Galen
Aelius Galenus or Claudius Galenus, often anglicized as Galen or Galen of Pergamon, was a Roman and Greek physician, surgeon, and philosopher. Considered to be one of the most accomplished of all medical researchers of antiquity, Galen influenced the development of various scientific disciplines, including anatomy, physiology, pathology, pharmacology, and neurology, as well as philosophy and logic.
The son of Aelius Nicon, a wealthy Greek architect with scholarly interests, Galen received a comprehensive education that prepared him for a successful career as a physician and philosopher. Born in the ancient city of Pergamon, Galen traveled extensively, exposing himself to a wide variety of medical theories and discoveries before settling in Rome, where he served prominent members of Roman society and eventually was given the position of personal physician to several emperors.
Galen's understanding of anatomy and medicine was principally influenced by the contemporary theory of the four humors: black bile, yellow bile, blood, and phlegm, as first advanced by the author of On the Nature of Man in the Hippocratic corpus. Galen's views dominated and influenced Western medical science for more than 1,300 years. His anatomical reports were based mainly on the dissection of Barbary apes. However, while dissections and vivisections on humans were practiced in Alexandria by Herophilus and Erasistratus in the 3rd century BCE under Ptolemaic permission, by Galen's time these procedures were strictly forbidden in the Roman Empire. As Galen discovered that the facial expressions of the Barbary apes were particularly vivid, Galen switched to pigs for his research to avoid prosecution. Aristotle had used pigs centuries earlier for his study of anatomy and physiology. Galen, like others, reasoned that animal anatomy had a strong conciliance with that of humans. Galen would encourage his students to go look at dead gladiators or bodies that washed up in order to get better acquainted with the human body.
Galen's theory of the physiology of the circulatory system remained unchallenged until, when Ibn al-Nafis published his book Sharh tashrih al-qanun li' Ibn Sina, in which he reported his discovery of pulmonary circulation. His anatomical reports remained uncontested until 1543, when printed descriptions and illustrations of human dissections were published in the seminal work De humani corporis fabrica by Andreas Vesalius, where Galen's physiological theory was accommodated to these new observations.
Galen saw himself as both a physician and a philosopher, as he wrote in his treatise titled That the Best Physician Is Also a Philosopher. Galen was very interested in the debate between the rationalist and empiricist medical sects, and his use of direct observation, dissection, and vivisection represents a complex middle ground between the extremes of those two viewpoints. Many of his works have been preserved or translated from the original Greek, although many were destroyed and some credited to him are believed to be spurious. Although there is some debate over the date of his death, he was no younger than seventy when he died.
Biography
Galen's Greek name Γαληνός comes from the adjective γαληνός 'calm'. Galen's Latin name implies he had Roman citizenship.Galen describes his early life in On the affections of the mind. He was born in September 129 CE. His father, Aelius Nicon, was a wealthy patrician, an architect and builder, with eclectic interests including philosophy, mathematics, logic, astronomy, agriculture and literature. Galen describes his father as a "highly amiable, just, good and benevolent man". At that time Pergamon was a major cultural and intellectual centre, noted for its library, second only to that in Alexandria, as well as being the site of a large temple to the healing god Asclepius. The city attracted both Stoic and Platonic philosophers, to whom Galen was exposed at age 14. His studies also took in each of the principal philosophical systems of the time, including Aristotelian and Epicurean. His father had planned a traditional career for Galen in philosophy or politics and took care to expose him to literary and philosophical influences. However, Galen states that in around 145 his father had a dream in which the god Asclepius appeared and commanded Nicon to send his son to study medicine.
Medical education
Following his earlier liberal education, Galen at age 16 began his studies at the prestigious local healing temple or asclepeion as a θεραπευτής for four years. There he came under the influence of men like Aeschrion of Pergamon, Stratonicus and Satyrus. Asclepiea functioned as spas or sanitoria to which the sick would come to seek the ministrations of the priesthood. Romans frequented the temple at Pergamon in search of medical relief from illness and disease. It was also the haunt of notable people such as the historian Claudius Charax, the orator Aelius Aristides, the sophist Polemo, and the consul Cuspius Rufinus.Galen's father died in 148, leaving Galen independently wealthy at the age of 19. He then followed the advice he found in Hippocrates' teaching and traveled and studied widely including such destinations as Smyrna, Corinth, Crete, Cilicia, Cyprus, and finally the great medical school of Alexandria, exposing himself to the various schools of thought in medicine. In 157, aged 28, he returned to Pergamon as physician to the gladiators of the High Priest of Asia, one of the most influential and wealthy men in Asia. Galen claims that the High Priest chose him over other physicians after he eviscerated an ape and challenged other physicians to repair the damage. When they refused, Galen performed the surgery himself and in so doing won the favor of the High Priest of Asia. Over his four years there, he learned the importance of diet, fitness, hygiene, and preventive measures, as well as living anatomy, and the treatment of fractures and severe trauma, referring to their wounds as "windows into the body". Only five deaths among the gladiators occurred while he held the post, compared to sixty in his predecessor's time, a result that is in general ascribed to the attention he paid to their wounds. At the same time he pursued studies in theoretical medicine and philosophy.
