REFUTATION OF THE CHARGES OF COWARDICE MADE AGAINST By JOSEPH WALSH, M.D. PHILADELPHIA, PA.

UMEROUSN and successful anceship (xix, 16) with some of its investigations in anatomy well-known medical men, he went to and physiology elevated (11, 217; v, 112) fifty miles Galen to a unique pedestal. to the south, and took two years of While agreeing on this eminence, and a post-graduate course. Still dissatis- rightly so, modern medical historians fied with his knowledge, and with the also agree, though wrongly, in making repute of the University of Alexandria him out a coward. This has not only in mind, he made the six hundred reflected an unfavorable light on him mile journey and spent five years as a man to be imitated, but has under the influence of the world tended to impair his standing as a renowned Egyptian Museum or Tem- scientist. With the evidence before ple of the Muses (11, 217; vn, 635; x, us, that his life was a manifestation of 53 et seq.; xvih, 806). resolution and courage, it is a satis- Four of the five summers in Alex- faction in this year, the eighteenth andria he suffered from an intermit- centenary of his birth1 to refute the tent fever, due he thought to overwork slander. and improper eating, though possibly He has been accused of cowardice a continuation of the condition which on two counts: First, that he ran away made him delicate as a child. in a discreditable fashion from an He returned home in the summer uprising associated with, or endanger- of the fifth year ill with what he diag- ing, his native city Pergamum in nosed as an abscess between his liver Asia Minor;2 second, that he ran away and diaphragm (vi, 756), but what I from a pestilence in . For a believe was a right pleural effusion, complete understanding of his conduct because he became well on bleeding in both instances, a little sketch of his as suggested to him by Aesculapius life and times is necessary. in a dream (xi, 314; xvi, 222) appar- Delicate in childhood (vi, 309)3 ently in the celebrated shrine of that Galen took the studies commonly god in Pergamum.4 pursued in the elementary grades from After recovery he entered on his his father, but at the age of fourteen career at the age of twenty-eight we find him in attendance at the (xiii , 599), having spent eleven years philosophical school (v, 41 et seq.). in medical schools. He was a brilliant He entered medicine in his native and industrious student, and had city Pergamum at the age of seven- profitted by every hour of this pro- teen still a little delicate (vi, 309, tracted course. As a consequence, 755) , and finished at twenty-one. within a year his repute was such Shortly before, his father died (vi, that he was appointed to the impor- 756) and left him such a competence tant post of physician to the gladia- that he never knew the need of tors: important to him on account money (v, 44 et seq.; xiv, 623). of its prominence and the associated Enthused by personal acquaint- practice of surgery, important to subsequent ages because it gave him the experiment on other pigs, and a well-equipped operating room and then on many other domestic as well animals without number to dissect as the wild animals of the amphi- and experiment on. theater, like the lion, and even the In Smyrna he had studied under long-necked crane and ostrich6 with Pelops, one of the two or three best the result that their peculiar cry or known medical teachers in the empire. utterance was invariably lost, he In agreement with his contemporaries the great Pelops incorrectly taught realized he had the nerve of speech that the diaphragm alone controlled which if cut or interfered with would respiration and that the expansion prevent man from talking (11, 218; of the chest walls was produced by iv, 278; xiv, 629 et seq.). the expansion of the lungs (11, 657). This not only meant the discovery From frequent dissections Galen early of the function of the recurrent laryn- recognized the additional action of the geal nerve, but practically the dis- intercostal muscles. Taking up this covery of the function of the brain, investigation into the mechanics of since it was commonly taught to be breathing he learned so much that for the cooling of the blood. The popu- almost nothing remained to be added. lar argument backed by the authority He described for us the diaphrag- of the philosophers Aristotle, Chrysip- matic muscle, its innervation, and pus and Diogenes of Babylon was: what happens when one and both we talk with the vocal cords, the phrenic nerves are cut. He was the impulse to their movement comes first to note the obliquity and decussa- from the lungs, intelligence must be tion of the fibers of the intercostal some place neighboring, and probably muscles and to explain the reason in the heart (v, 241). therefor, namely, that one part was In fact later in Rome, while he was active in the expansion, the other in promulgating this discovery, his op- contraction of the chest walls. He ponents brought forward what ap- sectioned the nerves to the inter- peared to them an absolutely clinch- costals and watched the action of the ing comparison (v, 245): diaphragm alone. Finally he showed “Urine,” they said, “is passed the influence of the thoracic muscles through the urethra by the compres- (11, 660-680; hi , 409 et seq.; iv, 465 sion of the bladder wall; words are et seq.). passed through the larynx by the The importance of this magnificent compression of the lungs,—it would piece of work can scarcely be over- be as logical to say that urine comes estimated, yet while pursuing it he from the brain as that speech does.” lighted on another discovery much Just as he had concluded these two more dramatic and interesting: I remarkable investigations on the am referring to the nerve of speech.5 mechanics of breathing and the func- Sectioning one at a time each of the tion of the recurrent laryngeal nerve, nerves