The son of Aelius Nicon, a wealthy architect with scholarly interests, Galen received a comprehensive education that prepared him for a successful career as a physician and philosopher. He 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 were principally influenced by the then-current theory of humorism, as advanced by many ancient Greek physicians such as Hippocrates. His theories dominated and influenced Western medical science for nearly two millennia. His anatomical reports, based mainly on dissection of monkeys and pigs, 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's theory of the physiology of the circulatory system endured until 1628, when William Harvey published his treatise entitled De motu cordis, in which he established that the blood circulates with the heart acting as a pump. Medical students continued to study Galen's writings until well into the 19th century. Galen conducted many nerve ligation experiments that supported the theory, which is still believed today, that the brain controls all the motions of the muscles by means of the cranial and peripheral nervous systems.
Galen saw himself as being both a physician and a philosopher, as he wrote in his treatise entitled 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 and/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.
In 148, when he was 19, his father died, leaving him independently wealthy. He then followed the advice he found in Hippocrates' teaching and travelled and studied widely including Smyrna (now Izmir), Corinth, Crete, Cilicia (now Çukurova), Cyprus and finally the great medical school of Alexandria, exposing himself to the various schools of thought in medicine. For a brief period in Hellenistic Alexandria, vivisections of human prisoners took place and were recorded in the work of Hellenistic anatomists. Galen had access to these works while in Alexandria, but his lack of citation to his predecessors leaves unclear how important they were to his study. 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 wealthiest men in Asia. The High Priest chose Galen over other physicians after Galen claims he eviscerated an ape and challenged other physicians to repair the damage. When they refused, Galen did the surgery himself and in doing so won himself the favor of the High Priest of Asia. Over the four years there he learnt 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 occurred while he held the post, compared to sixty in his predecessor's time, generally ascribed to his attention to their wounds. At the same time he pursued studies in theoretical medicine and philosophy.
Rome then engaged in the foreign wars in 161 AD. Marcus Aurelius and his colleague Lucius Verus were in the north fighting the Marcomanni. During the fall of 169 AD when Roman troops were returning to Aquileia, the great plague broke out and the emperor summoned Galen back to Rome. He was ordered to accompany Marcus and Verus to Germany as the court physician. In 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 Antoninus 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 AD, under Commodus’ reign, a pestilence occurred, the largest of which he had knowledge, in which 2,000 people died in Rome each day. It is most likely that this was the same plague that struck Rome during Marcus Aurelius’ reign.
Galen became physician to Septimius Severus during his reign in Rome. Galen compliments Septimius and Caracalla on keeping a supply of drugs for their friends and mentions three cases in which they had been of use in 198 AD Galen 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."
Garcia-Ballester says the following of Galen’s use of prognosis: "In modern medicine, we are used to distinguishing between the diagnostic judgment (the scientific knowledge of what a patient has) and the prognostic judgment (the conjecture about what will happen to him.) Galen, like the Hippocratics, was not. For him, to understand a clinical case technically, ‘to diagnose’, was among other things, to know with greater or lesser certainty the outcome fore the patient, ‘to prognosticate’. Prognosis, then, is one of the essential problems and most important objectives of Galenic diagnosis. Galen was concerned to distinguish it from divination or prophecy, both to improve diagnosis technically and to enhance the physician’s reputation."
Galen’s principal interest was in human anatomy, but Roman law had prohibited the dissection of human cadavers since about 150 BC. Because of this restriction, Galen performed anatomical dissections on living (vivisection) and dead animals, mostly focusing on pigs and primates. This work turned out to be particularly useful because in most cases, the anatomical structures of these animals closely mirror those of humans. Galen clarified the anatomy of the trachea and was the first to demonstrate that the larynx generates the voice. Galen may have understood the importance of artificial ventilation, because in one of his experiments he used bellows to inflate the lungs of a dead animal.
Among Galen’s major contributions to medicine was his work on the circulatory system. He was the first to recognize that there were distinct differences between venous (dark) and arterial (bright) blood. Although his many anatomical experiments on animal models led him to a more complete understanding of the circulatory system, nervous system, respiratory system and other structures, his work was not without scientific inaccuracies. Galen believed that the circulatory system consisted of two separate one-way systems of distribution, rather than a single unified system of circulation. His understanding was that venous blood was generated in the liver, from where it was distributed and consumed by all organs of the body. He posited that arterial blood originated in the heart, from where it was distributed and consumed by all organs of the body. The blood was then regenerated in either the liver or the heart, completing the cycle. Galen also believed in the existence of a group of blood vessels he called the rete mirabile, near the back of the human brain. Both of these theories of the circulation of blood were later shown to be incorrect.
In his work De motu musculorum, Galen explained the difference between motor and sensory nerves, discussed the concept of muscle tone and explained the difference between agonists and antagonists.
