GALEN
ON THE NATURAL FACULTIES
WITH AN ENGLISH TRANSLATION BY
ARTHUR JOHN BROCK, M.D.
EDINBURGH
LONDON: WILLIAM HEINEMANN
NEW YORK: G. P. PUTNAM'S SONS
MCMXVI
PREFACE
The text used is (with a few unimportant modifications) that of Kühn
(Vol. II), as edited by Georg Helmreich; Teubner, Leipzig, 1893. The
numbers of the pages of Kühn's edition are printed at the side of the
Greek text, a parallel mark (||) in the line indicating the exact
point of division between Kühn's pages.
Words in the English text which are enclosed in square brackets are
supplementary or explanatory; practically all explanations, however,
are relegated to the footnotes or introduction. In the footnotes,
also, attention is drawn to words which are of particular philological
interest from the point of view of modern medicine.
I have made the translation directly from the Greek; where passages of
special difficulty occurred, I have been able to compare my own
version with Linacre's Latin translation (1523) and the French
rendering of Charles Daremberg (1854-56); in this respect I am also
peculiarly fortunate in having had the help of Mr. A. W. Pickard
Cambridge of Balliol College, Oxford, who most kindly went through the
proofs and made many valuable suggestions from the point of view of
exact scholarship.
My best thanks are due to the Editors for their courtesy and for the
kindly interest they have taken in the work. I have also gratefully to
acknowledge the receipt of much assistance and encouragement from Sir
William Osler, Regius Professor of Medicine at Oxford, and from
Dr. J. D. Comrie, first lecturer on the History of Medicine at Edinburgh
University. Professor D'Arcy W. Thompson of University College,
Dundee, and Sir W. T. Thiselton-Dyer, late director of the Royal
Botanic Gardens at Kew, have very kindly helped me to identify several
animals and plants mentioned by Galen.
I cannot conclude without expressing a word of gratitude to my former
biological teachers, Professors Patrick Geddes and J. Arthur Thomson.
The experience reared on the foundation of their teaching has gone far
to help me in interpreting the great medical biologist of Greece.
I should be glad to think that the present work might help, however
little, to hasten the coming reunion between the "humanities" and
modern biological science; their present separation I believe to be
against the best interest of both.
A. J. B.
22nd Stationary Hospital, Aldershot.
_March_, 1916.
CONTENTS
PAGE
PREFACE v
INTRODUCTION ix
BIBLIOGRAPHY xli
SYNOPSIS OF CHAPTERS xliii
BOOK I 1
BOOK II 115
BOOK III 221
INDEX AND GLOSSARY 333
INTRODUCTION
[Sidenote: Hippocrates and Galen.]
If the work of Hippocrates be taken as representing the foundation
upon which the edifice of historical Greek medicine was reared, then
the work of Galen, who lived some six hundred years later, may be
looked upon as the summit or apex of the same edifice. Galen's merit
is to have crystallised or brought to a focus all the best work of the
Greek medical schools which had preceded his own time. It is
essentially in the form of Galenism that Greek medicine was
transmitted to after ages.
[Sidenote: The Beginnings of Medicine in Greece.]
The ancient Greeks referred the origins of medicine to a god Asklepios
(called in Latin Aesculapius), thereby testifying to their
appreciation of the truly divine function of the healing art. The
emblem of Aesculapius, familiar in medical symbolism at the present
day, was a staff with a serpent coiled round it, the animal typifying
wisdom in general, and more particularly the wisdom of the
medicine-man, with his semi-miraculous powers over life and death.
"_Be ye therefore wise as serpents and harmless as doves._"
[Sidenote: The Asclepiea or Health-Temples.]
The temples of Aesculapius were scattered over the ancient Hellenic
world. To them the sick and ailing resorted in crowds. The treatment,
which was in the hands of an hereditary priesthood, combined the best
of the methods carried on at our present-day health-resorts, our
hydropathics, sanatoriums, and nursing-homes. Fresh air, water-cures,
massage, gymnastics, psychotherapy, and natural methods in general
were chiefly relied on.
[Sidenote: Hippocrates and the Unity of the Organism.]
Hippocrates, the "Father of Medicine" (5th to 4th centuries, B.C.) was
associated with the Asclepieum of Cos, an island off the south-west
coast of Asia Minor, near Rhodes. He apparently revitalized the work
of the health-temples, which had before his time been showing a
certain decline in vigour, coupled with a corresponding excessive
tendency towards sophistry and priestcraft.
Celsus says: "_Hippocrates Cous primus quidem ex omnibus memoria
dignis ab studio sapientiae disciplinam hanc separavit_." He means
that Hippocrates first gave the physician an independent standing,
separating him from the cosmological speculator. Hippocrates confined
the medical man to medicine. He did with medical thought what Socrates
did with thought in general--he "brought it down from heaven to
earth." His watchword was "Back to Nature!"
At the same time, while assigning the physician his post, Hippocrates
would not let him regard that post as sacrosanct. He set his face
against any tendency to mystery-mongering, to exclusiveness, to
sacerdotalism. He was, in fact, opposed to the spirit of
trade-unionism in medicine. His concern was rather with the
physician's duties than his "rights."
At the dawn of recorded medical history Hippocrates stands for the
fundamental and primary importance of _seeing clearly_--that is of
_clinical observation_. And what he observed was that the human
organism, when exposed to certain abnormal conditions--certain
stresses--tends to behave in a certain way: that in other words, each
"disease" tends to run a certain definite course. To him a disease was
essentially a process, one and indivisible, and thus his practical
problem was essentially one of _prognosis_--"what will be the natural
course of this disease, if left to itself?" Here he found himself to
no small extent in opposition with the teaching of the neighbouring
medical school of Cnidus, where a more static view-point laid special
emphasis upon the minutiae of _diagnosis_.
