Galen: A Famous Medical Researcher of Classical Antiquity

Galen: A Famous Medical Researcher of Classical Antiquity


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Galen of Pergamum was one of the most renowned physicians that the Roman Empire had ever produced. In addition to being a celebrated physician, Galen is said to have also been a philosopher. Unlike his medical treatises, most of Galen’s philosophical writings have been lost, as a result of a fire that destroyed the Temple of Peace in Rome in 191 AD. His medical works, however, have survived, and have dominated the theory and practice of medicine not only of the Roman world, but also of the Islamic world and Medieval Europe.

The Early Life of Galen

Galen is believed to have been born during the reign of the Emperor Hadrian in around 130 AD. His father, a man by the name of Nicon, is recorded to have been a prosperous architect and builder. In his On the Passions and Errors of the Soul , Galen describes his father as such,

“I did enjoy the good fortune of having the least irascible, the most just, the most devoted, and kindest of fathers.”

By contrast, Galen described his mother as a woman “so very prone to anger”. Between the two, Galen professes to have emulated his father rather than his mother,

“When I compared my father's noble deeds with the disgraceful passions of my mother, I decided to embrace and love his deeds and to flee and hate her passions.”

Portrait of Galen.

Apart from his father, Galen’s early life was also influenced by the city he was born in, Pergamum (Pergamon). During Galen’s days, Pergamum was a bustling and flourishing city. Pergamum also had a library that almost rivalled the famed Library of Alexandria in Egypt, indicating that this was a center of learning. Moreover, Pergamum was famous for its statue of Asclepius, the Greek god of medicine and healing, to whom Galen devoted his life.

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According to Galen, at the age of 14, he attended lectures given (mostly) by local philosophers, primarily under a “Stoic who was the disciple of Philopator”. Additionally, he attended lectures for a period of time under a “Platonist, a disciple of Gaius”, a “disciple of Aspasius the Peripatetic”, as well as a “teacher from Athens, an Epicurean”. Galen points out that his father, being a concerned parent, accompanied him to these lectures,

“For my sake, my father made a close investigation of the lives and doctrines of all these men and went along with me to hear them.”

The reconstructed Temple of Trajan at Pergamon. (CC BY-SA 3.0 )

Nicon’s training, however, “lay chiefly in the sciences of geometry, arithmetic, architecture, and astronomy”, and viewed the subject of philosophy from quite a different perspective. For instance, drawing from his own experience in the sciences he had been trained in, Nicon reached the conclusion (the process prior to which is unclear, due to the Greek text being defective) that:

“there was no need for my teachers in the liberal disciplines to disagree with one another, just as there was no disagreement among the teachers of old in the aforementioned sciences, of which geometry and arithmetic are the foremost.“

Galen’s Medical Studies

From Galen’s writings, it can be seen that his father had a great influence on him, and helped shape his subsequent outlook on life. His greatest impact on Galen’s life, however, was a dream he had. In this dream, Asclepius is said to have appeared to Nicon, telling him to let his son study medicine. Nicon did as the god instructed, and for the next four years, Galen studied under the physicians who gathered in the sanctuary of Asclepius.

Following the death of his father, Galen began travelling, during which he also furthered his medical studies. His travels brought him to various places, including Smyrna, Corinth and Alexandria. After being abroad for a number of years, Galen returned to Pergamum in 157 AD, where he was appointed as a physician to the city’s gladiator. In this position, Galen gained much practical experience in the treatment of wounds. Galen remained in Pergamum until 162 AD, when he left for Rome, either as a result of his own ambitions, or due to the civil unrest that broke out in Pergamum.

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‘Muscles Man,’ showing the muscles and spine, back view, on an anatomical diagram. Mid-15th century Anathomia, (English) Claudius (Pseudo) Galen. (CC BY 4.0 )

In Rome, Galen became a successful physician, which made him resented by the other physicians of the city. As he had created powerful enemies, he decided to depart secretly in 166 AD for fear that he might lose his life if he stayed any longer. For the next couple of years, Galen kept a low profile. He was, however, summoned by Marcus Aurelius, the Roman Emperor, to serve as his court physician. Galen continued to serve in this capacity during the reigns of Caracalla and Septimius Severus. Galen died either around 200 AD or 216 AD.

Galen wrote hundreds of treatises. In the field of medicine, he is said to have compiled “all significant Greek and Roman medical knowledge to date”, and added his own observations and theories. Following the collapse of the Western Roman Empire, his works were mostly forgotten in the West.

In the Byzantine Empire and the Islamic world, by contrast, Galen’s works were featured prominently in the study of medicine. Thanks to this preservation of knowledge, Galen’s writings were able to find their way back to Western Europe during the Middle Ages.

Featured image: Galen of Pergamon (Claudius Galenus, or in French, Claude Galien) (Paris: Lithograph by Gregoire et Deneux, ca. 1865). Photo source: .


Galen

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Medical Works of Antiquity (16 vols.)

Medical Works of Antiquity assembles the writings of Hippocrates, Galen, and Celsus to bring you a comprehensive study of ancient medical practices, theories, and experiences. These texts remained valuable resources for hundreds of years, representing the best medical insight available at the time.

Known as the father of Western medicine, Hippocrates made extraordinary contributions to medical practices and vocabulary, including key terminology still in use today. Categorical terms such as &ldquoacute,&rdquo &ldquochronic,&rdquo &ldquoendemic,&rdquo and &ldquoepidemic,&rdquo as well as &ldquoexacerbation,&rdquo &ldquorelapse,&rdquo &ldquoresolution,&rdquo &ldquocrisis,&rdquo &ldquoparoxysm,&rdquo &ldquopeak,&rdquo and &ldquoconvalescence&rdquo were all coined by Hippocrates. While the specific techniques Hippocrates used in fourth and fifth century BC are outdated, Hippocrates introduced a number of medical approaches and the philosophy behind them that medical practitioners still use today, such as the modern adaptation of the famous Hippocratic Oath&mdashincluded in the Medical Works of Antiquity collection with Hippocrates&rsquo other medical writings.

