Galen
Aelius Galenus or Claudius Galenus (Greek: Κλαύδιος Γαληνός; September 129 – c. 216 AD), often anglicized as Galen or Galen of Pergamon, was a Roman and Greek physician, surgeon, and philosopher. Considered one of the most accomplished medical researchers of antiquity, Galen influenced the development of various scientific disciplines, including anatomy, physiology, pathology, pharmacology, and neurology, as well as philosophy and logic.
The son of Aelius Nicon, a wealthy Greek architect with scholarly interests, Galen received a comprehensive education that prepared him for a successful career as a physician and philosopher. Born in the ancient city of Pergamon (present-day Bergama, Turkey), Galen 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 was eventually appointed as the personal physician to several emperors.
Galen's grasp of anatomy and medicine was largely shaped by the prevailing theory of the four humors- black bile, yellow bile, blood, and phlegm- first proposed by the author of On the Nature of Man from the Hippocratic corpus. For over 1,300 years, his views reigned over and shaped Western medical science. His anatomical findings were primarily derived from dissection of Barbary apes. However, upon realizing that their facial expressions resembled those of humans too closely, he shifted his focus to other animals, such as pigs. Though Herophilus and Erasistratus conducted dissections and vivisections on humans in Alexandria during the 3rd century BCE with Ptolemaic approval, such practices were strictly prohibited in the Roman Empire by Galen's era. Thus, he had to rely on the dissection and vivisection of animals, notably barbary apes and pigs, echoing Aristotle's approach centuries earlier in studying anatomy and physiology. Like many of his contemporaries, Galen believed that animal anatomy closely mirrored that of humans. He encouraged his students to observe deceased gladiators or corpses washed ashore to familiarize themselves better with human anatomy.
Galen's circulatory physiology theory was widely accepted until around 1242, when Ibn al-Nafis released his book, Sharh tashrih al-qanun li' Ibn Sina (Commentary on Anatomy in Avicenna's Canon). In this work, he highlighted his discovery of pulmonary circulation. His findings went unchallenged until 1543, when Andreas Vesalius published De humani corporis fabrica, containing printed descriptions and illustrations of human dissections that incorporated new observations into Galen's physiological framework.
Galen saw himself as both a physician and a philosopher, as he wrote in his treatise titled " 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 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 at least seventy when he died.
Biography
Galen's Greek name, Γαληνός (Galēnós), derives from the adjective γαληνός (galēnós), meaning 'calm'. His Latin name (Aelius or Claudius) suggests he held Roman citizenship.
Galen describes his early life in On the Affections of the Mind. He was born in September 129 AD. His father, Aelius Nicon, was a wealthy patrician, an architect and builder, with eclectic interests including philosophy, mathematics, logic, astronomy, agriculture, and literature. Galen describes his father as a "highly amiable, just, good and benevolent man. " At that time, Pergamon (modern-day Bergama, Turkey) was a major cultural and intellectual center, noted for its library, second only to that in Alexandria, as well as being the site of a large temple to the healing god Asclepius. The city attracted both Stoic and Platonic philosophers, to whom Galen was exposed at age 14. His studies also encompassed each of the principal philosophical systems of the time, including Aristotelian and Epicurean. His father had planned a traditional career for Galen in philosophy or politics and took care to expose him to literary and philosophical influences. However, Galen states that around 145, his father had a dream in which the god Asclepius appeared and commanded Nicon to send his son to study medicine.
Medical education
Following his earlier liberal education, Galen, at age 16, began his studies at the prestigious local healing temple or asclepeion as a θεραπευτής (therapeutes, or attendant) for four years. There, he came under the influence of individuals such as Aeschrion of Pergamon, Stratonicus, and Satyrus. Asclepiea functioned as spas or sanitoria where the sick would come to seek the ministrations of the priesthood. Romans frequented the temple at Pergamon in search of medical relief from illnesses and diseases. It was also a gathering place for notable figures such as the historian Claudius Charax, the orator Aelius Aristides, the sophist Polemo, and the consul Cuspius Rufinus.
Galen's father died in 148, leaving Galen independently wealthy at the age of 19. He then followed the advice he found in Hippocrates' teachings and traveled and studied widely, including destinations such as Smyrna (now İzmir), Corinth, Crete, Cilicia (now Çukurova), Cyprus, and finally the great medical school of Alexandria, exposing himself to various schools of thought in medicine. In 157, at the age of 28, he returned to Pergamon as the physician to the gladiators of the High Priest of Asia, one of the most influential and wealthy men in Asia. Galen claims that the High Priest chose him over other physicians after he eviscerated an ape and challenged them to repair the damage. When they refused, Galen performed the surgery himself, thereby winning the favor of the High Priest of Asia. Over his four years there, he learned 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 among the gladiators occurred while he held the position, compared to sixty during his predecessor's time, a result generally ascribed to the attention he paid to their wounds. At the same time, he pursued studies in theoretical medicine and philosophy.