Observation taught Hippocrates to place unbounded faith in the
recuperative powers of the living organism--in what we sometimes call
nowadays the _vis medicatrix Naturae_. His observation was that even
with a very considerable "abnormality" of environmental stress the
organism, in the large majority of cases, manages eventually by its
own inherent powers to adjust itself to the new conditions. "Merely
give Nature a chance," said the father of medicine in effect, "and
most diseases will cure themselves." And accordingly his treatment
was mainly directed towards "giving Nature a chance."
His keen sense of the solidarity (or rather, of the constant
interplay) between the organism and its environment (the "conditions"
to which it is exposed) is instanced in his book, "Airs, Waters, and
Places." As we recognise, in our popular everyday psychology, that "it
takes two to make a quarrel," so Hippocrates recognised that in
pathology, it takes two (organism and environment) to make a disease.
As an outstanding example of his power of clinical observation we may
recall the _facies Hippocratica_, an accurate study of the countenance
of a dying man.
His ideals for the profession are embodied in the "Hippocratic oath."
[Sidenote: Anatomy.]
Impressed by this view of the organism as a unity, the Hippocratic
school tended in some degree to overlook the importance of its
constituent _parts_. The balance was re-adjusted later on by the
labours of the anatomical school of Alexandria, which, under the aegis
of the enlightened Ptolemies, arose in the 3rd century B.C. Two
prominent exponents of anatomy belonging to this school were
Herophilus and Erasistratus, the latter of whom we shall frequently
meet with in the following pages (_v._ p. 95 _et seq._).
[Sidenote: The Empirics.]
After the death of the Master, the Hippocratic school tended, as so
often happens with the best of cultural movements, to show signs
itself of diminishing vitality: the letter began to obscure and hamper
the spirit. The comparatively small element of theory which existed in
the Hippocratic physiology was made the groundwork of a somewhat
over-elaborated "system." Against this tendency on the part of the
"Dogmatic" or "Rationalist" school there arose, also at Alexandria,
the sect of the Empiricists. "It is not," they said, "the cause but
the cure of diseases that concerns us; not how we digest, but what is
digestible."
[Sidenote: Greek Medicine in Rome.]
Horace said "_Graecia capta ferum victorem cepit_." Political
domination, the occupation of territory by armies, does not
necessarily mean real conquest. Horace's statement applied to medicine
as to other branches of culture.
The introducer of Greek medicine into Rome was Asclepiades (1st
century B.C.). A man of forceful personality, and equipped with a
fully developed philosophic system of health and disease which
commended itself to the Roman _savants_ of the day, he soon attained
to the pinnacle of professional success in the Latin capital: he is
indeed to all time the type of the fashionable (and somewhat "faddy")
West-end physician. His system was a purely mechanistic one, being
based upon the atomic doctrine of Leucippus and Democritus, which had
been completed by Epicurus and recently introduced to the Roman public
in Lucretius's great poem "_De Rerum Natura_." The disbelief of
Asclepiades in the self-maintaining powers of the living organism are
exposed and refuted at considerable length by Galen in the volume
before us.
[Sidenote: The Methodists.]
Out of the teaching of Asclepiades that physiological processes depend
upon the particular way in which the ultimate indivisible molecules
come together ([Greek: en tê poia synodô tôn prôtôn ekeinôn sômatôn
tôn apathôn]) there was developed by his pupil, Themison of Laodicea,
a system of medicine characterised by the most engaging simplicity
both of diagnosis and treatment. This so-called "Methodic" system was
intended to strike a balance between the excessive leaning to
apriorism shown by the Rationalist (Hippocratic) school and the
opposite tendency of the Empiricists. "A pathological theory we must
have," said the Methodists in effect, "but let it be simple." They
held that the molecular groups constituting the tissues were traversed
by minute channels ([Greek: poroi], "pores"); all diseases belonged to
one or other of two classes; if the channels were constricted the
disease was one of _stasis_ ([Greek: stegnôsis]), and if they were
dilated the disease was one of _flux_ ([Greek: rhysis]). Flux and
stasis were indicated respectively by increase and diminution of the
natural secretions; treatment was of opposites by opposites--of
stasis by methods causing dilatation of the channels, and conversely.
Wild as it may seem, this pathological theory of the Methodists
contained an element of truth; in various guises it has cropped up
once and again at different epochs of medical history; even to-day
there are pathologists who tend to describe certain classes of disease
in terms of vaso-constriction and vaso-dilatation. The vice of the
Methodist teaching was that it looked on a disease too much as
something fixed and finite, an independent _entity_, to be considered
entirely apart from its particular setting. The Methodists illustrate
for us the tyranny of _names_. In its defects as in its virtues this
school has analogues at the present day; we are all acquainted with
the medical man to whom a name (such, let us say, as "tuberculosis,"
"gout," or "intestinal auto-intoxication") stands for an entity, one
and indivisible, to be treated by a definite and unvarying formula.
To such an individual the old German saying "_Jedermann hat am Ende
ein Bischen Tuberkulose_" is simply--incomprehensible.
[Sidenote: Galen.]
All the medical schools which I have mentioned were still holding
their ground in the 2nd century A.D., with more or less popular
acceptance, when the great Galen made his entry into the world of
Graeco-Roman medicine.
[Sidenote: His Nature and Nurture.]