Six hundred years after Hippocrates, Galen entered the medical field. With the best education available and a wealth of experience, Galen made contributions to medicine that lasted over 1,000 years, and his works were studied by medical practitioners as late as the nineteenth century. Galen knew that understanding the human body&rsquos mysteries was key to medical science, but since dissecting the deceased was illegal under Roman law, he studied anatomy by dissecting pigs and monkeys instead. Through this, he established a greater understanding of the human body than any physician before his time, as well as countless physicians after. Works like On the Natural Faculties survive today as fascinating explorations of ancient medical practices and the logic behind them.

Building from the writings of prominent physicians, Aulus Cornelius Celsus wrote On Medicine as a part of an encyclopedia on agriculture, medicine, military arts, rhetoric, philosophy, and jurisprudence. On Medicine is the only surviving text from the encyclopedia. It offers an accessible and comprehensive explanation of medical science leading up to the first century. All three volumes of On Medicine are contained in the Medical Works of Antiquity, covering subjects including the Greek schools of medicine, prognosis, diagnosis, ailments, treatment, surgeries, and more.

This collection contains the complete texts in their Loeb Classical Library editions. Each volume is included in its original language with an English translation for easy side-by-side comparison. Logos&rsquo language tools help you to go deeper into the Greek and Latin texts and explore each writer&rsquos elegant language. Use the dictionary lookup tool to examine difficult Greek or Latin words and find every occurrence in your library. There&rsquos never been a better way for students of history, medicine, culture, and Greek and Latin literature to absorb these intriguing works.


Galen: A Famous Medical Researcher of Classical Antiquity - History

Stanley Gutiontov
Chicago, Illinois, United States

The bad rap

“And the pig, though it has a split hoof completely divided, does not chew the cud it is unclean for you.”
—Leviticus 11: 7

Slaughtering of a pig

Pig: a word variably defined as “a young domesticated swine not yet sexually mature” or “a dirty, gluttonous, or repulsive person.” 1 Pork may harbor within it hundreds of infectious agents, at least two of which have been known since antiquity: the pig tapeworm, Taenia solium, and Trichinella spiralis, the parasite that causes trichinosis. Tapeworms were known to the ancient Egyptians, and T. solium itself was discussed in Aristotle’s History of Animals under the guise of “measled pork” 2 even today, neurocysticercosis secondary to T. solium infection is one of the leading causes of seizures and epilepsy in the developing world. 3 Figures as famous as Rudolf Virchow participated in research leading to the discovery of the life cycle of T. spiralis: 4 the “uncleanliness” of the pig has been well documented by some of the greatest thinkers of all time.

The genus Sus has been subjected to this bad rap for nearly the entire span of human history: in 2009, millennia after Aristotle’s description of “measled pork,” the global outbreak of swine flu precipitated hysteria and further vilified the creature. Vigilance is, of course, necessary. Ignorance is not. One must not disregard either of the implications of the similarity between sus scrofa domestica and homo sapiens sapiens: a creature that can serve as an intermediate reservoir of influenza that might later jump to us is also, by the very virtue of its biological proximity, one of the most useful—if not the most useful—animals in the history of medicine.

Inspired vivisection

Vivisected pig from De Humani Corporis Fabrica

In the above painting by Dutch Golden Age painter Adriaen van Ostade, pupil of Frans Hals and contemporary of Rembrandt van Rijn, the pig is not a creature of filth rather, it is all inspiration, warm light, artistic revelation. Moved to change his painterly style by Rembrandt’s superlative skill with light, Ostade completed his masterpiece one year before the older painter’s more famous Der geschlachtete Ochse. Here, the splayed pig is a veritable muse.

So it has been from time immemorial. Galen of Pergamon, the most important figure in classical medical science, used animals in his many dissections: the ox (for brain anatomy), the macaque (for cranial nerve anatomy), and the pig (for vivisection). During one of his experiments, as he was carrying out a strapped-down, struggling, and squealing pig, he accidentally cut its recurrent laryngeal nerves: the pig continued to struggle but now did so noiselessly. Following this serendipitous (the pig would beg to differ, if it could) occurrence, Galen went on to show that cutting both of these nerves in a menagerie of animals eliminated vocalization. His 2 nd -century fumble with the pig became the first experimental evidence that the brain controls behavior.

So famous did the squealing pig experiment become that Renaissance editions of Galen’s writings contain frontispieces depicting him cutting these nerves in a pig, Leonardo da Vinci produced a drawing of the recurrent laryngeal nerves, and Andreas Vesalius dedicated a large part of the last chapter of his 1543 opus De Humani Corporis Fabrica to the dissection of live animals, including a vivid image of an about-to-be vivisected pig. 5

An aside: the 1923 Nobel Prize in medicine

The Nobel Prize in Physiology or Medicine 1923 was awarded jointly to Frederick Grant Banting and John James Rickard Macleod “for the discovery of insulin.”
—Nobel Prize Announcement, 1923

The pig is—as was clear to both Galen and Vesalius—an anatomist’s marvel: the remarkable degree of similarity between the internal anatomy of the pig and that of the human is uncanny. The story only begins there: in physiology, too, we are astoundingly alike. On January 23, 1922, Leonard Thompson, a 14-year-old boy who lay dying of diabetic ketoacidosis at Toronto General Hospital was given the first injection of purified insulin his symptoms completely reversed. 6 Though Banting, Best, and Macleod first performed this miracle using hormone isolated from dog pancreas, the mass production of insulin until 1980—and therefore life-saving treatment for millions of people worldwide—required the pancreas of the ox or the pig. While the former yields insulin that differs from human insulin by three amino acids, pig insulin is just one amino acid shy of the real thing: a truly phenomenal molecular likeness.

