by
Galen

Translated by Arthur John Brock

Preface

The text used is (with a few unimportant modifications) that of Kühn (Vol. II), as edited by Georg Helmreich; Teubner, Leipzig, 1893. The numbers of the pages of Kühn’s edition are printed at the side of the Greek text, a parallel mark (||) in the line indicating the exact point of division between Kühn’s pages.

Words in the English text which are enclosed in square brackets are supplementary or explanatory; practically all explanations, however, are relegated to the footnotes or introduction. In the footnotes, also, attention is drawn to words which are of particular philological interest from the point of view of modern medicine.

I have made the translation directly from the Greek; where passages of special difficulty occurred, I have been able to compare my own version with Linacre’s Latin translation (1523) and the French rendering of Charles Daremberg (1854-56); in this respect I am also peculiarly fortunate in having had the help of Mr. A. W. Pickard Cambridge of Balliol College, Oxford, who most kindly went through the proofs and made many valuable suggestions from the point of view of exact scholarship.

My best thanks are due to the Editors for their courtesy and for the kindly interest they have taken in the work. I have also gratefully to acknowledge the receipt of much assistance and encouragement from Sir William Osler, Regius Professor of Medicine at Oxford, and from Dr. J. D. Comrie, first lecturer on the History of Medicine at Edinburgh University. Professor D’Arcy W. Thompson of University College, Dundee, and Sir W. T. Thiselton-Dyer, late director of the Royal Botanic Gardens at Kew, have very kindly helped me to identify several animals and plants mentioned by Galen.

I cannot conclude without expressing a word of gratitude to my former biological teachers, Professors Patrick Geddes and J. Arthur Thomson. The experience reared on the foundation of their teaching has gone far to help me in interpreting the great medical biologist of Greece.

I should be glad to think that the present work might help, however little, to hasten the coming reunion between the “humanities” and modern biological science; their present separation I believe to be against the best interest of both.

A. J. B.

22nd Stationary Hospital, Aldershot.
March, 1916.

Introduction

If the work of Hippocrates be taken as representing the foundation upon which the edifice of historical Greek medicine was reared, then the work of Galen, who lived some six hundred years later, may be looked upon as the summit or apex of the same edifice. Galen’s merit is to have crystallised or brought to a focus all the best work of the Greek medical schools which had preceded his own time. It is essentially in the form of Galenism that Greek medicine was transmitted to after ages.

The ancient Greeks referred the origins of medicine to a god Asklepios (called in Latin Aesculapius), thereby testifying to their appreciation of the truly divine function of the healing art. The emblem of Aesculapius, familiar in medical symbolism at the present day, was a staff with a serpent coiled round it, the animal typifying wisdom in general, and more particularly the wisdom of the medicine-man, with his semi-miraculous powers over life and death.

“Be ye therefore wise as serpents and harmless as doves.”

The temples of Aesculapius were scattered over the ancient Hellenic world. To them the sick and ailing resorted in crowds. The treatment, which was in the hands of an hereditary priesthood, combined the best of the methods carried on at our present-day health-resorts, our hydropathics, sanatoriums, and nursing-homes. Fresh air, water-cures, massage, gymnastics, psychotherapy, and natural methods in general were chiefly relied on.

Hippocrates, the “Father of Medicine” (5th to 4th centuries, B.C.) was associated with the Asclepieum of Cos, an island off the south-west coast of Asia Minor, near Rhodes. He apparently revitalized the work of the health-temples, which had before his time been showing a certain decline in vigour, coupled with a corresponding excessive tendency towards sophistry and priestcraft.

Celsus says: “Hippocrates Cous primus quidem ex omnibus memoria dignis ab studio sapientiae disciplinam hanc separavit.” He means that Hippocrates first gave the physician an independent standing, separating him from the cosmological speculator. Hippocrates confined the medical man to medicine. He did with medical thought what Socrates did with thought in general — he “brought it down from heaven to earth.” His watchword was “Back to Nature!”

At the same time, while assigning the physician his post, Hippocrates would not let him regard that post as sacrosanct. He set his face against any tendency to mystery-mongering, to exclusiveness, to sacerdotalism. He was, in fact, opposed to the spirit of trade-unionism in medicine. His concern was rather with the physician’s duties than his “rights.”