Claudius Galenus was born at Pergamos in Asia Minor in the year
A.D. His father was one Nicon, a well-to-do architect of that city. "I
had the great good fortune," says Galen,[1] "to have as a father a
highly amiable, just, good, and benevolent man. My mother, on the
other hand, possessed a very bad temper; she used sometimes to bite
her serving-maids, and she was perpetually shouting at my father and
quarrelling with him--worse than Xanthippe with Socrates. When,
therefore, I compared the excellence of my father's disposition with
the disgraceful passions of my mother, I resolved to embrace and love
the former qualities, and to avoid and hate the latter."
Nicon called his son [Greek: Galênos], which means _quiet, peaceable_,
and although the physician eventually turned out to be a man of
elevated character, it is possible that his somewhat excessive leaning
towards controversy (exemplified in the following pages) may have
resulted from the fact that he was never quite able to throw off the
worst side of the maternal inheritance.
His father, a man well schooled in mathematics and philosophy, saw to
it that his son should not lack a liberal education. Pergamos itself
was an ancient centre of civilisation, containing, among other
culture-institutions, a library only second in importance to that of
Alexandria itself; it also contained an Asclepieum.
Galen's training was essentially eclectic: he studied all the chief
philosophical systems of the time--Platonic, Aristotelian, Stoic, and
Epicurean--and then, at the age of seventeen, entered on a course of
medical studies; these he pursued under the best teachers at his own
city, and afterwards, during a period of _Wanderjahre_, at Smyrna,
Alexandria, and other leading medical centres.
Returning to Pergamos, he received his first professional
appointment--that of surgeon to the gladiators. After four years here
he was drawn by ambition to Rome, being at that time about thirty-one
years of age. At Rome the young Pergamene attained a brilliant
reputation both as a practitioner and as a public demonstrator of
anatomy; among his patients he finally numbered even the Emperor
Marcus Aurelius himself.
Medical practice in Rome at this time was at a low ebb, and Galen took
no pains to conceal his contempt for the ignorance, charlatanism, and
venality of his fellow-practitioners. Eventually, in spite of his
social popularity, he raised up such odium against himself in medical
circles, that he was forced to flee the city. This he did hurriedly
and secretly in the year 168 A.D., when thirty-six years of age. He
betook himself to his old home at Pergamos, where he settled down once
more to a literary life.
His respite was short, however, for within a year he was summoned back
to Italy by imperial mandate. Marcus Aurelius was about to undertake
an expedition against the Germans, who at that time were threatening
the northern frontiers of the Empire, and he was anxious that his
consulting physician should accompany him to the front. "Patriotism"
in this sense, however, seems to have had no charms for the Pergamene,
and he pleaded vigorously to be excused. Eventually, the Emperor gave
him permission to remain at home, entrusting to his care the young
prince Commodus.
Thereafter we know little of Galen's history, beyond the fact that he
now entered upon a period of great literary activity. Probably he died
about the end of the century.
[Sidenote: Subsequent History of Galen's Works.]
Galen wrote extensively, not only on anatomy, physiology, and medicine
in general, but also on logic; his logical proclivities, as will be
shown later, are well exemplified in his medical writings. A
considerable number of undoubtedly genuine works of his have come down
to us. The full importance of his contributions to medicine does not
appear to have been recognized till some time after his death, but
eventually, as already pointed out, the terms Galenism and Greek
medicine became practically synonymous.
A few words may be devoted to the subsequent history of his writings.
[Sidenote: Byzantine Medicine.]
During and after the final break-up of the Roman Empire came times or
confusion and of social reconstruction, which left little opportunity
for scientific thought and research. The Byzantine Empire, from the
4th century onwards, was the scene of much internal turmoil, in which
the militant activities of the now State-established Christian church
played a not inconsiderable part. The Byzantine medical scholars
were at best compilers, and a typical compiler was Oribasius,
body-physician to the Emperor Julian (4th century, A.D.); his
excellent _Synopsis_ was written in order to make the huge mass of
the Galenic writings available for the ordinary practitioner.
[Sidenote: Arabian Medicine.]
Greek medicine spread, with general Greek culture, throughout Syria,
and from thence was carried by the Nestorians, a persecuted heretical
sect, into Persia; here it became implanted, and hence eventually
spread to the Mohammedan world. Several of the Prophet's successors
(such as the Caliphs Harun-al-Rashid and Abdul-Rahman III) were great
patrons of Greek learning, and especially of medicine. The Arabian
scholars imbibed Aristotle and Galen with avidity. A partial
assimilation, however, was the farthest stage to which they could
attain; with the exception of pharmacology, the Arabians made
practically no independent additions to medicine. They were
essentially systematizers and commentators. "_Averrois che il gran
comento feo_"[2] may stand as the type _par excellence_ of the Moslem
sage.
Avicenna (Ebn Sina), (10th to 11th century) is the foremost name in
Arabian medicine: his "Book of the Canon in Medicine," when translated
into Latin, even overshadowed the authority of Galen himself for some
four centuries. Of this work the medical historian Max Neuburger says:
"Avicenna, according to his lights, imparted to contemporary medical
science the appearance of almost mathematical accuracy, whilst the art
of therapeutics, although empiricism did not wholly lack recognition,
was deduced as a logical sequence from theoretical (Galenic and
Aristotelian) premises."
[Sidenote: Introduction of Arabian Medicine to the West.
Arabo-Scholastic Period.]
Having arrived at such a condition in the hands of the Mohammedans,
Galenism was now destined to pass once more to the West. From the 11th
century onwards Latin translations of this "Arabian" Medicine (being
Greek medicine in oriental trappings) began to make their way into
Europe; here they helped to undermine the authority of the one medical
school of native growth which the West produced during the Middle
Ages--namely the School of Salerno.
