ON GALEN AND GALENISM

12 May

No  other  figure in the history  of medicine has influenced  concepts  of anatomy,  physiology,  therapeutics, and philosophy  as much as Galen, the physician known  as the Medical  Pope of the Middle Ages and the mentor  of  Renaissance  anatomists and  physiologists.  Galen  left  vo- luminous writings that  touch on all the major medical, scientific, philo- sophical, and religious issues of his time. Contemporary admirers, including his patron the emperor Marcus Aurelius, called him the ‘‘First of Physicians and Philosophers.’’  His critics preferred  titles like ‘‘mule head’’ and  called  him  a vain,  arrogant ‘‘windbag.’’ In  attempting to sum up his work and thought,  scholars  have said that,  as a physician, Galen  was  essentially  a  Hippocratic,  but  as  a  philosopher,   he  was generally an Aristotelian.

Galen was born in Pergamum,  a city in Asia Minor that claimed to be the  cultural  equal  of Alexandria.  When  describing  himself,  Galen asserted  that  he  had  emulated  the  excellent  character   of  his  father, Aelius Nikon,  a wealthy architect,  known  for his amiable and benevo- lent nature.  Although  he tried  to dissociate  himself from  the example set by his mother,  a bad-tempered woman,  perpetually  shouting  at his father,  provoking  quarrels,  and  biting  the servants,  these efforts  may not  have  been  completely  successful.  By the  time  he  was  14, Galen had mastered mathematics and philosophy.  About two years later, Asclepius came to Nikon  in a dream and told him that his son was des- tined  to  become  a physician.  While still a student  of medicine at  the famous  sanctuary  of Asclepius in Pergamum,  Galen composed  at least three books. Later, in his advice to medical students and teachers, Galen emphasized the importance of fostering a love of truth in the young that would  inspire them  to work  day and  night  to learn  all that  had  been written  by the Ancients  and  to find ways of testing  and  proving  such knowledge.

After  the  death  of  Nikon,  Galen  left  Pergamum  to  continue  his medical education  in Smyrna,  Corinth, and Alexandria.  On returning  to Pergamum  after years of study and travel, Galen was appointed physician to the gladiators.  Although  he also worked  at the Temple of Asclepius and  established  a  flourishing  private  practice,  within  a  few years,  he became restless again.  In 161, he arrived  in Rome  where through  good fortune,  brilliant diagnoses, and miraculous cures he soon attracted many

Galen, contemplating a human skeleton

Galen, contemplating a human skeleton.

influential  patients,  patrons, and  admirers.   During  this  period,  Galen engaged  in  public  anatomical  lectures,  demonstrations,  and  disputes, and composed some of his major anatomical and physiological texts. Five years later,  Galen  returned  to Pergamum,  claiming that  the hostility  of other  physicians  had  driven  him from  Rome.  His critics noted  that  his abrupt  departure coincided  with the  outbreak of an  epidemic that  had entered  the  city along  with  soldiers  returning  from  the  Parthian War. Not long afterwards,  honoring  a request from Emperor  Marcus Aurelius, Galen returned  to Rome and settled there permanently. Although  strictly speaking, Galen was not a ‘‘court physician,’’ he did enjoy the friendship

and protection of the emperors  Marcus  Aurelius,  Commodus, Septimius

Severus, and other  prominent figures.

Late in life, troubled  by evidence that  careless copyists, shameless impostors,   and  plagiarists  were  corrupting his  writings,  Galen  com- posed a guide for the cautious  reader called On His Own Books, which described the genuine works of Galen, as well as a reading program  for physicians. Works for beginners were necessary, Galen complained, because  many  students  lacked  a  good,  classical  education  and  most

‘‘physicians’’ were pretenders  who could barely read.  Galen’s medical, philosophical, and  philological  writings  discussed almost  every aspect of medical theory  and  practice  of Greek  and  Roman  times, as well as his own studies of anatomy,  physiology, dietetics, and therapeutics. Unfortunately, a fire in the  Temple  of Peace  in 191 destroyed  many of his manuscripts. Nevertheless,  his surviving works fill about  twenty volumes in Greek.  Some of his works survived in Arabic and medieval Latin  editions.

Galen  taught   that   the  best  physician  was  also  a  philosopher.

Therefore,  the true physician must master  the three branches  of philo- sophy: logic, the science of how to think; physics, the science of nature; and ethics, the science of what to do. With such knowledge,  the physi- cian could gain his patient’s obedience and the admiration due to a god. Ideally, the physician would practice medicine for the love of mankind, not for profit,  because the pursuit  of science and money were mutually exclusive. In his writings, Galen portrayed himself as a scholar who re- alized that  it was impossible to discover all that  he passionately  wished to know despite his persistent  search for truth.

The  essential  features  of Galen’s  system are  a view of nature  as purposeful  and  craftsman-like  and the principle  of balance  among  the four  qualities  and  the  four  humors.  For  Galen,  anatomical research was the source of a ‘‘perfect theology’’ when approached as the study of form and function  in terms of the ‘‘usefulness’’ of the parts.  Instead of sacrificing bulls and  incense, the anatomist demonstrated reverence for  the  Creator   by  discovering   his  wisdom,   power,   and   goodness through   anatomical  investigations.   The   dissection   of   any   animal revealed  a  little  universe  fashioned  by  the  wisdom  and  skill  of  the Creator.   Assuming  that   nature   acts  with  perfect  wisdom  and  does nothing  in vain, Galen  argued  that  every structure  was crafted  for its proper  function.

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