Medicine In Stamps Singapore Med J 2002 Vol 43(3) : 116-117

Medicine in Stamps Galen (130-201 A.D.): History’s Most Enduring Medic S Y Tan, MD, JD Professor of Medicine Adjunct Professor of Law, University of Hawaii

t the turn of the first millennium, GALEN WAS RIGHT Hippocratic medicine dominated western In medicine’s embryonic days, Galen was the first to Acivilisation. Despite a poor understanding insist on scientific experimentation as the evidentiary of anatomy and pathophysiology, the physicians basis for medical conclusions. He was an astute of that age generally accepted that natural rather clinician, and adhered to Hippocrates’ exhortation to than supernatural causes were responsible for carefully observe the signs and symptoms of disease. human maladies. But one man, virtually single- However, he built upon simple observations with handedly, brought the face of science to the actual experiments, and brought the understanding healing art. Expanding upon clinical observation of the human condition to new heights. If medicine with brilliant experimentation, he influenced the was art for Hippocrates, it was science for Galen. course of medicine over the next 1,500 years. That Galen recognised the critical importance of man was Claudius Galen. anatomy, and performed thousands of animal Born in Pergamum, a Greco-Roman town in dissections, his favourite being the macaque monkey. Asia Minor (now part of the city of Bergama, Turkey) He also dissected pigs and dogs, and on one occasion, in the year 130 A.D., Galen was a second an elephant. Human dissection was century Greek philosopher-physician forbidden in his days; as a result, he who switched to the medical profession drew many erroneous conclusions when after his father dreamt of this calling extrapolating the animal findings to man. for his son. Galen’s training and His understanding of human anatomy experiences brought him to Alexandria was limited; the little he knew came from and Rome, and he rose quickly to studying the wounds of the gladiators fame with public demonstrations of he treated, and from observations of anatomical and surgical skills. He old human skeletons at Alexandria. became physician to the Roman Notwithstanding this serious shortcoming, emperor Marcus Aurelius and his Galen was the first to correctly show that: ambitious son Commodus (both featured in the • Arteries were filled with blood rather than the recent movie, Gladiator). His most famous diagnosis vague life providing substance inhaled into the was that of “overindulgence” in the emperor himself, body called pneuma; and he is also said to have collected a fee of four • Chest expansion from diaphragmatic and thoracic hundred gold pieces, fifteen times the going rate, muscle action preceded ventilation rather than the for making a house-call on the wife of the Roman reverse; consul Flavius Boethius. • Urine was formed by the kidneys, not the bladder; It was Galen’s good fortune that parchment and • The spinal cord and spinal nerves controlled bookmaking were invented during his time. He wrote specific neuromuscular functions; prodigiously and was able to preserve his medical • Voice control originated in the recurrent laryngeal research in some twenty-two volumes of printed text, nerve, not in the heart; representing half of all Greek medical literature that • The heart was the origin of blood vessels, and the is available to us today. brain the source of nerves, not the converse; Singapore Med J 2002 Vol 43(3) : 117

• Sensory nerves were distinguishable from motor base, vital pneuma is converted to spiritual nerves; pneuma, which the brain then distributes via • Complex herbal therapy (galenicals) was effective hollow nerves. Ingested food passes into the liver, in a number of medical conditions. where it is converted into blood and vegetative pneuma. Through the veins, the blood is sent to Three men dominated medicine at the dawn nourish the rest of the body, passing ultimately of the first millennium. There was Dioscorides from the right side of the heart, via pores, into the the herbalist; Pliny the natural historian; and left ventricle. Galen the experimenter. However, it was Galen’s For the next 1,500 years, physicians adhered towering discoveries, preserved in his most to these erroneous teachings of Galen. Medical renowned anatomical work, De Usu Partium (The science had to wait until the 16th century before Uses of the Parts of the Body), that captured the these mistaken notions were corrected, first by historical spotlight. They even eclipsed the findings the elegant human anatomical studies of Vesalius, of yet another great man of his time – Aretaeus – followed by Harvey’s demonstration of the circulation who described the diabetic symptoms of polydipsia of blood. and polyuria, and correctly predicted contralateral paralysis following cerebral haemorrhage. THE PARADOX OF GALEN Galen’s name, derived from the word “galenos,” GALEN WAS WRONG means calm and serene, qualities that suitably Despite his brilliance, Galen committed cardinal described his father, but not Galen himself. He was errors. His dogmatically held views, coloured by anything but calm and serene, history depicting religious absolutism, led to false conclusions. him as fiery and excitable, very much like his mother He subscribed to teleology (the use of design or who is said to be quarrelsome and easy to arouse. purpose as an explanation of natural phenomena) Galen was also an arrogant man, evident in these that ended with unwarranted speculations. utterances: “Never as yet have I gone astray, whether Galen’s fervent belief in the four humours (blood, in treatment or in prognosis, as have so many other yellow bile, black bile, and phlegm) was a direct physicians of great reputation. . . . Whoever seeks inheritance from Hippocrates, so his prescriptions fame by deed, not alone by learned speech, need were misdirected at attempting to balance these only become familiar, at small cost of trouble, with humours. Like his predecessors, he wrongly believed all that I have achieved by active research during that the formation of pus was a necessary part of the course of my entire life.” wound healing. He embraced the concept of The proud and jealous Galen hurled insults “pneuma”, subscribed to the notion of innate heat on disagreeing colleagues, and bragged about of the heart, and insisted that there was a direct his intellect and accomplishments. Cocksure and communication between the two ventricles, each odious, he was quick to take offence and apparently with its own separate circulation. had no friends. He touted the truth based on an Anatomical findings from animal dissections also absolute trust in the perfection of a deity-given led him astray. The best example is the identification world, and allowed teleological notions to affect of a set of coiled blood vessels at the base of the his scientific judgment. Our genius of medicine brain of animals called the rete mirabile. Not would have done better to heed his father’s advice knowing that such vessels did not exist in humans, that “as desirable as are all the sciences, more he incorrectly proposed that they slowed the flow desirable still are the virtues of wisdom, justice, of vital pneuma to allow its conversion to psychic fortitude and temperance, virtues extolled by pneuma in the brain. everyone, even those who have them not.” On the basis of human observations and To this day, it remains a puzzle why Galen’s animal experiments, Galen surmised that the misplaced dogma remained unshakeable for so body had three basic organs – heart, brain, and long. The man who rivals Hippocrates as medicine’s liver. Pneuma from inspired air enters the left greatest succeeded in closing the minds of heart where it vitalises the warmed blood that physicians to further experimentation and scientific flows to the body, especially the brain. There, at its enquiry for another fifteen centuries.