Blending with the Scholastic philosophy at the universities of Naples
and Montpellier, the teachings of Aristotle and Galen now assumed a
position of supreme authority: from their word, in matters scientific
and medical, there was no appeal. In reference to this period the
Pergamene was referred to in later times as the "Medical Pope of the
Middle Ages."
It was of course the logical side of Galenism which chiefly commended
it to the mediaeval Schoolmen, as to the essentially speculative
Moslems.
[Sidenote: The Renascence.]
The year 1453, when Constantinople fell into the hands of the Turks,
is often taken as marking the commencement of the Renascence. Among
the many factors which tended to stimulate and awaken men's minds
during these spacious times was the rediscovery of the Greek classics,
which were brought to Europe by, among others, the scholars who fled
from Byzantium. The Arabo-Scholastic versions of Aristotle and Galen
were now confronted by their Greek originals. A passion for Greek
learning was aroused. The freshness and truth of these old writings
helped to awaken men to a renewed sense of their own dignity and
worth, and to brace them in their own struggle for self-expression.
Prominent in this "Humanist" movement was the English physician,
Thomas Linacre (_c._ 1460-1524) who, having gained in Italy an
extraordinary zeal for the New Learning, devoted the rest of his life,
after returning to England, to the promotion of the _litterae
humaniores_, and especially to making Galen accessible to readers of
Latin. Thus the "_De Naturalibus Facultatibus_" appeared in London in
1523, and was preceded and followed by several other translations,
all marked by minute accuracy and elegant Latinity.
Two new parties now arose in the medical world--the so-called "Greeks"
and the more conservative "Arabists."
[Sidenote: Paracelsus.]
But the swing of the pendulum did not cease with the creation of the
liberal "Greek" party; the dazzling vision of freedom was to drive
some to a yet more anarchical position. Paracelsus, who flourished in
the first half of the 16th century, may be taken as typifying this
extremist tendency. His one cry was, "Let us away with all authority
whatsoever, and get back to Nature!" At his first lecture as professor
at the medical school of Basle he symbolically burned the works of
Galen and of his chief Arabian exponent, Avicenna.
[Sidenote: The Renascence Anatomists.]
But the final collapse of authority in medicine could not be brought
about by mere negativism. It was the constructive work of the
Renascence anatomists, particularly those of the Italian school, which
finally brought Galenism to the ground.
Vesalius (1514-64), the modern "Father of Anatomy," for dissecting
human bodies, was fiercely assailed by the hosts of orthodoxy,
including that stout Galenist, his old teacher Jacques Dubois (Jacobus
Sylvius). Vesalius held on his way, however, proving, _inter alia_,
that Galen had been wrong in saying that the interventricular septum
of the heart was permeable (_cf._ present volume, p. 321).
Michael Servetus (1509-53) suggested that the blood, in order to get
from the right to the left side of the heart, might have to pass
through the lungs. For his heterodox opinions he was burned at the
stake.
Another 16th-century anatomist, Andrea Cesalpino, is considered by the
Italians to have been a discoverer of the circulation of the blood
before Harvey; he certainly had a more or less clear idea of the
circulation, but, as in the case of the "organic evolutionists before
Darwin," he failed to prove his point by conclusive demonstration.
[Sidenote: William Harvey (1578-1657).]
William Harvey, the great Englishman who founded modern experimental
physiology and was the first to establish not only the fact of the
circulation but also the physical laws governing it, is commonly
reckoned the Father of Modern Medicine. He owed his interest in the
movements of the blood to Fabricio of Acquapendente, his tutor at
Padua, who drew his attention to the valves in the veins, thus
suggesting the idea of a circular as opposed to a to-and-fro motion.
Harvey's great generalisation, based upon a long series of experiments
_in vivo_, was considered to have given the _coup de grâce_ to the
Galenic physiology, and hence threw temporary discredit upon the whole
system of medicine associated therewith.
Modern medicine, based upon a painstaking research into the details
of physiological function, had begun.
[Sidenote: Back to Galen!]
While we cannot sufficiently commend the results of the long modern
period of research-work to which the labours of the Renascence
anatomists from Vesalius to Harvey form a fitting prelude, we yet by
no means allow that Galen's general medical outlook was so entirely
invalidated as many imagine by the conclusive demonstration of his
anatomical errors. It is time for us now to turn to Galen again after
three hundred years of virtual neglect: it may be that he will help us
to see something fundamentally important for medical practice which is
beyond the power even of our microscopes and _X_-rays to reveal. While
the value of his work undoubtedly lies mainly in its enabling us to
envisage one of the greatest of the early steps attained by man in
medical knowledge, it also has a very definite intrinsic value of its
own.
[Sidenote: Galen's Debt to his Precursors.]
No attempt can be made here to determine how much of Galen's work is,
in the true sense of the word, original, and how much is drawn from
the labours of his predecessors. In any case, there is no doubt that
he was much more than a mere compiler and systematizer of other men's
work: he was great enough to be able not merely to collect, to digest,
and to assimilate all the best of the work done before his time, but,
adding to this the outcome of his own observations, experiments, and
reflections, to present the whole in an articulated "system" showing
that perfect balance of parts which is the essential criterion of a
work of art. Constantly, however, in his writings we shall come across
traces of the influence of, among others, Plato, Aristotle, and
writers of the Stoic school.
[Sidenote: Influence of Hippocrates on Galen.]
