“The Philanthropic,
Philosophical and Medically Infallible Galen, AD 129-216” Bruce
Short
Bust of Galen
The title of the article is a quote taken from a work by British
ancient historian, Professor Vivian Nutton, an internationally renowned
authority on the life and works of Galen.
The statement was written by Claudius Galen to advertise and
self-promote his medical abilities and to highlight the shortcomings of
competitors that cluttered the busy medical
marketplace within second century Rome.
Bust of Aristotle (384 – 322 BC)
When the use of coin had been discovered, out of the barter of
necessary articles arose the other art of moneymaking, namely retail
trade.
Aristotle’s Politics: I: VIII (350 BC)
Along with the arts of moneymaking and retail trade, described by
Aristotle (384-322 BC) I would argue that at least one other function
has arisen since the year 350 BC
when the Athenian philosopher wrote his treatise on political
philosophy,
namely the art, science and history of numismatics.
The discussion revolves around perhaps the one doctor who wrote the
greatest number and possibly the most significant tracts and books in
the whole of medical history
and about whom we know so much, his name was Claudius Galen. Although
most people
have heard far more about Galen’s predecessor, the quintessence of the
Greek
physician practicing on the Island of Cos situated in the eastern
Aegean Sea off the coast
of modern Turkey. His name was Hippocrates (c 460-c 375 BC).
Hippocrates and the Hippocratic Oath
We know far less about the life and the precise writings attributed to
Hippocrates, in spite of the name linkage with the modern medical
profession’s code of conduct, the
shared public declaration of the Hippocratic Oath, an oath of
ethics
said to have been written nearly 2,500 years ago. Contemporary medical
graduates from Western
universities may not recall taking one of the modern versions of the
code during their
graduation ceremonies. But the vast majority of doctors still regard
the pronouncement
as a moral compass, whilst a few others believe it has little if any
meaning in the modern world.
The original version of the oath may have commenced as, ‘I swear by
Apollo
the Healer, by Aesclapius, by Hygeia, by Panacea and
all the gods and goddesses, making them my witness, that I will carry
out according to my ability and judgement, this
oath and this indenture.’
Ancient Medicine
Demonstrating neither divine powers nor membership of the imperial
family, Galen left no ancient numismatic footprint, yet the Roman world
in which Galen lived contained
a wealth of numismatic material. Galen’s teachings together with the
writings
dating from the anonymously multi-authored Hippocratic Corpus from 420
– 350 BC, that roughly
corresponds to the active lifetime of Hippocrates, and the Arab medical
treatises
written in the ninth and tenth centuries, particularly the famed and
lengthy Canon of Medicine
authored by the eminent Avicenna (c AD 980-1037),3 became the
fundamentals to Western
medical practice taught up to the mid-nineteenth century.
Avicenna (Ibn Sina)
The physician Avicenna practised in Bukhara then a major city and home
to several brilliantly decorated mosques situated along the Silk Road,
today in modern Uzbekistan.
Avicenna was his Latinate name, whilst Ibn Sina was an abbreviation of
his given name.
The Hippocratic Corpus consisting of up to sixty or so works was first
assembled, catalogued and archived in the Great Library of the
Ptolemies, built within the estate of
Ptolemy I Soter (c 367-282 BC) and completed by his son, Ptolemy II
Philadelphus (c 308-246 BC), at Alexandria in Egypt in the early third
century BC.
Central to the Hippocratic-Galenical theory of disease causality was
the nature of the Air, a belief that disease arose from any adverse
meteorological or weather disturbance.
The quintessential example of medical advice devoted to both the
beneficial and adverse effects of geographical and meteorological
phenomena was given by the ancient author
of the book Airs, Waters and Places.4 The document is one of the
earliest accounts of the fraught relationship between climate and
humankind. Ancient Greek understandings
of how the body works, human physiology, were outlined in the first
book of the Hippocratic tome. The body’s conduits were called veins
that carried certain fluids called humors.
The Greeks believed in the existence of four humor fluids, those of
blood, bile, phlegm and black bile. Normal health resulted from a
rather vague state whereby the elements or
humors of the human body functioned together in a harmonious and
unified fashion.
Galen
Claudius Galen was born to a wealthy family in Pergamum in September AD
129. Pergamum was an ancient Greek city, a major cultural centre within
the classical Greek world
and situated in the ancient region of Mysia in Asia Minor, today the
Anatolia region of modern western Turkey, at a distance of some
twenty-five kilometres from the Aegean Sea.
