Thursday, August 02, 2012

120-200 A.D.: Galen becomes world's greatest physician

Galen (About 120-200 AD)
Claudius Galen of Pergamum was a Greco-Roman physician who lived from about 130-200 AD, or about 500 years after Hippocrates. He was the first physician to search for and discover the answer to the question "What causes disease?"

He would ask questions like:
  • What causes epilepsy?
  • What causes fever?
  • What causes pain?
  • What causes dypsnea?
  • What causes asthma?
He wasn't satisfied with the answer: the gods cause and cure diseases. Surely that was true, but he wanted to know specifics, like: 
  • Why do bodies form?
  • What causes life?
  • What causes maintains good health?
  • What changes occur to cause diseases?
  • How are diseases cured?
As a student these questions formed in his mind, and as a student, and later as a physician, he sought for answers.  He inspected the human body every chance he got, although it was illegal to dissect the human body for learning purposes.  So he usually had to be content to dissect mice, apes, pigs, and other such animals. Later, as a surgeon at the gymnasium at Pergamum he was able to see the insides of wounded humans. Although most of what he learned was from other physicians and sages around the world.  

This is a depiction of what Galen may have seen as he approached Pergamum.
Galen was born in Pergamum (Pergamos, Pergamon), which was a city-state of Greece, according to historian Jeanne Bendick.  She said there were grand palaces, houses and temples to the gods.  There was a library second only to the library at Alexandria.  There was  gymnasium where young men learned to become athletes, and where they were educated.  It was also a place where baths were taken.  There was also a coliseum where gladiators fought and where plays were performed.  (9, page 14)

The school Galen attended was build near a temple the god of health and healing.  To Galen and other Greeks this god was referred to as Asclepius, but to the Romans he was called Aesculapius. He was the most powerful of the gods of health and healing.  Around his temple was a gymnasium, a school, a library, a large bath with cold and hot water, and together these were referred to as the museum.

View of Acropolis from Sanctuary of Asclepion as it would be seen today.
Bendick said that "about 250 years before Galen was born, the last ruler or Pergamum had given his city-state to Rome on the condition that Rome would protect its independence.  But the people who lived there still considered it a Greek city."  Today Pergamum is part of Turkey.  (9, page 2)

Most physicians when Galen was born were poorly trained, and many were simply quacks.  This was because there were no requirements to be a physician and anyone could claim to be one. (7, page 53) (9, pages 3-4)

Pretty much, if a person claiming to be a physician succeeded in curing people he gained the respect of his peers and was able to continue his practice.  If he failed to cure, he often times was forced to seek another profession.  (9, page 3-4)

Galen's father was Nicon, and like most who were educated during this era, Nicon was educated in most wisdom of the day, and he specialized in one or two areas.  Bendick said Nicon specialized in engineering and architecture, although he was also knowledgeable in philosophy, astronomy, and botany.  (9, page 9)

Medical historian Thomas Bradford said Nicon was a man of great wealth and influence in Greece.  Medical historian John Watson said that Galen's father made sure Galen received the best education in philosophy and medicine, of which Galen would specialize in.  (1, page 149)

Historian John Brock referred to a quote by Galen himself, where he describes his own parents.  Galen said  (10, page xv)
I had a great good fortune to have as a father a highly amiable, just, good, and benevolent man. My mother, on the other hand, possessed a very bad temper; she used sometimes to bite her serving-maids, and she was perpetually shouting at my father and quarreling with him -- worse than Xanthippe and Socrates. When, therefore, I compared the excellence of my father's disposition, with the disgraceful passions of my mother, I resolve to embrace and love the former qualities, and to avoid and hate the latter. (10, page xv)
Brock said Galen tried to collect in himself the best of his father, and to escape from his mother.  However, the fact that Galen continued to get into conflicts during the course of his life, and to openly toot his own horn and blast those who disagreed with him, may have been evidence he was never fully able to escape his mother's scorn.  (10, page xv)

Many Greek and Roman citizens did very little work.  This was because when lands were conquered, those who were taken prisoner were turned into slaves who did all the work.  The citizens, therefore, were able to enjoy the profits of the work of others.