Although Galen is an eclectic in the best sense of influence of the
term, there is one name to which he pays a very special tribute--that
of his illustrious forerunner Hippocrates. Him on quite a number of
occasions he actually calls "divine" (_cf._ p. 293).
"Hippocrates," he says, "was the first known to us of all who have
been both physicians and philosophers, in that _he was the first to
recognise what nature does_." Here is struck the keynote of the
teaching of both Hippocrates and Galen; this is shown in the volume
before us, which deals with "the _natural_ faculties"--that is with
the faculties of this same "Nature" or vital principle referred to in
the quotation.
[Sidenote: "The Natural Faculties."]
If Galen be looked on as a crystallisation of Greek medicine, then
this book may be looked on as a crystallisation of Galen. Within its
comparatively short compass we meet with instances illustrating
perhaps most of the sides of this many-sided writer. The "Natural
Faculties" therefore forms an excellent prelude to the study of his
larger and more specialised works.
[Sidenote: Galen's "Physiology."]
What, now, is this "Nature" or biological principle upon which Galen,
like Hippocrates, bases the whole of his medical teaching, and which,
we may add, is constantly overlooked--if indeed ever properly
apprehended--by many physiologists of the present day? By using this
term Galen meant simply that, when we deal with a living thing, we are
dealing primarily with a unity, which, _quâ_ living, is not further
divisible; all its parts can only be understood and dealt with as
being _in relation to_ this principle of unity. Galen was thus led to
criticise with considerable severity many of the medical and surgical
specialists of his time, who acted on the assumption (implicit if not
explicit) that the whole was merely the sum of its parts, and that if,
in an ailing organism, these parts were treated each in and for
itself, the health of the whole organism could in this way be
eventually restored.
Galen expressed this idea of the unity of the organism by saying that
it was governed by a _Physis_ or Nature ([Greek: hê physis hêper
dioikei to zôon]), with whose "faculties" or powers it was the
province of [Greek: physiologia] (physiology, Nature-lore) to deal.
It was because Hippocrates had a clear sense of this principle that
Galen called him master. "Greatest," say the Moslems, "is Allah, and
Mohammed is his prophet." "Greatest," said Galen, "is the Physis, and
Hippocrates is its prophet." Never did Mohammed more zealously
maintain the unity of the Godhead than Hippocrates and Galen the unity
of the organism.
[Sidenote: Galen's Physics.]
But we shall not have read far before we discover that the term
_Physiology_, as used by Galen, stands not merely for what we
understand by it nowadays, but also for a large part of _Physics_ as
well. This is one of the chief sources of confusion in his writings.
Having grasped, for example, the uniqueness of the process of
_specific selection_ ([Greek: holkê tou oikeiou]), by which the
tissues nourish themselves, he proceeds to apply this principle in
explanation of entirely different classes of phenomena; thus he mixes
it up with the physical phenomenon of the attraction of the lodestone
for iron, of dry grain for moisture, etc. It is noteworthy, however,
in these latter instances, that he does not venture to follow out his
comparison to its logical conclusion; he certainly stops short of
hinting that the lodestone (like a living organ or tissue)
_assimilates_ the metal which it has attracted!
Setting aside, however, these occasional half-hearted attempts to
apply his principle of a [Greek: physis] in regions where it has no
natural standing, we shall find that in the field of biology Galen
moves with an assurance bred of first-hand experience.
[Sidenote: The Mechanical Physicists.]
Against his attempt to "biologize" physics may be set the converse
attempt of the mechanical Atomist school. Thus in Asclepiades he found
a doughty defender of the view that physiology was "merely" physics.
Galen's ire being roused, he is not content with driving the enemy out
of the biological camp, but must needs attempt also to dislodge him
from that of physics, in which he has every right to be.
[Sidenote: The Anatomists.]
In defence of the universal validity of his principle, Galen also
tends to excessive disparagement of morphological factors; witness his
objection to the view of the anatomist Erasistratus that the calibre
of vessels played a part in determining the secretion of fluids (p.
123), that digestion was caused by the mechanical action of the
stomach walls (p. 243), and dropsy by induration of the liver (p.
171).
[Sidenote: Characteristics of the Living Organism.]
While combating the atomic explanation of physical processes, Galen of
course realised that there were many of these which could only be
explained according to what we should now call "mechanical laws." For
example, non-living things could be subjected to [Greek: phora]
(passive motion), they answered to the laws of gravity ([Greek: tais
tôn hylôn oiakizomena rhopais], p. 126). Furthermore, Galen did not
fail to see that living things also were not entirely exempted from
the operation of these laws; they too may be at least partly subject
to gravity (_loc. cit._); a hollow organ exerts, by virtue of its
cavity, an attraction similar to that of dilating bellows, as well as,
by virtue of the living tissue of its walls, a specifically "vital" or
selective kind of attraction (p. 325).
As a type of characteristically vital action we may take _nutrition_,
in which occurs a phenomenon which Galen calls _active motion_
([Greek: drastikê kinêsis]) or, more technically, _alteration_
([Greek: alloiôsis]). This active type of motion cannot be adequately
stated in terms of the passive movements (groupings and re-groupings)
of its constituent parts according to certain empirical "laws."
Alteration involves _self-movement_, a self-determination of the
organism or organic part. Galen does not attempt to explain this
fundamental characteristic of _alteration_ any further; he contents
himself with referring his opponents to Aristotle's work on the
"Complete Alteration of Substance" (p. 9).
