17 May

When Celsus wrote about medicine in ad 40 he identified three main schools of medical practitioner. The ‘dogmatists’, the followers of Herophilus, believed we must look for hidden causes in order to explain biological processes, and therefore believed in vivisection and dissection, even if they had no opportunity to practise either. The ‘methodists’ had a simple mechanical account of disease as the result of particles travelling either too quickly or too slowly through the body, and believed a doctor could be trained in six months. And the ‘empirics’ rejected all theories of disease, insisting that we must learn from past experience which sorts of intervention are effective. A century later, Galen (who was a dogmatist) was arguing with the same groups, and if we look at early Arabic medicine, in the tenth and eleventh centuries, we find several competing traditions, all claiming to be descended from Greek antecedents.

Yet, a thousand years later, in both Arab and Christian lands, Galen had established himself as the one reliable authority on medical questions. This was perhaps because he was deeply interested in logic, and so his texts fitted well into a programme of education grounded in the Aristotelian syllogism. Moreover, Galen’s understanding of the body was, unlike that of the methodists and empirics, entirely com- patible with an Aristotelian preoccupation with function. There may have been important differences between Aristotle’s account of human biology and Galen’s, in their understanding of the function of the brain, for example, and, as we shall see, in their views on reproduction, but these were marginal compared to their overall compatibility.

So we can plausibly explain Galen’s survival; but it is almost impossible now to look back to the world in which Galenic medicine faced competition, because what survive are the books of Galen, not those of his competitors; the Hippocratic texts survive in large part because Galen declared himself to be a follower of Hippocrates and wrote commentaries on key Hippocratic texts. Galen certainly intended to dominate the field of medicine, and wrote at enormous length to achieve this effect –– the modern edition of Galen’s works in Greek runs to ten thousand pages, and much has been lost; much too survives only in Arabic translation. This copious production and trust in the written word must certainly have helped ensure his future dominance Knowledge of Greek medicine spread in a series of waves.

The first Greek doctor to be invited to Rome was Archagathus in 291 bc, and over the next five hundred years Greek doctors became more and more frequent in the capital of the Roman empire: Galen himself made the journey to Rome. By ad 500 there was general agreement in Alexandria on the key texts by Hippocrates and Galen that should form part of every doctor’s education. These texts were translated into Arabic in the ninth century, particularly by Hunayn ibn Ishaq (Johannitius, d. 873) of Baghdad. Many were then translated from Arabic into Latin by Constantine the African (d. 1087), in southern Italy, and by Gerald of Cremona in Toledo in the mid-twelfth cen- tury. It was these texts, along with translations of Arabic works, which formed the foundation of medical education in the new universities of the early thirteenth century: medical education was formalized in Montpellier by the 1220s, although the first medical degree we know of was awarded in 1268, and there was little university medical educa- tion outside Bologna, Paris and Montpellier until the mid-fourteenth century, a century which saw a flurry of translations directly from the Greek. With the printing press there came a new search for texts: a ‘com- plete’ edition of Galen in Greek was published in 1525, and this made generally available for the first time the key text for an understanding of Galen’s anatomy, On Anatomical Procedures, of which the first Latin translation appeared in 1531. It is very striking that Galen’s best work had only been available for a few years when Vesalius claimed to be able to improve on Galen –– up until 1531, it was always possible to the canon 51 assume that Galen indeed knew best, it was just that his best work had yet to be made available.

An abbreviated edition of Galen’s On the Use of Parts of the Body, which includes frequent references to dissection, had long been avail- able, and it was in the mistaken belief that he was imitating Galen, who actually dissected apes not people, that Mondino de’ Luzzi in Bologna in 1315 began to teach anatomy by the public dissection of a criminal’s corpse; a year later he wrote the first Latin textbook on human anatomy. Already in twelfth-century Salerno pigs had been dissected for anatomic instruction. Dissections of human cadavers to ascertain cause of death had taken place for some time before 1300; and the thirteenth-century practice of boiling up the bodies of Crusaders so that their bones could be returned to their homeland (banned by a papal bull in 1299) may have prepared the way for a new willingness to cut up the dead. The new activity of public dissection was slow to spread: the first public dissection took place in Spain in 1391, in the German territories in 1404, and it did not become stand- ard until Vesalius established it as a central part of medical education in the mid-sixteenth century. In the eighteenth century it became normal for every student to have some experience of dissection, which led to a severe shortage of bodies and a trade in the dead known as ‘body snatching’. Meanwhile, Greek medicine, as transmitted through Arabic, con- tinued to be the foundation of all medical education. The summary of medical knowledge in the Canon of Ibn Sina (known in Latin as Avicenna, d. 1037), translated into Latin in Muslim Spain by Gerald of Cremona in the 1140s, continued to be used as a textbook at Montpellier until 1650, and at some Italian universities until the eighteenth century. So important was this text that an edition in Arabic was published in the West in 1593. In 1701 the great Dutch physician Boerhaave gave his inaugural lecture ‘in praise of the Hippocratic school’ and as we have seen Sydenham was admired as ‘the English Hippocrates’. It was the Sydenham Society that pro- duced the major translation of Hippocrates into English in 1849.

Doctors thus had a set of key texts in common from ad 500 to 1850. Galen would consequently have had little difficulty making sense of a university education in medicine at least until the mid- seventeenth century, when new discoveries in anatomy began to come thick and fast. He would have been interested to see that his scattered comments on diagnosis from inspection of urine had been assembled to form a new discipline, uroscopy, which had taken shape in late fourth century Alexandria: among the texts translated by Con- stantinus Africanus was an Arabic text on the subject. And he would have been dismayed to discover that the Arabs had wedded medicine closely to astrology, and that this linkage had become part of uni- versity education in Latin Europe, so that doctors routinely took horoscopes to decide on treatment: in Valencia in 1332 it was decreed that barber surgeons must consult qualified doctors, or physicians as they had begun to be called since the early thirteenth century to reflect their university education in Aristotelian natural science, before bleeding their patients: this was to ensure that they did so only on days which were astrologically favourable. Galen himself had opposed the use of astrology (which had been imported into Graeco- Roman medicine from Babylonia). He had, on the other hand, edited with approval the Hippocratic text Regimen, which advocates diag- nosis from a patient’s dreams. To dream of a rough sea, for example, ‘indicates disease of the bowels. Light and gentle laxatives should be used to effect a thorough purgation’. But, except for the interest in astrology, he would easily have recognized medicine in 1650 as a direct continuation of medicine in 200.

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