the
femoral artery he proved that the arteries contain blood and not air
or _spiritus_ as had been generally supposed.[641] He failed, however,
to perform any experiments with the pulmonary veins, and so the notion
persisted that these conveyed “spirit” and not blood from the lungs to
the heart.[642]
[Sidenote: Did Galen ever dissect human bodies?]
It has usually been stated that Galen never dissected the human body
and that his inferences by analogy from his dissection of animals
involved him in serious error concerning human anatomy and physiology.
Certainly he speaks as if opportunities to secure human cadavers or
even skeletons were rare.[643] He mentions, however, the possibility
of obtaining the bodies of criminals condemned to death or cast to
beasts in the arena, or the corpses of robbers which lie unburied in
the mountains, or the bodies of infants exposed by their parents.[644]
It is not sufficient, he states in another passage,[645] to read books
about human bones; one should have them before one’s eyes. Alexandria
is the best place for the student to go to see actual exhibitions of
this sort made by the teachers.[646] But even if one cannot go there,
one may be able to procure human bones for oneself, as Galen did from a
skeleton which had been washed out of a grave by a flooded stream and
from the corpse of a robber slain in the mountains. If one cannot get
to see a human skeleton by these means or some other, he should dissect
monkeys and apes.
[Sidenote: Dissection of animals.]
Indeed Galen advises the student to dissect apes in any case, in order
to prepare himself for intelligent dissection of the human body, should
he ever have the opportunity. From lack of such previous experience the
doctors with the army of Marcus Aurelius, who dissected the body of a
dead German, learned nothing except the position of the entrails. Galen
at any rate dissected a great many animals. Tiny animals and insects
he let alone, for the microscope was not yet discovered, but besides
apes and quadrupeds he cut up many reptiles, mice, weasels, birds, and
fish.[647] He also gives an amusing account of the medical men at Rome
gathering to observe the dissection of an elephant in order to discover
whether the heart had one or two vertices and two or three ventricles.
Galen assured them beforehand that it would be found similar to the
heart of any other breathing animal. This particular dissection was
not, however, performed exclusively in the interests of science, since
it was scarcely accomplished when the heart was carried off, not to
a scientific museum, but by the imperial cooks to their master’s
table.[648] Galen sometimes dissected animals the moment he killed
them. Thus he observed that the lungs always sensibly shrank from the
diaphragm in a dying animal, whether he killed it by suffocation in
water, or strangling with a noose, or severing the spinal medulla near
the first vertebrae, or cutting the large arteries or veins.[649]
[Sidenote: Surgical operations.]
Surgical operations and medical practice were a third way of learning
the human anatomy, and Galen complains of the carelessness of those
physicians and surgeons who do not take pains to observe it before
performing an operation or cure. He himself had had one case where
the human heart was laid bare and yet the patient recovered.[650]
As a young practitioner before he came to Rome Galen worked out so
successful a method of treating wounds of the sinews that the care
of the health of the gladiators in his native city of Pergamum was
entrusted to him by several successive pontifices[651] and he hardly
lost a life. In the same passage he again speaks contemptuously of
the doctors in the war with the Germans who were allowed to cut open
the bodies of the barbarians but learned no more thereby than a cook
would. When Galen came from Pergamum to Rome he found the professions
of physicians and surgeons distinct and left cases to the latter which
he before had attended to himself.[652] We may note finally that he
invented a new form of surgical knife.[653]
[Sidenote: Galen’s argument from design.]