The most important characteristic of the Physis or Nature is its
[Greek: technê]--its artistic creativeness. In other words, the living
organism is a creative artist. This feature may be observed typically
in its primary functions of _growth_ and _nutrition_; these are
dependent on the characteristic _faculties_ or powers, by virtue of
which each part draws to itself what is proper or appropriate to it
([Greek: to oikeion]) and rejects what is foreign ([Greek: to
allotrion]), thereafter appropriating or assimilating the attracted
material; this assimilation is an example of the _alteration_ (or
qualitative change) already alluded to; thus the food eaten is
"altered" into the various tissues of the body, each of these having
been provided by "Nature" with its own specific faculties of
attraction and repulsion.
[Sidenote: The Three Categories.]
Any of the operations of the living part may be looked on in three
ways, either (_a_) as a [Greek: dynamis], faculty, potentiality;
(_b_) as an [Greek: energeia], which is this [Greek: dynamis] in
operation; or (_c_) as an [Greek: ergon], the product or effect of the
[Greek: energeia].[3]
[Sidenote: Galen's Method.]
Like his master Hippocrates, Galen attached fundamental importance to
clinical observation--to the evidence of the senses as the
indispensable groundwork of all medical knowledge. He had also,
however, a forte for rapid generalisation from observations, and his
logical proclivities disposed him particularly to deductive
reasoning. Examples of an almost Euclidean method of argument may be
found in the _Natural Faculties_ (_e.g._ Book III. chap. i.). While
this method undoubtedly gave him much help in his search for truth, it
also not unfrequently led him astray. This is evidenced by his
attempt, already noted, to apply the biological principle of the
[Greek: physis] in physics. Characteristic examples of attempts to
force facts to fit premises will be found in Book II. chap. ix., where
our author demonstrates that yellow bile is "virtually" dry, and also,
by a process of exclusion, assigns to the spleen the function of
clearing away black bile. Strangest of all is his attempt to prove
that the same principle of specific attraction by which the ultimate
tissues nourish themselves (and the lodestone attracts iron!) accounts
for the reception of food into the stomach, of urine into the kidneys,
of bile into the gall-bladder, and of semen into the uterus.
These instances are given, however, without prejudice to the system of
generalisation and deduction which, in Galen's hands, often proved
exceedingly fruitful. He is said to have tried "to unite professional
and scientific medicine with a philosophic link." He objected,
however, to such extreme attempts at simplification of medical science
as that of the Methodists, to whom diseases were isolated entities,
without any relationships in time or space (_v._ p. xv. _supra_).
He based much of his pathological reasoning upon the "humoral theory"
of Hippocrates, according to which certain diseases were caused by one
or more of the four humours (blood, phlegm, black and yellow bile)
being in excess--that is, by various _dyscrasiae_. Our modern
conception of "hormone" action shows certain resemblances with this
theory.
Besides observation and reasoning, Galen took his stand on
_experiment_; he was one of the first of experimental physiologists,
as is illustrated in the present book by his researches into the
function of the kidneys (p. 59 _et seq._). He also conducted a long
series of experiments into the physiology of the spinal cord, to
determine what parts controlled movement and what sensibility.
As a practitioner he modelled his work largely on the broad and simple
lines laid down by Hippocrates. He had also at his disposal all the
acquisitions of biological science dating from the time of Aristotle
five hundred years earlier, and reinforced by the discoveries in
anatomy made by the Alexandrian school. To these he added a large
series of researches of his own.
Galen never confined himself to what one might call the academic or
strictly orthodox sources of information; he roamed the world over for
answers to his queries. For example, we find him on his journeys
between Pergamos and Rome twice visiting the island of Lemnos in order
to procure some of the _terra sigillata_, a kind of earth which had a
reputation for healing the bites of serpents and other wounds. At
other times he visited the copper-mines of Cyprus in search for
copper, and Palestine for the resin called Balm of Gilead.
By inclination and training Galen was the reverse of a "party-man." In
the _Natural Faculties_ (p. 55) he speaks of the bane of sectarian
partizanship, "harder to heal than any itch." He pours scorn upon the
ignorant "Erasistrateans" and "Asclepiadeans," who attempted to hide
their own incompetence under the shield of some great man's name
(_cf._ p. 141).
Of the two chief objects of his censure in the _Natural Faculties_,
Galen deals perhaps less rigorously with Erasistratus than with
Asclepiades. Erasistratus did at least recognize the existence of a
vital principle in the organism, albeit, with his eye on the
structures which the scalpel displayed he tended frequently to forget
it. The researches of the anatomical school of Alexandria had been
naturally of the greatest service to surgery, but in medicine they
sometimes had a tendency to check progress by diverting attention from
the whole to the part.
[Sidenote: The Pneuma or Spirit.]
Another novel conception frequently occurring in Galen's writings is
that of the _Pneuma_ (_i.e._ the breath, _spiritus_). This word is
used in two senses, as meaning (1) the inspired air, which was drawn
into the left side of the heart and thence carried all over the body
by the arteries; this has not a few analogies with oxygen,
particularly as its action in the tissues is attended with the
appearance of the so-called "innate heat." (2) A vital principle,
conceived as being made up of matter in the most subtle imaginable
state (_i.e._ air). This vital principle became resolved into three
kinds: (_a_) [Greek: pneuma physikon] or _spiritus naturalis_, carried
by the veins, and presiding over the subconscious vegetative life;
this "natural spirit" is therefore practically equivalent to the
[Greek: physis] or "nature" itself. (_b_) The [Greek: pneuma zôtikon]
or _spiritus vitalis_; here particularly is a source of error, since
the air already alluded to as being carried by the arteries tends to
be confused with this principle of "individuality" or relative
autonomy in the circulatory (including, perhaps, the vasomotor)
system. (_c_) The [Greek: pneuma psychikon] or _spiritus animalis_
(anima = [Greek: psychê]), carried by longitudinal canals in the nerves;
this corresponds to the [Greek: psychê].