Map of Northern Asia Minor
At the time of Galen’s birth, Pergamum was at the height of its
prosperity, a thriving metropolis under Roman occupation during the
reign of emperor Hadrian (AD 76-138),
the adopted son and heir of his predecessor, the emperor Trajan (AD c
53-117). From early times the city boasted an extensive mint that was
supplied with abundant silver and
gold mined from the nearby Mt Ida mountain range, an area rich in
mineral deposits. Even today a Canadian gold mining company is cutting
a swathe through the area in search for
more minerals. Outside
Pergamum’s city walls was a huge temple complex dedicated to the
demi-god of medicine, Asclepius, built on the city’s acropolis during
the fourth century BC.
Asclepius
The refurbishment of this major building project, an Asclepion, linked
to the city by a paved sacred way, was undertaken in part by Galen’s
father, Nicon, a rich architect and
owner of several landed estates. The emperor Hadrian took a great
interest in the re-building programme and personally provided funds for
the extensive renovations.
Plan of the Asclepion of Pergamum (c 4th century BC)
Galen and his father obtained Roman citizenship, though the young Galen
was educated to speak the best Greek as well as Latin. His medical
studies were lengthy and extremely
bookish enabling him to later read and understand the early Greek used
by Hippocrates. His education was far more diverse than that undertaken
by the ordinary surgeon apprentice.
Galen received tuition from a series of teachers of the Hippocratic
schools and by philosophers from the four major sects, Stoic,
Platonist, Aristotelian and Epicurean. Teachers at
Alexandria particularly stressed the early importance of anatomy and
surgical techniques. Finally returning to Pergamum in 157 after many
years away, Galen’s proficiency with the
knife and the little or no use of cautery and aided by his family
connections, enabled him to obtain the prestigious job as surgeon to
the highly prized and valuable gladiatorial
company owned by the Pergamese high priest.6 Galen attended to the
gladiator’s
diet, oversaw their general health and cleaned and stitched their
wounds, proudly recording that
during his first period in the job, only two gladiators died compared
with sixteen
deaths under his predecessor’s care.
In his early thirties, during the summer of 162, with an already
established surgical reputation and armed with a list of valuable
contacts, Galen left Pergamum for Rome to establish
a career at the very heart of the empire. Here he treated the rich and
famous, the poor, the slave and freeman alike, at the same time he
zealously exploited contacts with leading
senators, consuls and members of the imperial household. Allegedly he
never
claimed a fee for his services or any payment from his students,
although he readily accepted substantial
gifts from the numerous grateful and more prosperous patients. During
his time at
Rome, Galen became an eloquent self-populist, quite self-opinionated
and above all, a scholarly
pedagogue.
By early modern history, Galen’s pre-eminent and distinguished
reputation was cautiously threatened by the writings of two renowned
seventeenth century English physicians,
Thomas Willis (1621-1675) and Thomas Sydenham (1624-1689) and by the
equally
illustrious Dr Herman Boerhaave (1668-1736) at Leiden in the
Netherlands during the
next century. Above all, Galen was a prolific author of both
philosophical and
medico-surgical texts. Galen’s writings in Greek amounted to
approximately 10% of all
literature before AD 350 contained in lengthy chronicles of firmly
expressed ideas
and contentions. With time numerous works of the Galenic Corpus were
lost, a process
beginning even during Galen’s lifetime, memorably in 192 by a fire at
the Temple of
Peace in Rome
The temple was begun by Vespasian (AD 9-79) in AD 71 and totally
destroyed only months before the assassination of Commodus (AD 161-192)
in December 192.
Four years after arriving at Rome, in the summer of 166, Galen slipped
away to return to Pergamum via a short stay in Sicily, in order to
avoid a plague outbreak in the city.
In retrospect the outbreak was probably a smallpox epidemic that Galen
may have mistakenly identified as ‘the great plague’. Professor Nutton
contends that if the Antonine
Plague that first appeared in the East at Nisibis and Smyrna in 165 and
reached Rome in late 166, brought back from Persia by the returning
army of the co-emperor
Lucius Verus (AD December 130-January 169) during the Parthian Campaign
(161-166),
it could not have erupted in Rome until several months after Galen’s
departure.
Silver Denarius of Aurelius (minted at Rome AD 177)
Towards the end of the year 168 Galen received an imperial decree to
return to Rome and attend the sick emperor Marcus Aurelius (AD
121-180), and his son-in-law,
Lucius Verus. Aged nine years younger than Aurelius, Verus was the
first chosen Roman
co-emperor in almost 200 years of imperial history.9 The joint rulers
were preparing
a campaign at Aquileia in northern Italy to evict German tribes who had
crossed the central
Danube and invaded the empire. However, Lucius Verus died in January
169 during
his return journey home before Galen’s arrival and Marcus Aurelius,
similarly ailing, continued to
Rome to arrange for the state funeral. After recuperating Marcus
returned north
to take charge of the army, but left Galen in Rome to look after his
natural son and sole heir apparent, the
seven-year old Commodus, who by then held the position of Caesar.