Hand on your heart

Big man, pig man, ha ha, charade you are
You well heeled big wheel, ha ha, charade you are
And when your hand is on your heart
You’re nearly a good laugh
—Pink Floyd, Pigs (Three Different Ones)

Porcine bioprosthetic valve xenograft

While the pharmaceutical factories were busy churning out purified pig insulin, the saga of the pig in medicine swung from molecular biology back to anatomy. A 1964 news bulletin in the Journal of the American Medical Association reads “pigskin dressings and immediate excision were both advocated for the treatment of burns at the 49 th Clinical Congress of the American College of Surgeons . . . ” 7 Evidence is then presented supporting the clinical benefit of such xenotransplantation—the transplantation of cells, tissues, or organs from an individual of one species into an individual of another. The burn wounds healed faster, experienced fewer infections, and the transplants fell away of their own accord in a few weeks’ time without noxious effects. These first successes with xenotransplantation were occurring at an immensely opportune time: it was in the 1960s that the first evidence supporting immunologic rejection came to light.

Just a decade after the results with pigskin and burn treatment in humans, a group of French surgeons led by Alain Carpentier—now the head of the French Academy of Sciences—delved into another anatomic realm by performing the first successful heart valve replacement surgery using a xenograft. 8 If the use of pigskin in burn treatment seems a small novelty, heart valve replacement is most assuredly not. By 1976, the first commercially available biologic heart valve (Medtronic’s Hancock porcine valve) was introduced. Today, more than 100,000 people in the U.S. with severe heart valve dysfunction need valve replacement surgery and many of them receive bioprosthetic valves from that most unlikely of creatures: the pig. 9

Chimera

The creatures outside looked from pig to man, and from man to pig, and from pig to man again but already it was impossible to say which was which.
—George Orwell, Animal Farm

Transplantation-friendly pig

While the Kafkaesque metamorphosis described in Animal Farm is the stuff of fiction, there are now millions of people walking around with pig parts sewn to one of their vital organs. If this alone is not sufficiently astounding, consider this: valves may very likely be just the beginning.

In the early 2000s, several research groups took the first steps in surmounting the immunologic hurdles first discovered in the 1960s. Using transgenic techniques, scientists succeeded in knocking out the pig alpha-1,3-galactosyltransferase gene that is responsible for some of the immunologic rejection seen in transplantation. 10 Thomas Starzl, considered by many to be the father of modern transplantation, said the following in regard to such techniques: “Cloning . . . has been done by nuclear transfer. . . . That is what I think may allow enough alteration in pig organs to make them comparable to allografts [organs from humans].” 11 If this is indeed the case, then along the Blue Ridge Mountains in Vermont, a company named Revivicor owns a farm that will determine the future of transplantation medicine. On that farm, frolicking with hundreds of other pigs are several transgenic pigs marked only by their slightly punched out ears. With them, Revivicor hopes to accomplish its self-stated goals: the replacement of pancreatic islets in order to cure type 1 diabetes and the production of pig hearts and kidneys for long-term transplantation as well as pig livers as bridges to definitive transplantation. 12

These fantastical chimeras, rivaling the fabled sphinx, are just the tip of the iceberg: similar genetic techniques have produced pigs that are excellent models for research in cystic fibrosis, cardiovascular disease, and Alzheimer’s. Perhaps George Orwell was correct on more accounts than one: by better understanding pigs, we will learn to better understand ourselves.

Galen could not have imagined that the relatives of that mute pig, struggling against its inevitable vivisection, would transform medicine. From his initial demonstration of the connection between the brain and behavior to the million-dollar transgenic pigs in Vermont, the admirable pig has evolved uses consistently outpacing our knowledge. Pig is no longer an expletive on the contrary, we should be honored to be called pig men: artificial skin, valves, and all.

References

  1. “Pig.” Merriam-Webster Dictionary. © 2012 Merriam-Webster Dictionary Incorporated, [cited 2013 25 Feb] http://www.merriam-webster.com/dictionary/pig.
  2. Wadia, N., Singh, G., Taenia Solium: A Historical Note in Taenia Solium Cysticercosis: From Basic to Clinical Science 2002, CABI Publishing
    p. 157-168.
  3. DeGiorgio, C.M., et al., Neurocysticercosis.Epilepsy Curr, 2004. 4(3): p. 107-11.
  4. Blumer, G., Some remarks on the early history of Trichinosis (1822-1866). Yale Journal of Biology and Medicine 1939(6): p. 581-588.
  5. Gross, C.G., Galen and the Sqealing Pig, in The Neuroscientist, 1988. p. 216-221.
  6. The Nobel Prize in Physiology or Medicine 1923. [cited 2013 25 Feb] Available from: http://www.nobelprize.org/nobel_prizes/medicine/laureates/1923/
  7. Pigskin Grafts, Excision for Burns. JAMA, 1964(3): p. 35.
  8. Carpentier, A., From Valvular Xenograft to Valvular Bioprosthesis: 1965—1970. Ann Thorac Surg, 1989. 48: p. 73-74.
  9. Vesely, I., Heart Valve Tissue Engineering. Circulation Research, 2005. 97: p. 743-755.
  10. Platt, J.L., Knocking out xenograft rejection. Nat Biotechnol, 2002. 20(3): p. 231-2.
  11. Revivicor: Curing human disease through regenerative medicine. 2010 Available from: http://www.revivicor.com/about.html.
  12. Whyte, J.J. and R.S. Prather, Genetic modifications of pigs for medicine and agriculture. Mol Reprod Dev, 2011. 78(10-11): p. 879-91.

STANLEY GUTIONTOV is a third-year medical student at Feinberg School of Medicine in Chicago. He enjoys writing short stories and performing slam poetry, studying history and literature, and getting people excited about learning. He hopes to one day work in oncology.


Influence

Galen’s writings achieved wide circulation during his lifetime, and copies of some of his works survive that were written within a generation of his death. By 500 ce his works were being taught and summarized at Alexandria, and his theories were already crowding out those of others in the medical handbooks of the Byzantine world. Greek manuscripts began to be collected and translated by enlightened Arabs in the 9th century, and about 850 Ḥunayn ibn Isḥāq, an Arab physician at the court of Baghdad, prepared an annotated list of 129 works of Galen that he and his followers had translated from Greek into Arabic or Syriac. Learned medicine in the Arabic world thus became heavily based upon the commentary, exposition, and understanding of Galen.