Bendick said this was the case with Nicon and his son Galen.  He said:
They could spend as much time as they wanted reading, studying, discussing ideas, and amusing themselves.  Nicon probably got paid for designing buildings and engineering projects, but he never had to earn a living.  He and his friends never had to help around the house, or take the children to school, or even dress themselves if they didn't want to.  They had slaves to do all the work." (9, page 9)
Bendick said that most children were educated by their mother until they were eight, but Galen's father took special interest in educating his son.  What Galen didn't learn from his father he learned from his father's slaves. Since young citizens were not allowed to go to the public library, this didn't matter to Galen, who had access to his father's private library, which had over a thousand scrolls.  (9, pages 9, 17-18)

Nicon could easily afford to send his son to the best universities.  Watson said that by the time Galen was seventeen:
"He was placed as a student at the Asclepion of Pergamum, under Satyrius, the pupil and successor of Quintus; and in the course of his studies had the advantage of instruction from Stratonicus, a Hippocratic rationalist, and from AEschrion, an emperic."  (1, page 149)
Medical historian Thomas Bradford said that the students of this era had very rare access to books, which was why it was important to learn at the Asclepions.  Everyone educated was instructed in all the wisdom of the day, which is why pretty much all ancient philosophers were also considered physicians.  Galen, however, paid special attention to medicine and surgery, and practiced it.  He thus became one of the most prolific physicians of his time and of all time.  (7, page 54)

It was at the ripe age of 14 that he commenced his studies of philosophy, and when he was seventeen he started his study of medicine, which took him three years to complete.  (7, page 53)

After graduating from school it was important for those desiring to become exemplary in their skills to travel to in order to learn from those most proficient in their skills.  This would explain why Galen, at the age of 21, " went to Smyrna, thence to Corinth, then to Alexandria and to other cities" before opening his own medical practice at Pergamum at the age of 28.  (7, page 40, 53)

Watson said that Alexandria was, at this time, "still most celebrated school of medicine." (1, page 149) Historian Edward Meryon said that studying in Greece, Asia and Italy was common practice for aspiring physicians, "justly regarding such a course as essential to an accomplished physician." (2, page 77)  

When he was 28 he returned to Pergamum and started his own medical practice. (7, page 40, 53) Perhaps in order to broaden his skills, he also signed a three year contract to be a physician to the gladiators.  He trained the gladiators, and then he treated their cuts, scrapes, broken bones, and other wounds. (9, pages 62-70)

In doing this he became very proficient at the basic surgical wisdom of ancient physicians.  There were wounds that occurred during the practices that occurred daily, but there were severe wounds, and some deadly wounds, that occurred during the actual fights.  He would have seen some cuts so deep he would have seen the lungs, and the beating heart.  (9, pages 62-70)

This was significant because of his inability to dissect humans.  Perhaps this inspired him to learn more, and to come up with theories.

Of these years of Galen's life, Bradford said: 
Here he was held in such high esteem by the people that the priests of Esculapius, through the Sovereign Pontiff or High Priest of the city, placed him in charge of the gymnasium then attached to the temple, at which the athletes and gladiators were daily in the habit of assembling to exercise. This office he held for several years, and it is said that he acquired great reputation for his skill in the treatment of fractures, and the wounds incident to the fierce combats of the time. Owing to a revolt in Pergamos, which occured in the year 163-4, and when he was 34 years of age, he was induced to leave that city and settle in Rome. His great renown had preceded him, and his great erudition and practical knowledge soon placed him in the first rank of his profession. (7, page 40-41)
Bradford said he was 34 when he decided to leave Rome. Bendick said he was 31.  This is a common confusion when trying to compile the life of such an ancient person as Galen.  Regardless, after three years as physician to the gladiators, Bendick said Galen decided to continue his studies, and open up a practice, in the greatest city in all the world: Rome.  The journey from Pergamum to Rome probably took him a year no matter what method he used to travel.  (9, pages 70-73)

Prior to his time in Rome he was not a famous physician.  As was typical of the ancient world, in order to gain fame you had to earn the favor of someone famous.  Bendick explains how Galen did this in Rome:
His fame began with his father's friend, Eudemus, who was getting sicker and sicker, even though his doctor was one of the most important in Rome.  Eudemus sent for Galen, who examined him carefully, made his own diagnosis, and prescribed treatment and medicine, which he made himself.  Eudemus recovered and suddenly important people all over rome wanted Galen to be their doctor.  
The important people were not only those who were rich, or who were government officials.  Orators and architects, philosophers and lawyers, astrologers and famous athletes were equals in Rome.  
One of the important people was the ocnsul, Flavius Boethius, wose wife was ill.  when Galen cured her, Boethius became his greatest fan.  He paid Galen a fee of 400 gold pieces for the cures.  (9, page 78-79)
Bendick said it was Boethius who encouraged Galen to give lectures to explain his medical ideas and his methods of curing sickness.   Now he would spend time at the gymnasium not as the student, and not as the physician, but as the lecturer of medicine.  (9, page 79)