Silver Denarius of Commodus (minted at Rome AD 179)
Galen much later wrote that Marcus Aurelius praised him as a true
gentleman, ‘the first among doctors and the only philosopher among
philosophers’. But somewhat unsurprisingly,
Galen was not mentioned in Marcus Aurelius’ collected thoughts, bearing
the contemporary title, Meditations, a book of short sayings written in
Greek by the emperor who had been
educated in Stoic Philosophy, clearly not designed with a view for
publication.
Commodus became co-emperor with Marcus Aurelius on his sixteenth
birthday and in March 180 became only the second emperor to succeed his
father in more than 200 years.
The first emperor to succeed his biological father was Titus (AD 30-81)
in 79 on the death of Vespasian. Commodus became weak and dissolute in
character and quite an unworthy
son of a noble father and was ultimately strangled in his private
apartments in the palace on the night of the 31 December 192. For the
rest of his life Galen remained one of the court
physicians and surprisingly stayed in Rome during the turbulent
three-months of the short rule of the successor to Commodus, the
emperor Pertinax (AD 126-193). Pertinax was
murdered by mutinous Praetorian Guards, a homicide which unleashed
almost four-years of civil war which included the deaths of three other
imperial contenders before
Septimius Severus (AD 145/146-211) seized power in April 193 and
founded a new dynasty, ending his days at York, England.
The Five Good Emperors
Marcus Aurelius was the last of what some historians have described as
the Five Good Emperors all of whom died from natural causes and not
from an assassin’s knife.
Brass Sestertius of Nerva (minted at Rome AD 97) Nerva (AD 30-98), the
first Good Emperor, between 96 and 98, shown on a brass sestertius
minted at Rome, half way through
his reign, in 97.
The reign of Trajan followed next, born in Spain in the year 53, and
rose to become a popular and efficient military leader and in the
typically Roman aristocratic custom,
was adopted by Nerva. He ruled for nineteen years, from 98 to 117.
Brass Dupondius of Trajan (minted at Rome AD 107)
The brass dupondius depicts the emperor Trajan wearing a radiate crown
rather than the usual laurel wreath depicted on Roman silver and gold
coins. The large and heavier coins,
the sestertius and dupondius, were minted using orichalcum, a
golden-coloured bronze alloy that contains between 10 to 20% zinc, some
lead and the rest copper.
Gold Aureus of Hadrian (minted at Rome AD 117) The next Good Emperor
was Hadrian, following Trajan’s sudden death in the Asia Minor city of
Cilicia. Hadrian too was
born in Spain and undertook a successful military career. He reigned
for twenty-one years dying in 138. Unlike his successors, Hadrian
travelled to almost every Roman province
during his reign and particularly admired Greek art, culture and
architecture. From the time of Julius Caesar, Rome accelerated the
mintage of pure gold coins each weighing
around 8.0 grams, the high output continued until the end of Marcus
Aurelius reign when accessible gold sources became scarce.
Brass Sestertius of Antoninus Pius (minted at Rome AD 147).The
fourth of the five worthy emperors was Antoninus Pius (AD 86-161),
ruling from 138 until his death, at
the old age of seventy-four, in 161.
Denarius of Marcus Aurelius
Finally, the learned and conscientious Marcus Aurelius assumed the
conjoint supreme role in 161 until his death in 180 at a place near
modern Vienna. He bore the junior imperial
rank of Caesar for twenty-two years and a further nineteen years as
co-emperor. Marcus died aged 59-years and was immediately deified.
Galen’s Theories of Medicine
At the base of Galen’s medicine lay a deep conviction of the supreme
importance of anatomy. Galen conceived the human body to contain three
cardinal organs, the heart, brain
and liver, each with its own natural spirit or pneuma, and each with
its
own conduits of arteries, nerves and veins respectively. Pneuma was
regarded by Galen as essential for life
and was inhaled and produced by digestion and stored in the heart, in
which any
blockage of its movement within the body proved fatal. Accepting the
Hippocratic theory of four
humors, Galen proposed nine possible humeral
mixtures, or as later interpreters described them, temperaments, one
temperament being an exact balance of the four Aristotelian
primary
qualities of hot, cold, wet and dry. The mixtures indicated a
predisposition to certain
types of illnesses rather than being in themselves simply unhealthy.
Each person
possessed a specific natural mixture and the physician’s role was to
restore the patient’s temperament
therapeutically.11 Knowledge of the physiology of the vascular system
was extended by Galen, though quite surprisingly he incorrectly
identified the pulse to be a movement within the coats
of the arteries and not synchronous with the forceful thrusts
of
cardiac contraction, the heartbeat.