Galen’s influence was initially almost negligible in western Europe except for drug recipes, but from the late 11th century Ḥunayn’s translations, commentaries on them by Arab physicians, and sometimes the original Greek writings themselves were translated into Latin. These Latin versions came to form the basis of medical education in the new medieval universities. From about 1490, Italian humanists felt the need to prepare new Latin versions of Galen directly from Greek manuscripts in order to free his texts from medieval preconceptions and misunderstandings. Galen’s works were first printed in Greek in their entirety in 1525, and printings in Latin swiftly followed. These texts offered a different picture from that of the Middle Ages, one that emphasized Galen as a clinician, a diagnostician, and above all, an anatomist. His new followers stressed his methodical techniques of identifying and curing illness, his independent judgment, and his cautious empiricism. Galen’s injunctions to investigate the body were eagerly followed, since physicians wished to repeat the experiments and observations that he had recorded. Paradoxically, this soon led to the overthrow of Galen’s authority as an anatomist. In 1543 the Flemish physician Andreas Vesalius showed that Galen’s anatomy of the body was more animal than human in some of its aspects, and it became clear that Galen and his medieval followers had made many errors. Galen’s notions of physiology, by contrast, lasted for a further century, until the English physician William Harvey correctly explained the circulation of the blood. The renewal and then the overthrow of the Galenic tradition in the Renaissance had been an important element in the rise of modern science, however.


The ‘Galen’ group of physicians in an image from the Vienna Dioscurides he is depicted top center.

Galen and Hippocrates. Galen of Pergamum, left, with Hippocrates on the title page of Lipsiae (1677), a medical book by Georgii Heinrici Frommanni. National Library of Medicine, Bethesda, Maryland

Galen’s Opera omnia, dissection of a pig. Venice, 1565

A drawing of a Hippocratic bench from a Byzantine edition of Galen’s work in the 2nd century AD


When words cut as deep as the scalpel

Luis Alejandro Salas discusses his new book about ancient Roman physician Galen of Pergamum’s medical experiments and prolific writing.

Luis Alejandro Salas

Galen of Pergamum was a second-century CE physician and philosopher famous both for his medical experiments and his writings about them. In his recent book about Galen, Luis Alejandro Salas, assistant professor of classics, offers a new account of Galen’s medical experiments in the context of the intellectual culture of Imperial Rome.

Cutting Words: Polemical Dimensions of Galen’s Anatomical Experiments focuses on three publicly conducted medical experiments, each of which bears on a different ancient controversy over how best to explain the functions of the body. In this Q&A, Salas talks about Galen’s medical and literary practices, offering a glimpse of what makes Galen an influential figure to this day.

What are some of the ways Galen used writing alongside his medical practice, and what made you want to study him as both a writer and a physician?

Throughout all of Greek and Roman antiquity — here I’m talking about a rough period of time between the early fifth century BCE to the late third century CE — there were no independent bodies that evaluated practitioners and conferred professional legitimacy on them. Consequently, in medicine as in other intellectual pursuits, legitimacy could be a place of continual contest.

My book is partly about how certain of these medical practitioners clashed with one another in public to establish their intellectual authority. I focus on this one figure in particular, the second-century CE physician and philosopher Galen of Pergamum. Galen self-identified as a Greek, although he spent the majority of his professional career in the city of Rome.

Part of what makes Galen such an interesting figure to research is that he engaged not only in public medical performances but also in carefully written narratives of them. I argue that Galen leveraged writing to recreate important social dynamics common to his live performances, in a written medium.

Galen’s approach required him to write experimental narratives in such a way as to incorporate his readership as members of an audience who could witness, judge, and in some sense participate as surrogates to the spectators who would have been present in a live performance. I argue that Galen was not only able to do just this, but also took full advantage of the book trade in second-century Rome to expand his circle of influence by curating his authorized writing and relentlessly depositing it in libraries around the empire.

What kinds of experiments did Galen conduct in these demonstrations?

For the most part, Galen’s demonstrations were concerned with questions about human physiology. He had a particular interest in establishing what systems in the body were most closely connected, in a causal sense, with motor-sensory functions, volition, and consciousness. Galen was actively engaged in debates over questions like these, and others that dominated philosophical and medical discourse about the body at the time.

The demonstrations were performed on non-human animals exclusively. For reasons that aren’t entirely clear, human dissection and vivisection were culturally off-limits throughout most of Greek and Roman antiquity. Galen, like all but a couple of ancient thinkers, arrived at his claims about the human body by analogy to animal ones.

In my book, I focus on three experiments: the first on voice production, which is really a suite of demonstrations the second on the bladder and the third on the femoral artery. Each of these experiments bears on different controversies over how best to explain the functions of the body and, for lack of a better word, the physics involved in those functions.

How unusual were Galen’s experiments — and his descriptions of them — at the time?

I think it’s difficult to say how unusual his experiments were in the context of second-century Roman intellectual culture. One of the exciting and frustrating aspects of studying Greek and Roman antiquity is that so much is lost. Galen was an unbelievably prolific author, and well over a hundred of his works survive. But there are so many treatises, his own and those of others, that have been swallowed by time.

Galen is really our only surviving author who writes about public medical demonstrations from an insider’s perspective. We have other references to these sorts of public displays, and we can make other plausible assumptions about their place in the broader intellectual culture of second-century Rome. Multiple sources tell us that public medical demonstrations, whether purely abstract lectures or practical dissections, were frequent and popular. Other authors of about Galen’s time describe crowds packing auditoria or public baths to watch these spectacular performances. They compare them to other performances common at the time, which gives a sense in my view of their cultural place even if it’s impossible to speak with great confidence about raw numbers of performances, participants, and spectators.