This view of a "vital principle" as necessarily consisting of matter
in a finely divided, fluid, or "etheric" state is not unknown even in
our day. Belief in the fundamental importance of the Pneuma formed the
basis of the teaching of another vitalist school in ancient Greece,
that of the Pneumatists.
[Sidenote: Galen and the Circulation of the Blood.]
It is unnecessary to detail here the various ways in which Galen's
physiological views differ from those of the Moderns, as most of these
are noticed in footnotes to the text of the present translation. His
ignorance of the circulation of the blood does not lessen the force of
his general physiological conclusions to the extent that might be
anticipated. In his opinion, the great bulk of the blood travelled
with a to-and-fro motion in the veins, while a little of it, mixed
with inspired air, moved in the same way along the arteries; whereas
we now know that all the blood goes outward by the arteries and
returns by the veins; in either case blood is carried to the tissues
by blood-vessels, and Galen's ideas of tissue-nutrition were
wonderfully sound. The ingenious method by which (in ignorance of the
pulmonary circulation) he makes blood pass from the right to the left
ventricle, may be read in the present work (p. 321). As will be seen,
he was conversant with the "anastomoses" between the ultimate branches
of arteries and veins, although he imagined that they were not used
under "normal" conditions.
[Sidenote: Galen's Character.]
Galen was not only a man of great intellectual gifts, but one also of
strong moral fibre. In his short treatise "That the best Physician is
also a Philosopher" he outlines his professional ideals. It is
necessary for the efficient healer to be versed in the three branches
of "philosophy," viz.: (_a_) _logic_, the science of how to think;
(_b_) _physics_, the science of what is--_i.e._ of "Nature" in the
widest sense; (_c_) _ethics_, the science of what to do. The amount of
toil which he who wishes to be a physician must undergo--firstly, in
mastering the work of his predecessors and afterwards in studying
disease at first hand--makes it absolutely necessary that he should
possess perfect self-control, that he should scorn money and the weak
pleasures of the senses, and should live laborious days.
Readers of the following pages will notice that Galen uses what we
should call distinctly immoderate language towards those who ventured
to differ from the views of his master Hippocrates (which were also
his own). The employment of such language was one of the few
weaknesses of his age which he did not transcend. Possibly also his
mother's choleric temper may have predisposed him to it.
The fact, too, that his vivisection experiments (_e.g._ pp. 59, 273)
were carried out apparently without any kind of anaesthetisation being
even thought of is abhorrent to the feelings of to-day, but must be
excused also on the ground that callousness towards animals was then
customary, men having probably never thought much about the subject.
[Sidenote: Galen's Greek Style.]
Galen is a master of language, using a highly polished variety of
Attic prose with a precision which can be only very imperfectly
reproduced in another tongue. Every word he uses has an exact and
definite meaning attached to it. Translation is particularly difficult
when a word stands for a physiological conception which is not now
held; instances are the words _anadosis_, _prosthesis_, and
_prosphysis_, indicating certain steps in the process by which
nutriment is conveyed from the alimentary canal to the tissues.
Readers will be surprised to find how many words are used by Galen
which they would have thought had been expressly coined to fit modern
conceptions; thus our author employs not merely such terms as
_physiology_, _phthisis_, _atrophy_, _anastomosis_, but also
_haematopoietic_, _anaesthesia_, and even _aseptic_! It is only fair,
however, to remark that these terms, particularly the last, were not
used by Galen in quite their modern significance.
[Sidenote: Summary.]
To resume, then: What contribution can Galen bring to the art of
healing at the present day? It was not, surely, for nothing that the
great Pergamene gave laws to the medical world for over a thousand
years!
Let us draw attention once more to:
(1) The high ideal which he set before the profession.
(2) His insistence on immediate contact with nature as the primary
condition for arriving at an understanding of disease; on the need for
due consideration of previous authorities; on the need also for
reflection--for employment of the mind's eye ([Greek: hê logikê
theôria]) as an aid to the physical eye.
(3) His essentially broad outlook, which often helped him in the
comprehension of a phenomenon through his knowledge of an analogous
phenomenon in another field of nature.
(4) His keen appreciation of the unity of the organism, and of the
inter-dependence of its parts; his realisation that the vital
phenomena (physiological and pathological) in a living organism can
only be understood when considered in relation to the _environment_ of
that organism or part. This is the foundation for the war that Galen
waged _à outrance_ on the Methodists, to whom diseases were things
without relation to anything. This dispute is, unfortunately, not
touched upon in the present volume. What Galen combated was the
tendency, familiar enough in our own day, to reduce medicine to the
science of finding a label for each patient, and then treating not the
patient, but the label. (This tendency, we may remark in parenthesis,
is one which is obviously well suited for the _standardising_ purposes
of a State medical service, and is therefore one which all who have
the weal of the profession at heart must most jealously watch in the
difficult days that lie ahead.)
(5) His realisation of the inappropriateness and inadequacy of
physical formulae in explaining physiological activities. Galen's
disputes with Asclepiades over [Greek: ta prôta ekeina sômata ta
apathê], over the [Greek: anarma stoicheia kai lêrôdeis onkoi], is but
another aspect of his quarrel with the Methodists regarding their
pathological "units," whose primary characteristic was just this same
[Greek: apatheia] (impassiveness to environment, "unimpressionability").