While his father encouraged him to be well learned, from his mother he appears to have obtained a "violent temper."  He was a very "boastful" speaker, and by his lectures he "attracted not only students of medicine, but also philosophers, politicians, and many others of the highest rank and influence," wrote Bradford. (7, page 41)(also see 9, page 9)

Perhaps we can see his "boastful" speaking by his "boastful" writing.  In his Natural Faculties, he blatantly criticizes Asclepiades, a vast critic of Hippocratic medicine. Galen said that Asclepiades had opposing views as to Galen when it came to yellow bile and jaundice, and black bile and the spleen.  Galen also quoted Asclepiades as saying that "nothing is naturally in sympathy with anything else, all substance being divided and broken up into harmonious elements 'molecules.'"(11, page 62-63)

Of this Galen took exception, and wrote: (11, page 63)
He (Asclepiades) is forced here, again, to talk nonsense, just as he did in regard to the urine. He also talks no less nonsense about the black bile and the spleen, not understanding what was said by Hippocrates; and he attempts in stupid -- I might say insane -- language, to contradict what he knows nothing about. (11, page 63)
So, according to Galen, while Asclepiades did a service by introducing Greek medicine to Rome, he was wrong to contradict Hippocrates.  Regardless, by the time Galen began his studies of medicine in Rome, medicine was in a state of flux.

Historian John Brock confirms for us that the medical community was in a state of flux, or "ebb," at the time Galen started his practice.  Brock said: (10, page xvii)
Medical practice at this time was at a low ebb, and Galen took no pains to conceal his contempt for the ignorance, charlatanism, and venality of his fellow-practitioners.  Eventually, in spite of his social popularity, he raised up such odium against himself in medical circles, that he was forced to flee the city. Thus he did hurriedly and secretly in the year 168 A.D., when thirty six years of age. He betook himself to his old home in Pergamos, where he settled down once more to a literary life. (10, page xvii)
Bradford likewise confirms that that after five years in Rome, and angering many of his fellow physicians, he moved to Brindusium, and then "set out to visit the East; he visited different parts of Palestine and the isle of Cyprus."  (7, page 41)

He ended up, as Brockk said, in Pergamus where he had a brief respite, although it was short lived.  Brock said after a year he was summoned by Roman Emperor marcus Aurelius to return to Rome.  (10, page xvii)

Bendick said the year was 168 A.D. when Galen was summoned out of his respite to return to Rome, so once again you can see the confusion when it came to exact dates.  It is possible it was the same year that he left Rome and returned, although considering it took about a year to travel the distance between the two cities, this is probably not the case.

So it was about 168 A.D., give or take a year, that Marcus Aurelius championed his friends to the cause of winning the war.  He wanted Galen to be his own personal physician.  There were other amature physicians called medici who took care of wounded soldiers.  Galen's job would be to tend only to the physician, and when he returned to Rome that is exactly what he did. Although he really wasn't in Rome, he was wherever the Roman military was.  (9, pages 102-107)

Regardless, Bradford said he was appointed by Marcus Aurelius and Lucius Verus as surgeon general of the army, Galen followed the emperor for a time, (7, page 41) but he was not concerned about the charm, glory, and patriotism of being on the front lines with the emperor.  He surely wanted to stay in the good graces of the emperor and his country, but he wanted out of his duty of following the emperor in battle.  (10, page xviii)

There may have been a variety of reasons for Galen's feelings about the Roman military, although Bendick speculates it may have been because of his fear of plagues.  Bendick said that plagues (of all sorts) were common back in Galen's time, and it was very common for soldiers to come into contact with these plagues.  Historians say that a plague wiped out about a third the population of the empire during Galen's lifetime, and some speculate based on descriptions of the disease that it was smallpox.  (9, pages 102-107)(10, page xvii)

So Galen was afraid of getting the plague, and therefore he wasn't happy with his role in the military.  He therefore managed to convince the emperor that his services would be better fit back in Rome, and thus obtained his honorable discharge.  (9, pages 102-107)(10, page xvii)