At the dawn of recorded medical history Hippocrates stands for the fundamental and primary importance of seeing clearly — that is of clinical observation. And what he observed was that the human organism, when exposed to certain abnormal conditions — certain stresses — tends to behave in a certain way: that in other words, each “disease” tends to run a certain definite course. To him a disease was essentially a process, one and indivisible, and thus his practical problem was essentially one of prognosis — “what will be the natural course of this disease, if left to itself?” Here he found himself to no small extent in opposition with the teaching of the neighbouring medical school of Cnidus, where a more static view-point laid special emphasis upon the minutiae of diagnosis.

Observation taught Hippocrates to place unbounded faith in the recuperative powers of the living organism — in what we sometimes call nowadays the vis medicatrix Naturae. His observation was that even with a very considerable “abnormality” of environmental stress the organism, in the large majority of cases, manages eventually by its own inherent powers to adjust itself to the new conditions. “Merely give Nature a chance,” said the father of medicine in effect, “and most diseases will cure themselves.” And accordingly his treatment was mainly directed towards “giving Nature a chance.”

His keen sense of the solidarity (or rather, of the constant interplay) between the organism and its environment (the “conditions” to which it is exposed) is instanced in his book, “Airs, Waters, and Places.” As we recognise, in our popular everyday psychology, that “it takes two to make a quarrel,” so Hippocrates recognised that in pathology, it takes two (organism and environment) to make a disease.

As an outstanding example of his power of clinical observation we may recall the facies Hippocratica, an accurate study of the countenance of a dying man.

His ideals for the profession are embodied in the “Hippocratic oath.”

Impressed by this view of the organism as a unity, the Hippocratic school tended in some degree to overlook the importance of its constituent parts. The balance was re-adjusted later on by the labours of the anatomical school of Alexandria, which, under the aegis of the enlightened Ptolemies, arose in the 3rd century B.C. Two prominent exponents of anatomy belonging to this school were Herophilus and Erasistratus, the latter of whom we shall frequently meet with in the following pages (v. block 1.84 et seq. ).

After the death of the Master, the Hippocratic school tended, as so often happens with the best of cultural movements, to show signs itself of diminishing vitality: the letter began to obscure and hamper the spirit. The comparatively small element of theory which existed in the Hippocratic physiology was made the groundwork of a somewhat over-elaborated “system.” Against this tendency on the part of the “Dogmatic” or “Rationalist” school there arose, also at Alexandria, the sect of the Empiricists. “It is not,” they said, “the cause but the cure of diseases that concerns us; not how we digest, but what is digestible.”

Horace said “Graecia capta ferum victorem cepit.” Political domination, the occupation of territory by armies, does not necessarily mean real conquest. Horace’s statement applied to medicine as to other branches of culture.

The introducer of Greek medicine into Rome was Asclepiades (1st century B.C.). A man of forceful personality, and equipped with a fully developed philosophic system of health and disease which commended itself to the Roman savants of the day, he soon attained to the pinnacle of professional success in the Latin capital: he is indeed to all time the type of the fashionable (and somewhat “faddy”) West-end physician. His system was a purely mechanistic one, being based upon the atomic doctrine of Leucippus and Democritus, which had been completed by Epicurus and recently introduced to the Roman public in Lucretius’s great poem “De Rerum Natura.”The disbelief of Asclepiades in the self-maintaining powers of the living organism are exposed and refuted at considerable length by Galen in the volume before us.

Out of the teaching of Asclepiades that physiological processes depend upon the particular way in which the ultimate indivisible molecules come together (ἐν τῇ ποίᾳ συνόδῳ τῶν πρώτων ἐκείνων σωμάτων τῶν άπαθῶν) there was developed by his pupil, Themison of Laodicea, a system of medicine characterised by the most engaging simplicity both of diagnosis and treatment. This so-called “Methodic” system was intended to strike a balance between the excessive leaning to apriorism shown by the Rationalist (Hippocratic) school and the opposite tendency of the Empiricists. “A pathological theory we must have,” said the Methodists in effect, “but let it be simple.” They held that the molecular groups constituting the tissues were traversed by minute channels (πόροι, “pores”); all diseases belonged to one or other of two classes; if the channels were constricted the disease was one of stasis (στέγνωσις), and if they were dilated the disease was one of flux (ῥύσις). Flux and stasis were indicated respectively by increase and diminution of the natural secretions; treatment was of opposites by opposites — of stasis by methods causing dilatation of the channels, and conversely.