All that being said, Galen’s vivid narratives of his performances are to my knowledge unique among the surviving writings of other authors from Greek and Roman antiquity.

How do they relate to later medical texts?

The last chapter of my book discusses Galen’s writing from the perspective of Andreas Vesalius, the famous 16th-century author, and anatomist. Vesalius’ anatomical work is popularly said to have been a watermark that distinguishes the beginnings of modern anatomy from the ancient material that preceded it. An important difference between the anatomical practices of Galen and Vesalius, and here I mean the writing along with the cutting, is that Vesalius had access to human subjects while Galen did not. Vesalius also had access to the printing press. These differences and others emphasize Vesalius’ status as a figure of rupture with his medical past.

In the book, I focus on points of continuity between Vesalius and antiquity. I argue that Vesalius’ engagement with his intellectual rivals has deep and striking parallels to that of Galen’s almost 1,400 years earlier. In Vesalius, we find the same sort of erudite engagement with — and reconstruction of — the classical past as we do in Galen, with the express purpose of establishing intellectual and professional authority and undermining that of rival practitioners. Readers familiar with the importance of the printing press to Vesalius’ anatomical work may be surprised to discover the overarching attention Galen paid to the dissemination of his ideas through writing technologies available to him in the second century.

There are other interesting parallels between the moment in which Vesalius was writing and Galen’s time, in particular the highly competitive and polemical manner in which elite physicians jockeyed for position in the medical world.

Why should we read Galen today?

The man was a fascinating figure — brilliant, professionally driven beyond measure, and unbelievably influential in the history of medicine. Galen’s writing is riveting stuff that offers a view of second-century Roman life that’s rich and invaluable from a historical perspective. Those are all really good reasons, in my view, to read his work.

However, I think we also owe it to ourselves to read material like this for other reasons. Galen and other ancient authors, flawed and challenging in so many ways, force careful readers to examine their intellectual moorings. The theories and perspectives they present to us are so distant in time and place from our own that they can appear fundamentally alien at one moment and familiar in the next. These conceptual differences provide a helpful contrast through which to consider the shape of our own medical and scientific beliefs, and how they are embedded in time. And here I don’t just mean what we’d call scientific theories reading these texts invites us to consider our broader cultural views of the world. This is one of the most powerful experiences I have reading Greco-Roman writing, one which continues to force me to reflect on my own place in history.

About the Author

John Moore is the humanities communications specialist in Arts & Sciences. He works with departments, faculty, and graduate students to make the work of the humanities visible on campus and in the community.


The History of Melancholy

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For more information, read Michigan Publishing's access and usage policy.

Even if the medical concepts involved appear to be completely obsolete, the history of melancholy is of interest to a modern audience for at least two reasons. Melancholia was one of the cardinal forms of madness in earlier times, and its name and concept encapsulate the whole history of humoralism, since melancholia is black bile, one of the peccant humors recognized in Hippocratic and Galenic medicine that have counterparts in the classical system of Ayurvedic medicine in India. A study of humoral medicine that would be respectful of classical phrasings, philosophical tenets and technical concepts of scholarly medicine, might help the modern anthropologist and epistemologist of medicine to elaborate upon concepts currently in use, like somatization, illness as a culturally constructed experience of disease, etc., which have never been grounded on any knowledge of medical history. The history of melancholy is also important to understand the recent developments of cultural psychology.

My first encounter with melancholy was, as a South Asianist, in my research on Ayurvedic psychiatry. I have been attempting to make sense of the alleged relationship between the torments of Love, Grief, and Fear and the vitiation of pneuma and other vital fluids in the body. Earlier reflections published in The Discourse on Remedies in the Land of Spices ( Le Discours des Remedes au Pays des Epices , Paris 1989 English version, Berkeley, forthcoming from the University of California Press) have been followed by a study of patterns common to the Galenic and Ayurvedia Scholarly Traditions of Medicine (Paris, in press). The purpose of my inquiries into the history of melancholy was to make sense of statements such as, ``Love, grief and fear provoke wind,'' which are found in Sanskrit texts, or equivalent statements like Hippocrates's aphorism in Greek, ``Grief and fear, when lingering, provoke melancholia.'' Do such statements relate to some clinical reality, irrespective of the cultural context, which would make the study of classical medical knowledge relevant to modern cultural psychology? Some of the most innovative work on emotion is occurring in cross-cultural research on depression. The publication of Culture and Depression by Arthur Kleinman and Byron Good in 1985 (Berkeley, Univ. of California Press) was a landmark in this field, at the confluent of anthropology, psychology and literary studies. Literary studies are involved, because the most telling expressions of depression, sadness, exhaustion, consumption, loss, grief, and melancholy, are to be found in romance and poetry. Furthermore, these public expressions of affects have been shaping the cultural patterns of affect in our society. Melancholy has been shaped in the form of a culture-bound syndrome, from Latin antiquity through nineteenth century Romanticism, in Western Europe. Similarly, burning out and the drastic wasting of all vital fluids have been shaped in the form of a culture-bound syndrome in India. One interesting conceptual and methodological problem that arises from cross-cultural studies of depression is that of universals of emotion. Is depressive disorder a Western cultural construct or a universal schema? To recognize the existence of such a schema does not mean we must admit that it is a psychobiological process. We can see such schemata rooted in the rhetoric and imagery of scholarly traditions of medicine.

The history of melancholia is that of an innately human experience of suffering becoming the object of a cultural construct. As a mood or emotion, the experience of being melancholy or depressed is at the very heart of being human: feeling ``down'' or blue or unhappy, being dispirited, discouraged, disappointed, dejected, despondent, melancholy, depressed, or despairing many aspects of such affective experiences are within the normal range. Everyone suffers from this kind of metaphorical melancholia, as Robert Burton said, because ``Melancholy in this sense is the character of mortality'' ( The Anatomy of Melancholy , I.I.I.5.), that is, a figure of the human condition. To be melancholic or depressed is not necessarily to be mentally ill or in a pathological state. It is only with greater degrees of severity or longer durations when dispositions are transformed into habits as Burton would say that such affective states come to be viewed as pathological. On choosing to focus on melancholy as a clinical condition, we are faced with the issue of whether it is a disease or some other sort of assemblage of signs and symptoms. But we can rely on the very rich historiography of the theme in literature and philosophy, starting with the Letters of Hippocrates .

