Galen

• 1. Introduction

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  Galen, born in September of the year 129, would shape how Western medicine understood the human body for more than 1,300 years. He was a physician, a surgeon, and a philosopher, the son of a wealthy Greek architect named Aelius Nicon. The emperor Marcus Aurelius once called him first among doctors and unique among philosophers. Yet for all his authority, Galen never dissected a human being. Roman law forbade it. So how did a man who studied apes and pigs come to dominate medical thinking for over a millennium? Why did his account of the heart and blood go unchallenged until 1543? And what did it take, finally, to prove him wrong? This is the story of a man whose words outlived almost every other writer of antiquity, and whose errors traveled just as far as his insights.

• 2. Pergamon And A Father's Dream

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  Aelius Nicon was a patrician of broad appetites, a builder whose interests ranged across philosophy, mathematics, logic, astronomy, agriculture, and literature. His son remembered him as a highly amiable, just, good and benevolent man. The family lived in Pergamon, in what is now Bergama, Turkey, a city famous for a library second only to the one in Alexandria.

  At the age of 14, the young scholar was exposed to Stoic and Platonic philosophers who passed through the city. His studies took in the Aristotelian and Epicurean systems as well. Nicon had mapped out a traditional path for his son in philosophy or politics, and steered him toward literary and philosophical influences.

  In around 145, everything changed because of a dream. Nicon dreamed that the god Asclepius appeared and commanded him to send his son to study medicine. Pergamon held a large temple to that very healing god, and the city drew the sick from across the region in search of relief.

• 3. The Gladiators' Surgeon

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  At age 16, the future physician entered the local healing temple, the asclepeion, serving four years as a therapeutes, or attendant. There he studied under Aeschrion of Pergamon, Stratonicus, and Satyrus. His father died in 148, leaving him independently wealthy at the age of 19.

  Following advice he found in the teaching of Hippocrates, he traveled and studied widely. His destinations included Smyrna, now İzmir, along with Corinth, Crete, Cilicia, Cyprus, and finally the great medical school of Alexandria. In 157, aged 28, he returned to Pergamon as physician to the gladiators of the High Priest of Asia.

  He claimed the High Priest chose him after a grim audition. He eviscerated an ape, then challenged rival physicians to repair the damage, and when they refused, he did the surgery himself. Over four years tending the gladiators, he treated fractures and severe trauma, calling their wounds windows into the body. Only five gladiators died while he held the post, compared with sixty under his predecessor.

• 4. Rivals And Poison In Rome

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  Galen arrived in Rome in 162 and quickly made enemies. His public demonstrations and his impatience with rival views set him against other doctors in the city. When the Peripatetic philosopher Eudemus fell ill with quartan fever, Galen treated him, writing that he felt obliged since the man was his teacher and lived nearby.

  Galen leaned on prognosis to treat Eudemus, a practice that clashed with a standard of care built on divination and mysticism. His method was simple, as quoted by Garcia-Ballester: in order to diagnose, one must observe and reason. Roman physicians criticized him, and he hit back by defending his approach against doctors who proceeded, in his words, alogos and askeptos.

  Eudemus also delivered a warning. He told Galen that rivals unable to harm him by unscrupulous conduct might turn to poison. He recalled a young man who had come to the city years earlier, given practical demonstrations of the art, and been put to death by poison along with two servants. Fearing exile or poisoning, Galen left the city.

• 5. The Antonine Plague

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  In the autumn of 169, as Roman troops returned to Aquileia, a great pestilence broke out, most likely one of the first appearances of smallpox in the Mediterranean world. It was named the Antonine Plague after Marcus Aurelius' family name of Antoninus, and also became known as the Plague of Galen. He was present in Rome when it first struck in 166, and again in the winter of 168 to 169 during an outbreak among the troops.