Rome
Galen went to Rome in 162 and made his mark as a practicing physician. His public demonstrations and impatience with alternative views on medicine brought him into conflict with other doctors practicing in the city. When the Peripatetic philosopher Eudemus became ill with quartan fever, Galen felt obliged to treat him "since he was my teacher and I happened to live nearby". He wrote: "I return to the case of Eudemus. He was thoroughly attacked by the three attacks of quartan ague, and the doctors had given him up, as it was now mid-winter." Some Roman physicians criticized Galen for his use of the prognosis in his treatment of Eudemus. This practice conflicted with the then-current standard of care, which relied upon divination and mysticism. Galen retaliated against his detractors by defending his own methods. Garcia-Ballester quotes Galen as saying: "In order to diagnose, one must observe and reason." This was the basis of his criticism of the doctors who proceeded alogos and askeptos.However, Eudemus warned Galen that engaging in conflict with these physicians could lead to his assassination. "Eudemus said this, and more to the same effect; he added that if they were not able to harm me by unscrupulous conduct they would proceed to attempts at poisoning. Among other things he told me that, some ten years before, a young man had come to the city and had given, like me practical demonstrations of the resources of our art; this young man was put to death by poison, together with two servants who accompanied him." When Galen's animosity with the Roman medical practitioners became serious, he feared he might be exiled or poisoned, so he left the city.
Rome was engaged in foreign wars in 161; Marcus Aurelius and his then co-Emperor and adoptive brother Lucius Verus were in the north fighting the Marcomanni. During the autumn of 169 when Roman troops were returning to Aquileia, a great plague, most likely one of the first appearances of smallpox in the Mediterranean world, broke out, and the emperor summoned Galen back to Rome. He was ordered to accompany Marcus and Verus to Germany as the court physician. The following spring Marcus was persuaded to release Galen after receiving a report that Asclepius was against the project. He was left behind to act as physician to the imperial heir Commodus. It was here in court that Galen wrote extensively on medical subjects. Ironically, Lucius Verus died in 169, and Marcus Aurelius himself died in 180, both victims of the plague.
Galen was the physician to Commodus for much of the emperor's life and treated his common illnesses. According to Dio Cassius 72.14.3–4, in about 189, under Commodus' reign, a pestilence occurred which at its height killed 2,000 people a day in Rome. This was most likely the same plague that struck Rome during Marcus Aurelius' reign. Galen was also physician to Septimius Severus during his reign in Rome. He complimented Severus and Caracalla on keeping a supply of drugs for their friends and mentioned three cases in which they had been of use in 198.
The Antonine Plague
The Antonine Plague was named after Marcus Aurelius' family name of Antoninus. It was also known as the Plague of Galen and held an important place in medicinal history because of its association with Galen. He had first-hand knowledge of the disease, and was present in Rome when it first struck in 166, and was also present in the winter of 168–69 during an outbreak among troops stationed at Aquileia. He had experience with the epidemic, referring to it as very long lasting, and described its symptoms and his treatment of it. His references to the plague are scattered and brief. Galen was not trying to present a description of the disease so that it could be recognized in future generations; he was more interested in the treatment and physical effects of the disease. For example, in his writings about a young man afflicted with the plague, he concentrated on the treatment of internal and external ulcerations. According to Niebuhr, "this pestilence must have raged with incredible fury; it carried off innumerable victims. The ancient world never recovered from the blow inflicted upon it by the plague that visited it in the reign of M. Aurelius."The mortality rate of the plague was 7–10 percent; the outbreak in 165–168 would have caused approximately 3.5 to 5 million deaths. Otto Seeck believes that over half the population of the empire perished. J. F. Gilliam believes that the Antonine plague probably caused more deaths than any other epidemic during the empire before the mid-3rd century. Although Galen's description is incomplete, it is sufficient to enable a firm identification of the disease as related to smallpox.
Galen notes that the exanthema covered the victim's entire body and was usually black. The exanthem became rough and scabby where there was no ulceration. He states that those who were going to survive developed a black exanthem. According to Galen, it was black because of a remnant of blood putrefied in a fever blister that was pustular. His writings state that raised blisters were present in the Antonine plague, usually in the form of a blistery rash. Galen states that the skin rash was close to the one Thucydides described. Galen describes symptoms of the alimentary tract via a patient's diarrhea and stools. If the stool was very black, the patient died. He says that the amount of black stools varied. It depended on the severity of the intestinal lesions. He observes that in cases where the stool was not black, the black exanthema appeared. Galen describes the symptoms of fever, vomiting, fetid breath, catarrh, cough, and ulceration of the larynx and trachea.