When Hippocrates, called by the people of Abdera, to cure Democritus from his alleged madness, went to visit him one day, he found Democritus in his garden in the suburbs at Abdera, under a shady tree, with a book on his knees, busy at his study, sometimes writing, sometimes walking. The subject of his book was Melancholy and madness. About him lay the carcasses of several beasts, recently cut up by him and anatomized, not that he had contempt for God's creatures, as he told Hippocrates, but to find the seat of his black bile or Melancholy, whence it proceeds, and how it was engendered in men's bodies, with the intention that he might better cure it in himself, by his writing and observations. ``I do anatomize and cut up these poor beasts, he said to Hippocrates, to see the cause of these distempers, vanities, and follies,'' which are the burden of all creatures. I have been quoting Robert Burton's paraphrase of the celebrated Letter to Damagetus in the Preface of his Anatomy . Melancholy, or Sorrow in the Eastern traditions of medicine and philosophy, is the very essence of lived experience. This lived experience was described by physicians, in the context of humoral medicine, as materialized in vital fluids, the humors, especially black bile and pneuma. At the core of traditional psychiatry, there is an imagery of fluids, that will thicken and become very similar to the dregs of wine, or turn acrid as vinegar, ferment and give off bubbles of gas, as Galen says of black bile in severe cases of melancholia. This imagery is the materialization of a psychological experience.

Raymond Klibansky, Erwin Panofskky, and Fritz Saxl, in Saturn and Melancholy: Studies in the History of Natural Philosophy, Religion, and Art (London New York, 1964), have commented magnificently upon a classical analysis of melancholy by Aristotle, who used the image of wine to expose the nature of black bile. Black bile, just like the juice of grapes, contains pneuma, which provokes hypochondriac diseases like melancholia. Black bile like wine is prone to ferment and produce an alternation of depression and anger, an alternation of cuthymia and dysthymia (the thymos being the fluid essence of emotion). Fluids are the materialization of mental fluctuations, and this concept of affect remained prevalent down to the nineteenth century. The example of melancholia teaches something of the classical conceptions of relationships between body and mind. It shows, Burton says (L2.5.1), how the body, being material, works upon the immaterial soul, by mediation of humours and spirits, which participate of both, and ill-disposed organs. It illustrates the circle of sympathetic disorders, in which distractions and perturbations of the mind alter the temperature or temperament of the body, which in turn will cause the distemperature of the soul. Therefore, before the advent of Cartesianism, and even later, parallel to the development of intellectualist psychology, there remained an ancient tradition of humoral psychology which is of interest to us, now, in showing us the way to a renewed anthropology of emotions linked to environment, local contexts, climatic factors and dietetic resources.

The history of melancholy teaches us a number of useful concepts, schemes, and analytical constructs that could be used today in the context of social and epistemological studies of medicine. The concept of substitution, for example, was invented by Galen to interpret diseases like melancholy, assuming there was a substantial identity between the flows of humours and the fluctuation of thought. In a chapter of his treatise On the Affected Parts (Book III, chapter 10), Galen locates these fluctuations in the brain conceived of ``as a homoiomeric part,'' that is, as a tissue and not an organ. The brain as a tissue materializes the flow of affects. The thickened humours collected in the brain injure it now as an organ, now as an homoiomeric part, thus creating ``substitutions of epilepsy and melancholia'': epilepsy—when blocking the conduits—and melancholia - when impairing the tissue that materializes emotions. I would surmise that the classical concept of the substitution of two sympathetic affections for one another is still useful today in our analysis of what psychiatrists call somatization. Indeed we must take some distance from classical nosology (the branch of medicine that deals with the classification of diseases), since ancient categories like epilepsy and melancholia do not actually correspond to clinical realities described in scientific medicine. We should also be more precise in the commentary of texts, and Galen's citation should be put back in the context of an elaborate epistemology, where ``affections,'' for example, are carefully distinguished from ``dispositions,'' and ``diseases.'' One of the tenets of medical anthropology for the last twenty years has been to distinguish between disease (an analytical construct) and illness (the culturally informed flow of lived experience). This distinction, invented in the early 1970s by culturally oriented physicians, was not grounded on any historical knowledge. However, all the scholarly traditions of medicine, not only in the West but also in India and elsewhere, have been developing concepts of affections, dispositions and habits, accidents and the trajectory of ``sympathetic diseases,'' in other words, semantic networks that capture the meaning of illness.

