Galen of Pergamon (c. 129 - 216 AD) is well known in the history of medicine. His extensive writings and theories prevail for over 2000 years. Purveyor of Hippocrates' Four Humors theory, Galen rouses the ire of many, most famously Paracelsus and Robert Fludd.
Galen is a prominent Greek physician, surgeon, and philosopher whose influence on the development of medicine lasts for many centuries. Born in the city of Pergamon in what is now Turkey, Galen receives an extensive education, first in philosophy and then in medicine.
He studies at the medical school of Pergamon and later in Alexandria, famous for its scholarship and a pioneering center for the study of anatomy. Previously, Hippocrates also studies at the medical school(s) of Alexandria.
Galen becomes physician to several gladiators. He observes injuries and treatments closely. His work as a physician complements his philosophical background, He develops a unique approach combining rational thought and empirical observation.
By the time of his death, Galen has authored over 100 texts on various medical subjects, many of which would form the basis of medical practice for centuries to come. His Four Humors theory prevails until the 19th century, when scientists discover germs.
Galen spends considerable time dissecting animals, first monkeys. He finds their faces too human-like thus dissects pigs instead. He develops an excellent understanding of the anatomy of pigs, and could have been a butcher and just stopped there. But no.
Throughout his career, Galen produces over 350 manuscripts on subjects including anatomy, physiology, pharmacology and therapeutics. His ideas have a profound impact during the Middle Ages and Renaissance, influencing both Islamic and European medicine.
Due to the humors theory, during the Renaissance especially people turn to purging to find medical relief from diseases unknown. Purging is done with laxatives, diuretics, emetics, sudoforics, cough and sneeze induction and the classic favorite, bleeding with leeches.
Galen is influenced by earlier medical theorists, particularly Hippocrates, whose emphasis on clinical observation and the Hippocratic Corpus find their way into many of Galen's ideas. He integrates concepts from Plato and Aristotle, the latter purveying the Four Elements theory.
Aristotle's work significantly affects Galen. Aristotle's writings on biology and natural philosophy gives Galen insight into his dissections. For example, Galen famously adapts Aristotle's descriptions concerning the heart, particularly its role in circulation and body heat.
Aristotle posits the heart has three ventricles and that the brain is only to cool the blood. He considers the stomach as the seat of emotions, and believes the mind is in the heart. He deduces this based on his concept of empirical observation.
During Galen's time, medical practice is based on a mixture of said empirical observation and philosophical tenets, but not as it's understood today. Medicine is largely influenced by ancient superstitions, spiritual explanations for disease, and the omnipresent humoral theory.
In the Four Humors Theory the body consists of four fluids: blood, phlegm, black bile, and yellow bile. An imbalance of these humors is thought to be the root cause of all illnesses, and treatments are often aimed at restoring humoral balance.
The Four Humors Theory, attributed to Hippocratic medicine, is somewhat refined by Galen. He expands on the idea by suggesting that the humors or bodily fluids are not just physical substances, but reflect a fundamental interaction between body and environment.
Each humor is associated with characteristics, seasons and elements. For Galen, the humors are important in pathology and the diagnosis and treatment of diseases. He observes symptoms to deduce the condition of the humors, and concocts treatments accordingly.
Blood: Linked with a sanguine temperament, it suggests vitality and warmth. Imbalance of blood is usually treated by bloodletting. It's the most common medical practice performed by surgeons from until the late 19th century.
Phlegm: Associated with a phlegmatic temperament, it represents calmness and apathy. Hippocratic books mentioned the following treatment:
"Chest diseases: Take barley soup plus vinegar and honey to bring up phlegm."
Black bile: Related to a melancholic temperament, it indicates sadness and introspection. Purgatives are given to expel too much black bile, which has the tendency to accumulate in certain regions of the body.
Yellow bile: Connected to a choleric temperament, it represents ambition and hostility. According to Hippocrates, yellow bile is found in the spleen and is associated with hot and dry temperatures. Yellow bile is a real part of the body, produced to aid in the breakdown of fats in meat. It's most often associated with the summer months.
Galen's treatments include dietary adjustments, herbal remedies and bloodletting.
Anatomical Discoveries
Galen’s anatomical knowledge is primarily based on animal dissection and through this he interprets human anatomy. This is odd considering he studies at Alexandria, a place known as the first to allow human dissections.
The volunteers are convicted criminals. However this predates Galen by about three hundred years. He would definitely be exposed to the burgeoning practice of alchemy, but shows no inclination in this direction except in herbal preparations.
At the time alchemy is a practice of alloying and coloring metals, imitating gems, dyeing textiles and making pigments. Alchemists are expected to know how to gild, patinate and the art of metal plating as well.
Alchemy also has roots in ancient medicine and herbalism, which often relate to dyes and pigments and are used for health. The ancient Romans famously employ alchemists for such creations as poison antidotes.
Metals like platinum, lithium, zinc, silver, copper, and bismuth are used to remedy heartburn, arthritis, mineral deficiency, cancers, tumors, viral infections and depression. Gold-based medications remain the only pharmaceuticals capable of treating rheumatoid arthritis.
Galen makes substantial contributions to misunderstanding the physiology of numerous systems in the body. His description of the circulatory system and his misconceptions about it persist for centuries despite Renaissance advances in medicine.
Pathology
Galen introduces important concepts regarding the nature of disease and its development. His emphasis on the observation of patients, the identification of symptoms, and his concepts of the relationship between symptoms and underlying pathology.
Therapeutics
He explores the effects of numerous plants and minerals on health. His extensive writings on medicinal plants and properties are among the earliest systematic views in pharmacological literature. Aristotle and Dioscorides (c. 40-90 AD) are influential in this area too.
Ethics and Philosophy in Medicine
Galen emphasizes the importance of the physician’s role in society, both ethically and philosophically. He asserts a doctor must be knowledgeable not just in medicine but also in philosophy, ethics, and the arts to offer comprehensive care.
By the 13th century astrology has become a part of everyday medical practice in Europe. Doctors combined Galenic medicine with studies of the stars. For several centuries astrology is an esteemed part of medical knowledge, though this is only indirectly Galen's fault.
Trepanning, a practice of drilling holes in one's skull to let out demons, disease, or bad humors, is in use from the Neolithic through to the 1800s. A surprising number of people actually survive this treatment.
Legacy
Galen’s works, especially "On the Anatomical Procedures," remain central to medical education in Europe and the Islamic world for over a millennium. Paracelsus famously rants against his beliefs and publicly burns his books, and Robert Fludd fails the London medical exam six times for refusing to buy into the Four Humors theory.
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