Galen was also a highly skilled surgeon, and he performed surgical operations on human patients. Many of the procedures and techniques that he utilized would not be used again for centuries. Of particular note are procedures that Galen performed on patients’ brains and eyes. In order to correct cataracts in patients, Galen performed an operation that was similar to what is performed by contemporary ophthalmologists. Using a needle-shaped instrument, Galen attempted to remove the cataract from behind the lens of the eye.
At first reluctantly, but then with increasing vigour, Galen promoted Hippocratic teaching including venesection and bloodletting, then unknown in Rome. This was sharply criticised by the Erasistrateans, who predicted dire outcomes, believing that it was not blood but pneuma that flowed in the veins. Galen however staunchly defended venesection in his three books on the subject, and in his demonstrations and public disputations.
Galen was highly interested in the importance of combining philosophical thought with medical practice, an idea he expressed in his brief work "That the Best Physician is also a Philosopher." He refused to be placed into one particular school of thought, instead taking aspects from each group and combining them with his original thoughts to form his own unique approach to medicine. He was a proponent of medicine as a highly interdisciplinary field that was best practiced by utilizing theory, observation, and experimentation in conjunction to yield the most complete results. This attitude was largely a result of his pluralist education, which exposed him to the four major schools of thought (Platonists, Peripatetics, Stoics, Epicureans), and encouraged him to pick and choose aspects from each to adhere to. His early education also included instruction both from teachers who belonged to the Rationalist sect and from teachers who belonged to the Empiricist sect, allowing him to learn about the merits of both schools.
Because Galen's works were not translated into Latin in the ancient period, and because of the collapse of the Roman Empire in the West, the study of Galen, along with the Greek medical tradition as a whole, went into decline in Western Europe during the Early Middle Ages, when very few Latin scholars could read Greek. However, Galen and the ancient Greek medical tradition generally continued to be studied and followed in the Eastern Roman Empire, commonly known as the Byzantine Empire. All of the extant Greek manuscripts of Galen were copied by Byzantine scholars. In the Abbasid period (after 750 AD) Arab Muslims began to be interested in Greek scientific and medical texts for the first time, and had some of Galen's texts translated into Arabic, often by Syrian Christian scholars (see below). As a result some texts of Galen exist only in Arabic translation, while others exist only in medieval Latin translations of the Arabic. In some cases scholars have even attempted to translate from the Latin or Arabic back into Greek where the original is lost. For some of the ancient sources, such as Herophilus, Galen's account of their work is all that survives.
Even in his own time, forgeries and unscrupulous editions of his work were a problem, prompting him to write On his Own Books. Forgeries in Latin, Arabic or Greek continued until the Renaissance. Some of Galen's treatises have appeared under many different titles over the years. Sources are often in obscure and difficult to access journals or repositories. Although written in Greek, by convention the works are referred to by Latin titles, and often by merely abbreviations of those. No single authoritative collection of his work exists, and controversy remains as to the authenticity of a number of works attributed to Galen. Consequently research on Galen's work is fraught with hazard.
Various attempts have been made to classify Galen's vast output. For instance Coxe (1846) lists a Prolegomena, or introductory books, followed by 7 classes of treatise embracing Physiology (28 vols.), Hygiene (12), Aetiology (19), Semeiotics (14), Pharmacy (10), Blood letting (4) and Therapeutics (17), in addition to 4 of aphorisms, and spurious works. The most complete compendium of Galen's writings, surpassing even modern projects like the Corpus Medicorum Graecorum, is the one compiled and translated by Karl Gottlob Kühn of Leipzig between 1821 and 1833. This collection consists of 122 of Galen's treatises, translated from the original Greek into Latin (the text is presented in both languages). Over 20,000 pages in length, it is divided into 22 volumes, with 676 index pages. Many of Galen's works are included in the Thesaurus Linguae Graecae, a digital library of Greek literature started in 1972. Another useful modern source is the French Bibliothèque interuniversitaire de médicine (BIUM).
Thus Galen summarised and synthesised the work of his predecessors, and it is in Galen's words (Galenism) that Greek medicine was handed down to subsequent generations, such that Galenism became the means by which Greek medicine was known to the world. Frequently this was in the form of restating and reinterpreting, such as in Magnus of Nisibis' 4th century work on urine, which was in turn translated into Arabic. Yet the full importance of his contributions was not appreciated till long after his death. Galen's rhetoric and prolificity were so powerful as to convey the impression that there was little left to learn. The term Galenism has subsequently taken on both a positive and pejorative meaning as one that transformed medicine in late antiquity yet so dominated subsequent thinking as to stifle further progress.