  His attention fell on treatment rather than on cataloguing the disease for posterity. Writing about a young man afflicted with the plague, he focused on internal and external ulcerations. He noted that the rash covered the entire body and was usually black, and that those who survived developed a black exanthem. He recorded symptoms of fever, vomiting, fetid breath, cough, and ulceration of the larynx and trachea, and observed that if a patient's stool was very black, the patient died.

  The death toll was staggering. The mortality rate ran between 7 and 10 percent, and the outbreak of 165 to 168 would have caused roughly 3.5 to 5 million deaths. Otto Seeck believed over half the population of the empire perished. Both Lucius Verus, who died in 169, and Marcus Aurelius, who died in 180, were victims of the plague.

• 6. The Heart, The Blood, And The Soul

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  Galen was the first to recognize that venous blood, which is dark, differs from arterial blood, which is bright. From there he built a model of the body as two separate one-way systems rather than a single loop. He believed blood originated in the liver, which converted food into blood, and that small holes in the septum between the heart's two ventricles let blood pass across to receive air from the lungs. Those holes do not exist.

  His famous public experiment was the squealing pig. He would cut open a living pig and, while it squealed, tie off the recurrent laryngeal nerve, showing that those vocal cords controlled sound. By the same method of tying off the ureters, he demonstrated his theories of kidney and bladder function. He was the first to show that the larynx generates the voice, and in his work De motu musculorum he distinguished motor from sensory nerves.

  Galen also located the soul inside the body. Drawing on Plato, he described a tripartite soul, rational, spiritual, and appetitive, and assigned each a place: the rational soul in the brain, the spiritual in the heart, the appetitive in the liver. This idea is now called localization of function. He opposed the Stoics, who placed a single rational soul in the heart, arguing that medicine proved them wrong.

• 7. Ten Million Words

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  Galen may have produced more work than any author in antiquity, rivaling the output of Augustine of Hippo. His surviving texts represent nearly half of all the extant literature from ancient Greece. By one report he employed twenty scribes to take down his words, and he may have written as many as 500 treatises totaling some 10 million words. Even his surviving works run to roughly 3 million words, thought to be less than a third of the whole.

  Much was lost. In 191, or more likely 192, a fire in the Temple of Peace destroyed many of his works, especially treatises on philosophy. Forgeries plagued him even in his lifetime, prompting him to write On His Own Books. The most complete compendium came much later, compiled and translated by Karl Gottlob Kühn of Leipzig between 1821 and 1833, running to 122 treatises across 22 volumes and over 20,000 pages.

  The survival of his words owed much to translation. After 750, Syrian Christians made the first translations into Syriac and Arabic. Hunayn ibn Ishaq translated 129 works of Jalinos into Arabic. Some of Galen's texts now exist only in Arabic, while others survive only in medieval Latin translations of the Arabic.

• 8. The Long Reign And Its End

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  Marcus Aurelius' praise set the tone for centuries: first among doctors and unique among philosophers. The 7th-century poet George of Pisida went further, referring to Christ as a second and neglected Galen. In the Middle Ages, Galen was even called the Medical Pope. So strong was his authority that Mondino de Liuzzi, describing rudimentary blood circulation, still insisted the left ventricle should contain air.

  The physiology of his circulatory system stood until around 1242, when Ibn al-Nafis published his commentary on anatomy in Avicenna's Canon, reporting his discovery of pulmonary circulation. His anatomical reports held until 1543, when Andreas Vesalius published De humani corporis fabrica, built on dissections of human cadavers. Vesalius showed that Galen had described details present in monkeys but not in humans, despite fierce opposition from pro-Galenists such as Jacobus Sylvius.

  Galen's death remains contested. The Suda lexicon put it at age 70, around the year 199, but Arabic sources say he died in Sicily at age 87, after 17 years studying medicine and 70 practicing it, placing his death around 216. According to those sources, his tomb in Palermo was still well preserved in the tenth century. In 2018, the University of Basel found that a Greek papyrus with mirror writing, once held by the jurist Basilius Amerbach, may be an unknown medical document of Galen, describing a phenomenon called hysterical apnea.