The classical knowledge of Humanism and Renaissance medicine culminated in Robert Burton's Anatomy of Melancholy in the beginning of the seventeenth century, and I shall conclude this brief review by mentioning the recent publication of a definitive, critical edition (T.C. Faulkner, N. K. Kiessling and R. L. Blair, Eds., Oxford, Clarendon Press, Three Volumes, 1989-1994). One might very well conclude that this masterpiece of English literature has no longer anything to teach us in the domain of medicine, but it is of the utmost interest to any anthropologist or cultural psychologist studying emotions. Emotions have come to the forefront of contemporary social science research, because we have come to recognize that they play the central role in cognition as well as in politics. Emotions have been traditionally approached through the study of rhetoric. The cultural shaping of sentiments in Europe from the Renaissance onwards, as Norbert Elias has shown in his celebrated book The Civilization of Manners , was based on classical rhetoric. Elegant figures of speech borrowed from the Latin manuals of rhetoric were transposed into elegant manners to be displayed by the well-educated ladies and gentlemen. But this transposition of rhetoric into manners is also to be observed in the domain of classical medicine. What is of interest to us in Robert Burton's Anatomy is not so much the contents as the format, the very project of an anatomy—displaying What it is, With all the kinds, causes, symptoms, prognostics, and several cures of it, Philosophically, Medicinally, Historically opened and cut up (as the subtitle reads)— and the rhetoric used to describe and analyze the flow of experience. Let me just give here a sample of congeries (work heaps) and Senecan style (curt style, with abruptness and jaggedness) used to convey the sense of an epidemical disease (from the Preface). ``And to omit all impertinent digressions, to say no more of such as are improperly melancholy, or metaphorically mad, lightly mad, or in disposition [``disposition'' being contrasted with ``disease'' proper], as stupid, angry, drunken, silly, sottish, sullen, proud, vainglorius, ridiculous, beastly, peevish, obstinate, impudent, extravagant, dry, doting, dull, desperate, harebrain, and mad, frantic, foolish, heteroclite, which no new hospital can hold, no physick [medicine] help my purpose and endeavor is, in the following discourse, to anatomize this humour of Melancholy [i.e., black bile], through all his parts and species, as it is a habit or an ordinary disease, and that philosophically, medicinally, to show the causes, symptoms, and several cures of it, that it may be better avoided. and that splenetic hypochondriacal wind especially, which proceeds from the spleen and short ribs. Being then as it is, a disease, that so often, so much crucifies the body and mind.'' The history of melancholy thus based on classical readings is a history of the traditional rhetoric of emotions, and the figures of speech are as many keys to the observation of behavior in clinical settings as well as in ethnographic fieldwork.

We tend to assume that illnesses are universals. We argue that, whether or not a particular society treats depression as a disease, for example, the syndrome of chronic exhaustion is a ubiquitous illness behavior that can be described and interpreted in all sorts of situations and contexts. Therefore, the task of anthropology in a clinical context is to interpret illness meanings. The patient's body idiom, beyond the physical pain, may be expressing the pain of failure, the pain of loneliness, soliciting love and support and warding off distressing thoughts, but we must find appropriate modes of discourse to translate the patient's body idiom. The history of classical medicine and related literature, including belles lettres and Renaissance rhetoric, might provide us with tools for such interpretive tasks.

Francis Zimmermann holds the chair of South Asian Anthropology and the History of Science, at the School for Advanced Studies in the Social Sciences, Paris. He lectured at the University of Michigan on December 16, 1994, on universals in the scholarly traditions of medicine the event was co-sponsored by the Working Group on Health of the International Institute and the Center for South and Southeast Asian Studies.


Galen and the Rhetoric of Healing

Susan Mattern’s monograph on Galen of Pergamum is perhaps slightly mistitled: she may have been more justified in replacing the phrase “the rhetoric of healing” with “the narratives of healing,” since the focus of her work is a close examination of the medical narratives found in the writings of Galen. This opening quibble about the title, however, is just that: a very minor criticism of a work which successfully renders an interesting and readable portrait of the varied complexities of the social aspects of ancient medicine. Mattern’s work is not, as she rightfully stresses, a book about medicine it is rather a detailed picture of the place and role of the physician in Greco-Roman society of the second century, one produced by drawing upon the admittedly subjective, but nonetheless valuable, evidence of its most famous medical practitioner.

As any researcher who has approached the works of Galen can attest, the sheer volume of his writings can be both immensely exciting and rather intimidating (Vivian Nutton has estimated that the Galenic corpus accounts for almost ten percent of extant Greek literature up to 350 AD). 1 Galen’s writings have of course been frequently mined by historians of medicine, who are looking for a greater understanding of the medical theories and practices of the classical world, both those of Galen himself and those of his rivals, whom he frequently excoriates. Mattern, for her part, narrows in on those sections of Galen’s work which she reasonably equates with the modern medical case history: the narrative account of the patient and his (only occasionally her) presenting symptoms, the diagnosis and prognosis offered, the therapeutic actions taken by Galen and others, and the outcome of these actions. (An appendix is very helpfully supplied, in which is listed all of the narratives to which Mattern makes reference. This is not an all-inclusive list of the narratives to be found in Galen’s writing, for she excludes the Hippocratic case histories to which Galen refers and those which are clearly hypothetical or which do not pertain to a particular individual.) Galen’s narratives do not always include all of the elements of a case history now and then, for example, he will fail to include the outcome of a case, which is the sort of detail likely to frustrate the modern reader. Mattern contends, however, that Galen often wrote with more than one aim in mind: on most occasions he employs narrative to display or convey his medical knowledge, but on other occasions his purpose is far more obviously literary or social, and sometimes two or three motives are evident in a given narrative.

The value of medical narrative as social and cultural evidence has long been noted by both anthropologists and historians, but Mattern is the first, to my knowledge, to place Galen’s medical narratives in this particular spotlight. Medical narrative has a long tradition in the ancient world Mattern cites not only Hippocrates’ Epidemics (for which Galen himself wrote commentaries) but also works as varied as those of Aelius Aristides and the votive inscriptions offered to Asclepius and other gods of healing. The fact that Galen’s narratives lack the sort of precision and regularity which modern medical case histories contain is duly noted by Mattern she argues, however, that while these passages from Galen may be of dubious quality as historical or even medical documents (and she wisely eschews the practice of retrospective diagnosis in these narratives), it is precisely their anecdotal and subjective quality which renders them valuable as evidence of Galen’s own perception of his position and status as a physician within his society, from which one can draw further inferences about his society at large.

The bulk of the first chapter is taken up by a more general discussion on medical narrative and its place in Galen’s writings. This is accompanied by a brief but useful overview of the demographics of disease, both urban and rural, in the Roman empire, as well as some biographical background on Galen himself. The second chapter seeks to provide some temporal and spatial context for the narratives this is a daunting task, as the evidence from Galen’s narratives is sparse, but Mattern does well with the limited material with which she is working. Most notably, she argues that the vagueness of Galen’s references to time and space implies a close connection between the writer and his audience, which she identifies as being composed of not just his fellow physicians but also of the pepaideumenoi, that class of educated men who considered a grasp of medicine an important aspect of their education.