After the collapse of the Western Empire the study of Galen and other Greek works almost disappeared in the Latin West. In contrast, in the predominantly Greek-speaking eastern half of the Roman empire (Byzantium), many commentators of the subsequent centuries, such as Oribasius, physician to the emperor Julian who compiled a Synopsis in the 4th century, preserved and disseminated Galen's works, making Galenism more accessible. Nutton refers to these authors as the "medical refrigerators of antiquity". In late antiquity medical writing veered increasingly in the direction of the theoretical at the expense of the practical, with many authors merely debating Galenism. Magnus of Nisibis was a pure theorist, as were John of Alexandria and Agnellus of Ravenna with their lectures on Galen's De Sectis. So strong was Galenism that other authors such as Hippocrates began to be seen through a Galenic lens, while his opponents became marginalised and other medical sects such as Asclepiadism slowly disappeared. Greek medicine was part of Greek culture, and Syrian Eastern Christians came in contact with it while the Eastern Roman Empire (Byzantium) ruled Syria and Western Mesopotamia, regions that were conquered from Byzantium in the 7th century by Arab Muslims. After 750 AD, Muslims had these Syrian Christians make the first translations of Galen into Arabic. From then on Galen and the Greek medical tradition in general became assimilated into the medieval and early modern Islamic Middle East.
Galen's insistence on a rational systematic approach to medicine set the template for Islamic medicine, which rapidly spread throughout the Arab Empire. Arabic sources, such as Rhazes (Muhammad ibn Zakarīya Rāzi 865-925 AD), continue to be the source of discovery of new or relatively inaccessible Galenic writings. As the title, Doubts on Galen by Rhazes implies, as well as the writings of physicians such as Ibn Zuhr (Avenzoar) and Ibn al-Nafis, the works of Galen were not taken on unquestioningly, but as a challengeable basis for further inquiry.
A strong emphasis on experimentation and empiricism led to new results and new observations, which were contrasted and combined with those of Galen by writers such as Rhazes, Ali ibn Abbas al-Majusi (Haly Abbas), Abu al-Qasim al-Zahrawi (Abulasis), Ibn Sina (Avicenna), Ibn Zuhr and Ibn al-Nafis. For example, the experiments carried out by Rāzi and Ibn Zuhr contradicted the Galenic theory of humorism, while Ibn al-Nafis' discovery of the pulmonary circulation contradicted the Galenic theory on the heart.
Galenism's final defeat came from a combination of the negativism of Paracelsus and the constructivism of the Italian Renaissance anatomists, such as Vesalius in the 16th century. In the 1530s, Flemish anatomist and physician Andreas Vesalius took on a project to translate many of Galen's Greek texts into Latin. Vesalius' most famous work, De humani corporis fabrica, was greatly influenced by Galenic writing and form. Seeking to examine critically Galen's methods and outlook, Vesalius turned to human cadaver dissection as a means of verification. Galen's writings were shown to describe details present in monkeys but not in humans by Vesalius, who demonstrated Galen's limitations through books and hands-on demonstrations, despite fierce opposition from pro-Galenist orthodoxy, such as Jacobus Sylvius. Since Galen states that he is using observations of monkeys (human dissection was prohibited) to give an account of what the body looks like, Vesalius could portray himself as using Galen's approach of description of direct observation to create a record of the exact details of the human body, since he worked in a time when human dissection was allowed. Galen argued that monkey anatomy was close enough to humans for physicians to learn anatomy with monkey dissections and then make observations of similar structures in the wounds of their patients, rather than trying to learn anatomy only from wounds in human patients as students being trained by the Empiricist medical sect would. The examinations of Vesalius also disproved medical theories of Aristotle and Mondino de Liuzzi. One of the best known examples of Vesalius' overturning of Galenism was his demonstration that the interventricular septum of the heart was not permeable, as Galen had taught (Nat Fac III xv).However, this had been revealed 2 years before by Michael De Villeneuve( Michael Servetus) in his fatidique "Christianismi restitutio" (1553).
Michael De Villanueva (Michael Servetus), Vesalius' fellow student, was the best galenist at the University of Paris, according to Johann Winter von Andernach, who taught both. In the galenism of the Rennaisance, editions of the Opera Omnia by Galen were very important. It was begun in Venice in 1541-1542 by the Guinta. There were fourteen editions of the book from that date until 1625. Just one edition was produced from Lyon, between 1548-1551. The Lyon edition has commentaries on breathing and blood streaming, that correct the work of earlier renowned authors such as Vesalius, Caius or Cornerius . Michael De Villeneuve had contracts with Jean Frellon for that work, and the Servetus scholar-researcher González Echeverría and the International Society of History of Medicine consider him as the author of the comentaries of this edition of Frellon, in Lyon.
Another convincing case where understanding of the body was extended beyond where Galen had left it came from these demonstrations of the nature of the circulation and the subsequent work of Andrea Cesalpino, Fabricio of Acquapendente and William Harvey. Some Galenic teaching, such as his emphasis on bloodletting as a remedy for many ailments, however remained influential until well into the 19th century.
Category:129 births Category:2nd-century Romans Category:3rd-century Romans Category:3rd-century deaths Category:Ancient Greek physicians Category:Ancient Greek anatomists Category:Ancient Greek science writers Category:Ancient Roman physicians Category:Herbalists Category:History of anatomy Category:History of neuroscience Category:Roman-era Greeks Category:People from Pergamon
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