We have of course our Physiatric or Iatromechanical school at the
present day, to whom such processes as absorption from the alimentary
canal, the respiratory interchange of gases, and the action of the renal
epithelium are susceptible of a purely physical explanation.[4]
(6) His quarrel with the Anatomists, which was in essence the same as
that with the Atomists, and which arose from his clear realisation
that that primary and indispensable desideratum, a view of the whole,
could never be obtained by a mere summation of partial views; hence,
also, his sense of the dangers which would beset the medical art if it
were allowed to fall into the hands of a mere crowd of competing
specialists without any organising head to guide them.
[1] _On the Affections of the Mind_, p. 41 (Kühn's ed.).
[2] "Averrhoës who made the great Commentary" (Dante). It
was Averrhoës (Ebn Roshd) who, in the 12th century,
introduced Aristotle to the Mohammedan world, and the
"Commentary" referred to was on Aristotle.
[3] What appear to me to be certain resemblances between
the Galenical and the modern vitalistic views of Henri
Bergson may perhaps be alluded to here. Galen's vital
principle, [Greek: hê technikê physis] ("creative
growth"), presents analogies with _l'Evolution créatrice_:
both manifest their activity in producing qualitative
change ([Greek: alloiôsis], _changement_): in both, the
creative change cannot be analysed into a series of static
states, but is one and continuous. In Galen, however, it
comes to an end with the _development of the individual_,
whereas in Bergson it continues indefinitely as the
_evolution of life_. The three aspects of organic life may
be tabulated thus:--
[Greek: dynamis] [Greek: energeia] [Greek: ergon]
Work to be done. Work being done. Work done, finished.
Future aspect. Present aspect. Past aspect.
Function. Structure.
The _élan vital_. A "thing."
A changing which
cannot be understood
as a sum of static
parts; a constant
becoming, never
stopping--at least
till the [Greek: ergon]
is reached.
Bergson's Bergson's Bergson's "outlook
"teleological" "philosophical" of physical
aspect. aspect. science."
Galen recognized "creativeness" ([Greek: technê]) in the
_development_ of the individual and its parts (ontogeny)
and in the maintenance of these, but he failed to
appreciate the creative _evolution_ of species
(phylogeny), which is, of course, part of the same
process. To the teleologist the possibilities ([Greek:
dynameis]) of the Physis are limited, to Bergson they
are unlimited. Galen and Bergson agree in attaching most
practical importance to the middle category--that of
Function.
While it must be conceded that Galen, following
Aristotle, had never seriously questioned the fixity of
species, the following quotation from his work _On
Habits_ (chap. ii.) will show that he must have at least
had occasional glimmerings of our modern point of view
on the matter. Referring to _assimilation_, he says:
"Just as everything we eat or drink becomes _altered in
quality_, so of course also does the altering factor
itself become altered.... A clear proof of the
assimilation of things which are being nourished to that
which is nourishing them is the change which occurs in
plants and seeds; this often goes so far that what is
highly noxious in one soil becomes, when transplanted
into another soil, not merely harmless, but actually
useful. This has been largely put to the test by those
who compose memoirs on farming and on plants, as also by
zoological authors who have written on the changes which
occur according to the countries in which animals live.
Since, therefore, not only is the nourishment altered by
the creature nourished, but the latter itself also
undergoes some slight alteration, _this slight
alteration must necessarily become considerable in the
course of time_, and thus properties resulting from
prolonged habit must come to be on a par with natural
properties."
Galen fails to see the possibility that the "natural"
properties themselves originated in this way, as
activities which gradually became habitual--that is to
say, that the effects of _nurture_ may become a "second
nature," and so eventually _nature_ itself.
The whole passage, however, may be commended to modern
biologists--particularly, might one say, to those
bacteriologists who have not yet realised how
extraordinarily _relative_ is the term "specificity"
when applied to the subject-matter of their science.
[4] In terms of filtration, diffusion, and osmosis.
BIBLIOGRAPHY
Codices
Bibliothèque Nationale. Paris. No. 2267.
Library of St. Mark. Venice. No. 275.
Translations
Arabic translations by Honain in the Escurial Library, and
in the Library at Leyden. Hebrew translation in the
Library at Bonn. Latin translations in the Library of
Gonville and Caius College (MSS.), No. 947; also by
Linacre in editions published, London, 1523; Paris,
1528; Leyden, 1540, 1548, and 1550; also by C.G. Kühn,
Leipzig, 1821.
Commentaries and Appreciations
Nic. de Anglia in Bib. Nat. Paris (MSS.), No. 7015; J.
Rochon, _ibidem_, No. 7025; J. Segarra, 1528; J. Sylvius,
1550, 1560; L. Joubert, 1599; M. Sebitz, 1644, 1645;
J.B. Pacuvius, 1554; J.C.G. Ackermann, 1821, in
the introduction to Kühn's translation, p. lxxx; Ilberg
in articles on "Die Schriftstellerei des Klaudios
Galenos," in _Rhein. Mus._, Nos. 44, 47, 51, and 52
(years 1889, 1892, 1896 and 1897); I. von Mueller in
_Quæstiones Criticae de Galeni libris_, Erlangen, 1871;
Steinschneider in Virchow's _Archiv_, No. cxxiv. for
1891; Wenrich in _De auctorum graecorum versionibus
et commentariis syriacis, arabicis, armiacis, persisque_,
Leipzig, 1842.
SYNOPSIS OF CHAPTERS
BOOK I
Chapter I
Distinction between the effects of (_a_) the organism's
_psyche_ or soul (_b_) its _physis_ or nature. The
author proposes to confine himself to a consideration of
the latter--the vegetative--aspect of life.