Dr Robert Sullivan looks at the fascinating figure of Claudius Galen, one of the founding fathers of medicine, whose legacy divides medical opinion today as much as his practices did in Roman times
Medicine, like all professions, has its heroes and villains. Galen is remarkable in that countless people have argued over the category to which he belongs. Regardless of the verdict, he undoubtedly holds a place amongst the ‘fathers’ of medicine. His legacy, as controversial as it is amazing, remains to this day.
Claudius Galen was born around 129 A.D. in the city of Pergamon, which was a large Greek city located on what is now the western coast of modern-day Turkey. Unlike its present state of ruins, at that time, it was a large regional centre for culture and civilization. His father was Nicon, a famous and extremely wealthy architect. Galen enjoyed a privileged education, focusing on mathematics, logic, philosophy and grammar. His later education became more centred upon, but not limited to, medicine.
From Pergamon, Galen travelled to Corinth and then onto Alexandria, where he studied for five years. After the completion of his studies and the death of his father, Galen returned to the city of Pergamon as a surgeon to serve the gladiators.
h4. Combat wounds
For several years, he treated the combat wounds that these men suffered, fascinated by their lesions which he described as ‘windows into the body’. Galen was forced to leave in 162 A.D. as civil unrest erupted. Tempted by ambition and opportunity, he left for Rome, where he earned quite a reputation for himself.
Whilst in Rome, Galen made and used connections with those in the higher echelons of society to establish a reputation as a healer, scholar and innovator. He routinely accused his competitors of greed and incompetence. It may have been during this period that he became physician to the emperor, Marcus Aurelius.
During his time in Rome, he increased his production of papers and used his vast inheritance to employ some 20 scribes to record his observations. Despite, or indeed because of his power and reputation, Galen had quickly amassed a large number of enemies, to the extent that he was forced to leave after just four years.
h4. To seek only the truth
He later wrote, ‘my father taught me to despise the opinion and esteem of others and to seek only the truth’. He returned briefly to Pergamon, until he was rapidly called in to assist the Roman army whilst they went on a campaign against the Germans. During this campaign, Galen was once again physician to the emperor.
The campaign did not last long and Galen returned with the emperor to the ‘eternal city’, where he continued to practice medicine and write incessantly until his death, some time in the first 20 years of the third century.
After his death, his works became regarded as the unquestionable gold standard of medicine for all to follow. He often included theological references in his work, currying favour with Church authorities who later referred to him as ‘Divinus Galenus’ or Galen the Divine. Stories persist of those who questioned his beliefs being burned at the stake.
h4. Over 500 papers
Galen wrote over five hundred papers, on a wide range of subjects. Amongst his first was: ‘The best doctor is also a philosopher’. Many of his works were lost in a fire in 191 AD, in a temple where they were kept for safe-keeping. Many of his remaining works survive only because they were copied — the originals lost for centuries.
He also conducted animal experimentation. For example, to disprove the theory that the bladder produced urine, he tied the ureters of animals and noted the ensuing swelling of the kidneys. When it came to the nervous system, he separated the nerve in question and studied the effect by observation, noting loss of sensation and motor function.
Galen believed in the ancient Greek theory that disease was caused by an imbalance of the ‘four humours’. He also believed in the logic of opposites; for example if a patient was hot, one implemented measures to cool him down.
This ‘opposite’ approach was also used if a patient was weak; strong physical exercises were needed to restore his health and equally, if one was short of breath, singing exercises were prescribed.
A considerable controversy surrounds Galen and the subject of dissection. It is likely that Galen never dissected a human. Dissection was forbidden by Roman law. He dissected a lot of animals including pigs and dogs, although his favourite was the Barbary ape. He underestimated the structural differences between humans and other creatures. As a result of this, some of his observations on anatomy were grossly incorrect.
For example, he believed that the ‘rete mirabile’, a plexus of vessels at the base of the brain found in some creatures, was present in humans. He also maintained that the liver has five lobes, as that is the case in dogs, and that the heart has two chambers.
Galen believed that the blood passed from one side of the heart to the other through pores too small to be seen. He thought that the veins and arteries were entirely separate systems.
He thought that blood was produced continuously in the liver and went into either arteries or veins, with the former vessel carrying blood and air and the latter vessel carrying just blood. The blood travelled to its target and went no further from there, he maintained.
h4. Seven cranial nerves
He did, however, identify seven of the 12 cranial nerves. He also described the heart valves and proved that the blood vessels carried blood, as opposed to air. He described the foramen ovale and the ductus arteriosus in the foetal heart. Perhaps his most important discovery was the importance he placed upon taking the pulse, something which most physicians of the time ignored.
He showed that damage to the recurrent laryngeal nerve produced hoarseness. He said that the female ovary was analogous to the male testes. He suggested that tuberculosis was contagious and that dogs were involved in the spread of rabies.
It has been suggested that he provided a description of rheumatoid arthritis, which would make him the first to describe this condition. He used medicines grown from his own garden on patients, hence the term ‘Galenic’, which describes medicine from vegetable or animal origin. He claimed that by changing the dose a drug could be therapeutic, toxic or useless.
h4. Aftermath
Much of Galen’s work has failed to stand up to the test of time, but this should not take from his claim as a key figure in the development of medicine. He practised medicine at a time long before microscopes, radiology and laboratory science. His theories would become the cornerstone of practice throughout Europe until the Renaissance, when people would begin to question his beliefs.
That said, even those who challenged him later paid tribute to his achievements. William Harvey noted that he had all of the ingredients for explaining the functions of the heart; it was incredible that he did not consider circulation.
There remain two great ironies of Galen and his life. Firstly, he actively encouraged experimentation and the questioning of established theory. Yet those who followed were restricted from questioning his work.
Secondly, even though he produced correct explanations to many questions, he is now remembered more for his many mistakes. He is also remembered for the punishments delved out to those who challenged his work. His observations on human anatomy based upon animal dissection have also tarnished his reputation. Galen remains as controversial thousands of years after his death as he did in life.
About Gary Culliton
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