Marcus Aurelius gave him his honorable discharge in exchange for being in charge of his nine-yearold son Aurelius Commodius. Galen then succeeded in curing the prince of a fever, and also curing his brother, Sextus. Of this, Bradford said: (7, page 41)
"(Galen) secured the favor of the boy's mother Faustina.  When the emperor came back he became ill, and the physicians said that he had ague; but Galen diagnosed dyspepsia and cured him. This greatly added to his fame, and the grateful emperor exclaimed: 'We have but one physician -- Galen is the only man in the faculty.'  Thus enjoying royal confidence, he devoted his time to practice, and to writing his immortal works on medicine, He passed the rest of his professional life in Rome."  (7, page 41)
So you can see that he had a pretty well established reputation among the aristocracy which, again, was something that was almost essential during this era in order to obtain a reputation among society.  He was also a great teacher, and gave lectures in the open.  Students yearning to learn might have traveled long distances to learn from the great physician.

Brock said Galen spent the rest of his days in Rome, and it was during this time that he did most of his writings.  There are various dates surrounding the date of his death.  Some say he died in 201 A.D., some say 202, some 210.  Some Arabic physicians noted his date as 215 or 216 A.D.  Brock perhaps said it best when he wrote, "Probably he died about the end of the century." (10, page xviii)

Galen died around the year 201 or 202 or 210.  Some say he died around 216.  So it's difficult to know for sure when he died.  Chances are, since all those numbers are similar, and since they were probably transcribed so many times, they were probably mixed up, and thereby making it impossible for modern historians to know when he actually died.

Through the course of his life he studied the works of the sages and physicians of the world, he studied all the books he could, and he performed experiments on his own.  He would find all the answers to his questions, write down his theories for other physicians to learn from, and he would go on to become the most famous physician not just of his lifetime, but of all time.

Further reading:

  1. Galen: the worlds first pathologist
  2. Galen wonders what causes asthma

References:
  1. Watson, John, "The Medical Profession from the Earliest Times: an anniversary discourse delivered before the New York Academy of Medicine November 7, 1855," 1856, New York, Baker & Godwini
  2. Meryon, Edward, "The History of Medicine," Volume I, 1861, London,
  3. Fourgeaud, V.J., "Historical Sketches: Galen," Pacific Medical and Surgical Journal," 1864, Vol VII, San Francisco, J. Thompson & Co., pages 22-29
  4. Jackson, Mark, "Asthma: A Biography," 2009, Oxford University Press, the quote from Jackson comes from On the Affected Parts by Galen
  5. Young, Thomas, "A Historical and Practical Treaties on Consumptive Diseases:  Deduced From Original Observations, And Collected From Authors Of All Ages," 1815, London, B.R., page 145
  6. Adams, Francis, "The Medical Works of Paulus Agineta: The Greek Physician; translated into English with a Copious Commentary," vol. I, London, page 407-8, 1834, Adams gives a long list of ancient physicians who wrote about asthma
  7. Bradford, Thomas Lindsley, writer, Robert Ray Roth, editor, “Quiz questions on the history of medicine from the lectures of Thomas Lindley Bradford M.D.,” 1898, Philadelphia, Hohn Joseph McVey
  8. Garrison, Fielding Hudson, "Introduction to the history of medicine, 3rd edition, 1922, Philadelphia and London, W.B. Saunders Company
  9. Bendick, Jeanne, "Galen and the gateway to medicine," 2002, U.S., Bethlehem Books Ignatius Press
  10. Brock, Arthur John, translator and author of introduction, Galen, author, "Galen on the natural faculties," 1916, London, New York, William Heinemann, G.P. Putnam's Sons
  11. Galen, author, Arthur John Brock, translator, "Galen on the natural faculties," 1916, London, New York, William Heinemann, G.P. Putnam's Sons
  12. Gill, M. H., "Review and Bibliographic Notices: "On the spasmotic asthma of adults," by Bergson, published Gill's book, "The Dublin Quarterly Journal of Medical Science," volume X, August and November, 1850, Dublin, Hodges and Smith, pages 373-388
  13. Freudenthal, Wolff, "Bronchial Asthma," New York Medical Journal: A Weekly Review of Medicine, edited by Edward Swift Dunster, James Bradbridge Hunter, Frank Pierce Foster, Charles Euchariste de Medicis Sajous, Gregory Stragnell, Henry J. Klaunberg, Félix Martí-Ibáñez, volume CV, January-June, 1917 (Saturday, January 6, 1917), New York, A.R. Elliot Publishing, Co., pages 1-5
Originally published 7/25/2012 and edited and resubmitted on 8/2/2012 and again on 10/29/2013 by Rick Frea

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