Wild as it may seem, this pathological theory of the Methodists contained an element of truth; in various guises it has cropped up once and again at different epochs of medical history; even to-day there are pathologists who tend to describe certain classes of disease in terms of vaso-constriction and vaso-dilatation. The vice of the Methodist teaching was that it looked on a disease too much as something fixed and finite, an independent entity, to be considered entirely apart from its particular setting. The Methodists illustrate for us the tyranny of names. In its defects as in its virtues this school has analogues at the present day; we are all acquainted with the medical man to whom a name (such, let us say, as “tuberculosis,” “gout,” or “intestinal auto-intoxication”) stands for an entity, one and indivisible, to be treated by a definite and unvarying formula.

To such an individual the old German saying “Jedermann hat am Ende ein Bischen Tuberkulose” is simply — incomprehensible.

All the medical schools which I have mentioned were still holding their ground in the 2nd century A.D., with more or less popular acceptance, when the great Galen made his entry into the world of Graeco-Roman medicine.

Claudius Galenus was born at Pergamos in Asia Minor in the year 131 A.D. His father was one Nicon, a well-to-do architect of that city. “I had the great good fortune,” says Galen, “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 quarrelling with him — worse than Xanthippe with Socrates. When, therefore, I compared the excellence of my father’s disposition with the disgraceful passions of my mother, I resolved to embrace and love the former qualities, and to avoid and hate the latter.”

Nicon called his son Γαληνός, which means quiet, peaceable, and although the physician eventually turned out to be a man of elevated character, it is possible that his somewhat excessive leaning towards controversy (exemplified in the following pages) may have resulted from the fact that he was never quite able to throw off the worst side of the maternal inheritance.

His father, a man well schooled in mathematics and philosophy, saw to it that his son should not lack a liberal education. Pergamos itself was an ancient centre of civilisation, containing, among other culture-institutions, a library only second in importance to that of Alexandria itself; it also contained an Asclepieum.

Galen’s training was essentially eclectic: he studied all the chief philosophical systems of the time — Platonic, Aristotelian, Stoic, and Epicurean — and then, at the age of seventeen, entered on a course of medical studies; these he pursued under the best teachers at his own city, and afterwards, during a period of Wanderjahre, at Smyrna, Alexandria, and other leading medical centres.

Returning to Pergamos, he received his first professional appointment — that of surgeon to the gladiators. After four years here he was drawn by ambition to Rome, being at that time about thirty-one years of age. At Rome the young Pergamene attained a brilliant reputation both as a practitioner and as a public demonstrator of anatomy; among his patients he finally numbered even the Emperor Marcus Aurelius himself.

Medical practice in Rome 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. This he did hurriedly and secretly in the year 168 A.D., when thirty-six years of age. He betook himself to his old home at Pergamos, where he settled down once more to a literary life.

His respite was short, however, for within a year he was summoned back to Italy by imperial mandate. Marcus Aurelius was about to undertake an expedition against the Germans, who at that time were threatening the northern frontiers of the Empire, and he was anxious that his consulting physician should accompany him to the front. “Patriotism” in this sense, however, seems to have had no charms for the Pergamene, and he pleaded vigorously to be excused. Eventually, the Emperor gave him permission to remain at home, entrusting to his care the young prince Commodus.

Thereafter we know little of Galen’s history, beyond the fact that he now entered upon a period of great literary activity. Probably he died about the end of the century. [Subsequent History of Galen’s Works.]

Galen wrote extensively, not only on anatomy, physiology, and medicine in general, but also on logic; his logical proclivities, as will be shown later, are well exemplified in his medical writings. A considerable number of undoubtedly genuine works of his have come down to us. The full importance of his contributions to medicine does not appear to have been recognized till some time after his death, but eventually, as already pointed out, the terms Galenism and Greek medicine became practically synonymous.

A few words may be devoted to the subsequent history of his writings.

During and after the final break-up of the Roman Empire came times or confusion and of social reconstruction, which left little opportunity for scientific thought and research. The Byzantine Empire, from the 4th century onwards, was the scene of much internal turmoil, in which the militant activities of the now State-established Christian church played a not inconsiderable part. The Byzantine medical scholars were at best compilers, and a typical compiler was Oribasius, body-physician to the Emperor Julian (4th century, A.D.); his excellent Synopsis was written in order to make the huge mass of the Galenic writings available for the ordinary practitioner.