Rome
In 162, Galen arrived in Rome and established himself as a physician. His public demonstrations and refusal to accept alternative medical views led to disputes with other physicians in the city. When Eudemus, a Peripatetic philosopher and his teacher, fell ill with quartan fever, Galen felt it necessary to treat him because they lived close to each other. He 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 relying on prognosis in his treatment of Eudemus, as this approach clashed with the prevailing standard of care rooted in divination and mysticism. In response to his critics, Galen defended his methods, stating, "In order to diagnose, one must observe and reason." This assertion formed the foundation of his critique against those physicians who operated without reason or investigation.
Eudemus cautioned Galen that confronting these physicians might result in his assassination. He mentioned, "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." When Galen's hostility towards the Roman doctors intensified, he worried he might be exiled or poisoned, prompting him to leave the city.
Rome was engaged in foreign wars in 161; Marcus Aurelius and his then co-emperor and adoptive brother, Lucius Verus, were in the north fighting the Marcomanni. During the autumn of 169, as Roman troops returned to Aquileia, a great plague, most likely one of the first appearances of smallpox (then referred to as the Antonine Plague) in the Mediterranean world, broke out, prompting the emperor to summon Galen back to Rome. He was ordered to accompany Marcus and Verus to Germany as the court physician. The following spring, Marcus was persuaded to release Galen after receiving a report that Asclepius opposed the project. Galen was left behind to serve as physician to the imperial heir, Commodus. It was in court that Galen wrote extensively on medical subjects. Ironically, Lucius Verus died in 169, and Marcus Aurelius himself died in 180, both victims of the plague.
Galen served as the physician to Commodus for a significant part of the emperor's life, treating his common ailments. As noted by Dio Cassius around the year 189, a pestilence struck during Commodus' rule, peaking at 2,000 deaths daily in Rome. This epidemic was likely the same as the so-called'Antonine Plague,' probably smallpox, that afflicted Rome during the time of Marcus Aurelius. Additionally, Galen served as physician for Septimius Severus during his rule in Rome. He praised both Severus and Caracalla for maintaining a supply of medicines for their associates and cited three instances where these provisions were beneficial in 198.
The Antonine Plague
The Antonine Plague, named after Marcus Aurelius' family name, Antoninus, was also referred to as the Plague of Galen, marking its significance in medical history due to its connection with Galen. He had direct experience with the disease, having been in Rome when it first appeared in 166, and again during an outbreak among troops in Aquileia in the winter of 168- 69. Galen described the epidemic as enduring and provided accounts of its symptoms and his treatment methods. However, his references to the plague are mostly brief and not intended as a detailed description for future recognition; instead, he focused on treatments and the disease's physical impacts. For instance, when discussing a young man suffering from the plague, he emphasized the management of both internal and external ulcers. According to Niebuhr, "this pestilence must have raged with incredible fury; it carried off innumerable victims. The ancient world never recovered from the blow inflicted upon it by the plague that visited it in the reign of M. Aurelius." The plague had a mortality rate of 7–10 percent, leading to an estimated 3.5 to 5 million deaths during the outbreak from 165 to 168. Otto Seeck posits that more than half the empire's population died as a result. At the same time, J. F. Gilliam suggests that the Antonine plague likely caused more fatalities than any other epidemic in the empire before the mid-3rd century. Although Galen's accounts are not exhaustive, they allow for a clear identification of the disease as related to smallpox.
Galen notes that the exanthema covered the victim's entire body and was typically black. The exanthem became rough and scabby in areas without ulceration. He states that those who were likely to survive developed a black exanthem. According to Galen, it was black due to remnants of blood that had putrefied in a pustule from a fever blister. His writings indicate that raised blisters were present during the Antonine plague, usually appearing as a blistering rash. Galen mentions that the skin rash resembled the one described by Thucydides. He details symptoms of the alimentary tract through a patient's diarrhea and stools. If the stool was very dark, the patient died. He notes that the quantity of black stools varied, depending on the severity of the intestinal lesions. He observes that in cases where the stool was not black, the black exanthema appeared. Galen describes symptoms of fever, vomiting, fetid breath, catarrh, cough, and ulceration of the larynx and trachea.
Later years
In his later years, Galen persisted in his scholarly work, completing treatises on drugs and remedies, along with a comprehensive compendium of diagnostics and therapeutics. This work would significantly impact medical practices in both the Latin Middle Ages and Medieval Islam.
The 11th-century Suda lexicon states that Galen died at the age of 70, which would place his death in about the year 199. However, there is a reference in Galen's treatise "On Theriac to Piso" (which may, however, be spurious) to events of 204. There are also statements in Arabic sources that he died in Sicily at age 87, after 17 years studying medicine and 70 practicing it, which would mean he died about 216. According to these sources, the tomb of Galen in Palermo was still well-preserved in the tenth century. Nutton believes that "On Theriac to Piso" is genuine, that the Arabic sources are correct, and that the Suda has erroneously interpreted the 70 years of Galen's career in the Arabic tradition as referring to his whole lifespan. Boudon-Millot] more or less concurs and favors a date of 216.