Galen recognised that the immediate cause of the ever-present fevers
was an unnatural state of behaviour of the blood. It was this
haematological dysfunction that the body
attempted to resolve by trying to prepare the blood back to a healthy
state, a
dynamic process known as concoction. A recovery from fever indicated
that the preparation
phase had occurred and the ‘morbific matter’ had been expelled through
the appropriate
channel, all at apposite and proper stages. Throughout the ‘long
eighteenth century’
great apprehension arose within European communities during epidemics
of hitherto unknown fevers and
may be compared by the intense trepidation and, at times irrationality,
that accompanied the twenty-first century pandemic fever,
COVID-19 caused by SARS-CoV-2 virus, and first
reported to the WHO Country Office in China on the
31 December 2019. By
the late eighteenth century, physicians still diagnosed fever as a
symptom complex rather than relying on
clinical thermometry. The complex embraced
headache, feeling of
coldness and rigors, lassitude, fast pulsation, ‘red and thick’ urine,
thirst, loss of appetite, abnormal warmth and invariably
insomnia. By the seventeenth
century, European physicians diagnosed
fever by a single sign, a rapid and bounding pulse. But by the
eighteenth century no Western fever theory yet fully
embraced the
rudimentary concept, that the development of an abnormal
elevation of body temperature represented an inner reaction to
disease, a predictable physiological response
to
infection or inflammation.
The date of Galen’s death was often quoted as 200, but Nutton’s
pioneering work translating records by Byzantine chronographers
strongly supports Galen’s death at about the
age of eighty-seven, that is in the year 216.13 So ended a life
that
spent a lengthy seventeen-years as a student and seventy as a
practitioner and writer. His lifetime, however,
spanned the reigns of no less than eleven emperors. Beginning with the
Spanish born
Hadrian and ending during the very brief reigns between April 217 and
June 218 of the
emperor Macrinus (c 164-218) who proclaimed his ten-year old son,
Diadumenian (AD 208-218) as
co-emperor. Both emperors spent the entire fourteen-month reign in the
empire’s eastern regions and never visited Rome, ultimately executed by
a disaffected Roman army near the
ancient Syrian city of Antioch on the Orontes.
Conclusion
Yet, Galen was not the only young man from a wealthy family in Asia
Minor who studied at Alexandria and came to play leading roles in the
community and establish links with
provincial or senatorial aristocracy. But the length, depth and variety
of Galen’s
studies, the sheer size of Galen’s surviving books and manuscripts
written in a typically forceful
persuasive manner, his international acclaim with patients writing for
advice from many
parts of the empire and his status as an imperial physician were such
that within a generation
of Galen’s death his books were copied in remote places such as Upper
Egypt, today a region up
river from the Aswan Dam.14 In Rome, Galen’s medical opinions and
teachings
had become pre-eminent and the dominance of his physician’s
status made almost unassailable.
References.
Vivian Nutton, ‘The Life and Career of Galen’ in Ancient Medicine, 2nd
ed. (London: Routledge, 2013), 222-235; 233.
Kathy Oxtoby, ‘Is the Hippocratic Oath still relevant to practising
doctors today?’, BMJ, 2016; 355: i6629.
Ibn Sina [Avicenna], Al-Qanum fi’l-Tibb, (Rome: Typographia Medicea,
1593).
Hippocrates, ‘Airs, Waters and Places’ in The Genuine Works of
Hippocrates, trans. from the Greek by Francis Adams, 1st ed. 2 vols.
(London: Sydenham Society, 1849), vol. I, 179-222.
Richard Evans, A History of Pergamum: Beyond Hellenistic Kingship,
(London: Continuum International Publishing, 2012).
Vivian Nutton, ‘The Chronology of Galen’s Early Career’, Classical
Quarterly, 1973; 23 (1): 158-171, 163.
Vivian Nutton, ‘The Fortunes of Galen’ in The Cambridge Companion of
Galen, ed. R J Hankinson, (Cambridge: Cambridge University Press,
2008), 355-390, 355-6.
R P Duncan-Jones, ‘The Impact of the Antonine Plague’, J. Roman
Archaeology, 1996; 9: 108-136.
David R Sear, Roman Coins and Their Values, vol. 2 of 5 (London: Spink,
2002), 289.
Marcus Aurelius, Meditations, trans. A S L Farquharson, (London: Pan
Macmillan, 2011).
Galen, Galen: Works on Human Nature, volume I On Temperaments trans. P
N Singer et al. (Cambridge: Cambridge University Press, 2018) 47-102.
Herman Boerhaave, Aphorismi de cognoscendis et curandis morbus,
(Leiden: T Hak, S Luchtmans, J & H Verbeck, 1737) No. 673.
Vivian Nutton, (1973) ibid., 216.
Vivian Nutton, (1973) ibid., 235. Return
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