Greek medicine spread, with general Greek culture, throughout Syria, and from thence was carried by the Nestorians, a persecuted heretical sect, into Persia; here it became implanted, and hence eventually spread to the Mohammedan world. Several of the Prophet’s successors (such as the Caliphs Harun-al-Rashid and Abdul-Rahman III) were great patrons of Greek learning, and especially of medicine. The Arabian scholars imbibed Aristotle and Galen with avidity. A partial assimilation, however, was the farthest stage to which they could attain; with the exception of pharmacology, the Arabians made practically no independent additions to medicine. They were essentially systematizers and commentators. “Averrois che il gran comento feo” may stand as the type par excellence of the Moslem sage.

Avicenna (Ebn Sina), (10th to 11th century) is the foremost name in Arabian medicine: his “Book of the Canon in Medicine,” when translated into Latin, even overshadowed the authority of Galen himself for some four centuries. Of this work the medical historian Max Neuburger says: “Avicenna, according to his lights, imparted to contemporary medical science the appearance of almost mathematical accuracy, whilst the art of therapeutics, although empiricism did not wholly lack recognition, was deduced as a logical sequence from theoretical (Galenic and Aristotelian) premises.”

Having arrived at such a condition in the hands of the Mohammedans, Galenism was now destined to pass once more to the West. From the 11th century onwards Latin translations of this “Arabian” Medicine (being Greek medicine in oriental trappings) began to make their way into Europe; here they helped to undermine the authority of the one medical school of native growth which the West produced during the Middle Ages — namely the School of Salerno.

Blending with the Scholastic philosophy at the universities of Naples and Montpellier, the teachings of Aristotle and Galen now assumed a position of supreme authority: from their word, in matters scientific and medical, there was no appeal. In reference to this period the Pergamene was referred to in later times as the “Medical Pope of the Middle Ages.”

It was of course the logical side of Galenism which chiefly commended it to the mediaeval Schoolmen, as to the essentially speculative Moslems.

The year 1453, when Constantinople fell into the hands of the Turks, is often taken as marking the commencement of the Renascence. Among the many factors which tended to stimulate and awaken men’s minds during these spacious times was the rediscovery of the Greek classics, which were brought to Europe by, among others, the scholars who fled from Byzantium. The Arabo-Scholastic versions of Aristotle and Galen were now confronted by their Greek originals. A passion for Greek learning was aroused. The freshness and truth of these old writings helped to awaken men to a renewed sense of their own dignity and worth, and to brace them in their own struggle for self-expression.

Prominent in this “Humanist” movement was the English physician, Thomas Linacre (c. 1460-1524) who, having gained in Italy an extraordinary zeal for the New Learning, devoted the rest of his life, after returning to England, to the promotion of the litterae humaniores, and especially to making Galen accessible to readers of Latin. Thus the “De Naturalibus Facultatibus” appeared in London in 1523, and was preceded and followed by several other translations, all marked by minute accuracy and elegant Latinity.

Two new parties now arose in the medical world — the so-called “Greeks” and the more conservative “Arabists.”

But the swing of the pendulum did not cease with the creation of the liberal “Greek” party; the dazzling vision of freedom was to drive some to a yet more anarchical position. Paracelsus, who flourished in the first half of the 16th century, may be taken as typifying this extremist tendency. His one cry was, “Let us away with all authority whatsoever, and get back to Nature!” At his first lecture as professor at the medical school of Basle he symbolically burned the works of Galen and of his chief Arabian exponent, Avicenna.

But the final collapse of authority in medicine could not be brought about by mere negativism. It was the constructive work of the Renascence anatomists, particularly those of the Italian school, which finally brought Galenism to the ground.

Vesalius (1514-64), the modern “Father of Anatomy,” for dissecting human bodies, was fiercely assailed by the hosts of orthodoxy, including that stout Galenist, his old teacher Jacques Dubois (Jacobus Sylvius). Vesalius held on his way, however, proving, inter alia, that Galen had been wrong in saying that the interventricular septum of the heart was permeable (cf. present volume, block 3.88).

Michael Servetus (1509-53) suggested that the blood, in order to get from the right to the left side of the heart, might have to pass through the lungs. For his heterodox opinions he was burned at the stake.

Another 16th-century anatomist, Andrea Cesalpino, is considered by the Italians to have been a discoverer of the circulation of the blood before Harvey; he certainly had a more or less clear idea of the circulation, but, as in the case of the “organic evolutionists before Darwin,” he failed to prove his point by conclusive demonstration.