The Australian Numismatic Society

A Paper given at the June 2020 online Conference


“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 to Library

Return to ANS Main Page


8th June 2020