This audience of physicians and fellow pepaideumenoi plays a crucial role in Mattern’s third chapter, in which she outlines the strongly agonistic aspect of ancient medicine. Medicine was an activity which was highly competitive (and almost exclusively masculine) in nature the practice of medicine was a social, often even a public, event, not the private and closeted activity of today. Mattern sets Galen’s writings upon the broader canvas of the Second Sophistic (and thus, no doubt, her titular reference to rhetoric). The physicians of Galen’s day not only competed with each other at the patients’ bedsides, but also readily participated in the rhetorical and competitive performances — medical debates, demonstrations, dissections and lectures — to an audience which came to cheer or jeer, depending upon their loyalties and the persuasive efforts of the competitors. These public performances might occur in front of an audience of a half dozen (in the sickroom, for example) or of sufficient numbers to fill a theatre, but Mattern notes that whatever the venue, victory was predicated upon a therapeutic outcome, a purely intellectual exercise of diagnosis and prognosis, or a verbal debate, or at times upon any combination of these elements.

Mattern’s account of this competitive aspect of ancient medicine is well done, but it is in the final two chapters that the book takes full shape and becomes most interesting. In these chapters, she turns her scrutiny away from the audience and rivalries surrounding medical performances and refocusses it on the main actors: the patient and the physician. Even in agonistic settings, the highly intimate relationship between these two “characters” is evident in Galen’s narratives, and, unlike the medical narratives of Hippocrates or those of the modern physician, the patient himself is able to provide his own perspective in many of Galen’s narratives, through the means of indirect discourse. There is even evidence for a modicum of patient-physician negotiation, as revealed in narratives in which the patient’s and Galen’s voices alternate with one another. Galen’s patients were no doubt drawn from the entire spectrum of society, but Mattern demonstrates that Galen places marked emphasis upon the adult, urban male of the leisure class, particularly one with a warm, dry temperament, setting this patient up as the archetypal patient (and even seeing himself, she argues, in this ideal patient). Mattern argues for a correlation between this ideal Galenic patient and the Greek conception of a citizen. She notes that Greco-Roman regimens of health held both moral and social significance as much as they held medical meaning she points, for example, to the psychological connection between gymnastic exercise, an activity vigorously promoted by Galen as part of a healthy lifestyle for men, and Greek civic life, in the competitive, masculine, and highly public nature inherent in both.

Galen’s characterization of his patients, which could include aspects of their emotional temperaments, is dealt with in the fourth chapter the final chapter examines his self-representation as a physician. Mattern discusses Galen’s narrative emphasis on his own ability to “read” his patients, sometimes “at a glance.” She also highlights the intriguing manner in which Galen depicts his interactions with fever, which was considered by ancient physicians as a disease in its own right and not merely a symptom, noting his use of military metaphors but also persuasively suggesting that Galen on many occasions depicts fever as an animal whose movements the physician must track and outwit. It is Mattern’s exploration of the delicacy of the physician’s power and status in relation to the patient, however, which is of particular note. Medical therapies require intimate physical contact with a patient: bathing, drying, massaging, feeding. Galenic theory, moreover, demanded a thorough inspection of the bodily wastes produced by the patient. Galen’s narratives are strangely ambiguous about who in fact is performing these chores: whether he undertook these essentially servile tasks himself or delegated these tasks to slaves (his own or those belonging to the household) is seldom clear. Galen further portrays himself frequently acting in concert with household slaves, gaining from them “inside” information about the family which helps determine his diagnosis and therapeutic response. This close connection with servility, therefore, prompts a clear power struggle in many of the narratives, in which he strives not to overcome competitive rivals, but rather to assert his power over the patient and the household. The ancient physician seems to have walked a fine line between servility and authority, at least when dealing with members of the ruling classes.

Mattern’s work is well-organized, well-argued, and clearly presented, with minimal editorial problems (only four typographical errors were spotted). The book will appeal equally to historians, whether of ancient medicine in particular or of the social history of the time period, and to the general reading public Mattern clearly aspires to attract some of the latter, particularly physicians, whom she hopes will “see through what must seem the absurdity of [Galen’s] doctrines and the outrageousness of his arrogance to the ancient human drama at the heart of medicine” (162).


Medical Science

The advent of Islam did not cause any disruption in the evolution of medical science. The Classical Greek and Roman tradition for treatment and medication was further developed in the Islamic world, where it was gradually enriched with new ideas from the Persian and Indian cultural spheres.

Scientific works from Antiquity were made available to a larger public through translations into Arabic. As early as the beginning of the 9th century, the famous medical works of Hippocrates and Galen were translated at schools and libraries in Damascus, Baghdad, and other major cities in the Islamic world. In the field of medicine, Dioscorides’s De Materia Medica was translated and revised.

The Arabic texts inspired by Dioscorides, in particular, exhibit a close connection between scientific research in the Islamic world and the legacy of Antiquity. As was done in Antiquity, both medicinal herbs and other medicines were categorized according to the degree of potency of the “cardinal qualities”: dry, moist, hot, and cold. This method was to enable correct medication for sicknesses that could be related to an imbalance in the four cardinal humors – another concept that was adopted from Greek medicine.

Although independent medical research was not widespread, it did exist. An original and very important contribution by medicine in the Islamic world is the pioneering manuscript by al-Razi (Rhazes), Kitab al-jadari w-l-hasba (the book on smallpox and measles). This volume, which was translated numerous times into Latin and other European languages from the end of the 15th to the 19th century, was the first to note the difference between the two diseases.

The hospital (maristan) was perhaps the most important medical innovation contributed by Islamic high culture. The first true hospitals in a modern sense were found for the first time in history in 8th-century Baghdad. Like our own, medieval Islamic hospitals had special departments for eye problems, internal medicine, and orthopedic complaints. There were even special departments for mental illnesses and infectious diseases. Patients were treated both at the hospital and at home, and even prison inmates received care.


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