entering the thorax to learn if and in the midst of the peace and it had an influence on breathing, he quiet of his charming native city was cut the recurrent laryngeal, and to pursuing others of equal importance his amazement the pig previously of which we will speak later, there squealing became silent. Repeating was an uprising of the Parthians (xiv, 622, 647, 648) under their new intelligence. Their continuance, how- and enterprising ruler Vologeses hi . ever, made it difficult to carry on Proceeding from the interior of other work, especially his beloved Asia the Parthians advanced to Elcgia in Armenia where they annihilated a Roman Army of about 11,000 men7 marching to intercept them. Elegia is 800 miles east of Pergamum, but with the principal Asiatic contingent of the Roman army destroyed, Asia Minor naturally became alarmed. The barbarians, however, instead of ad- vancing on the cities of Pergamum, Smyrna, and Rhodes, turned their steps southward toward , the Eastern Capital of the Empire,3 and never came within 700 miles of Pergamum. The uprising took place in March 161 a .d .,9 and Vologeses’ first success was practically speaking also his last, for although he actually moved his army almost to the walls of Antioch and took some of the lesser cities on the way, he got no further. In the meantime legions with more com- research. Now was the time to learn petent generals from , Pan- what was being done in the much nonia, Noricum, Rhetia, , Brit- talked of philosophical and medical ain, Italy and Africa began to pour schools of the Capital and he pro- by land through Asia Minor, and by ceeded to take advantage of it. The boat through Antioch, and before a very fact that he intended (xiv, 622) year had passed the danger to Per- to return and did return, shows that gamum and the other coastal cities he did not leave under discreditable was removed. circumstances. It was about six months later, in In spite of the fact, however, that other words, somewhat more than a Vologeses and his army never came year and a half after the war began, within seven hundred miles of Perga- and six months after the crisis had mum, a thirty-live day march, it subsided that Galen made up his mind might still be asked why Galen did to visit Rome.10 Pergamum was gain- not enlist? To answer this requires ing in courage daily with the constant only the slightest comprehension of success of the Imperial troops, but military conditions at the time. conditions were far from normal. The standing army of the Empire The activities at the beginning of the was composed of thirty legions of revolt in which he was glad to partici- Roman soldiers, which together with pate, had settled down to an estab- the auxiliaries impressed from the lished routine requiring but little provinces amounted to over 300,000 fighting men.11 Some of these were exempted by law, even in great stationed in Italy, particularly in the emergencies. Among these were ofli- CapitaI,Hmt the great majority were cials of government, priests, physi-

distributed over the various frontiers. cians,13 philosophers, and sev- On every side beyond the Roman eral other varieties of teachers. And boundaries were barbarians, and the all of them accepted their prerogative, frequency of revolt can be seen from except of course, those who wished to the fact that during the nineteen-year enlist in the regular army. For in- reign of the then Emperor, Marcus stance, the poet , who was only Aurelius, there was an uprising at five years older than Galen, was at different times of the *Britains,12 the time teaching in southern France. , Quadi, Jazyges, Ger- His parents lived in Samosata, on the mans, , *Costobocci in line of march from Elegia to Antioch. Greece, *Egyptians and Parthians, Rushing across the continent to his not reckoning the rebellion of his most native city he removed his relatives competent general in Antioch, who to , but he did not enlist. set himself up as Emperor. If an His courage, however, has never been insurrection signified one was con- called into question, since standing scientiously bound to enlist, almost almost alone in the face of intense constant service would be the result, superstition this classical poet atheist and it would be more satisfactory to poked fun at all the religions of the become a professional soldier at the world. beginning. Even when an outbreak This rebellion against the Roman was critical it simply meant the tem- arms took place while Galen was in porary transference to the point of the midst of a further piece of work danger of legions from elsewhere. on the differentiation of motor and On account of the frequency of sensory nerves, and their location war and the necessity sometimes of in the spinal cord (11, 684). In its conscription, various professions were later completed form this investiga- tion stands the test of today, and was and new discoveries in physiology not added to for 1600 years till the which intrigued the philosophers, and work of the celebrated Charles Bell with a prejudice against sectarianism in the nineteenth century. This re- search was now brought to a standstill. With his broad scholarship he could not help but recognize he was bringing to light scientific knowledge of value to all future ages, and was accomplish- ing more in the extension of biology than all the rest of the world put together. Important as he had a legitimate right to deem himself he, nevertheless, remained in Pergamum for a year and a half, remained till all danger was passed and Vologeses was retreating with a Roman army of about 75,000 men14 in active pursuit. He then, as I previously stated packed up and retired to Rome (xi, 299; xiv, 648). He went not into hiding but to the actual seat of government from which the war was being con- ducted. Finding it difficult to con- tinue his research, he went to the which antagonized the physicians of Capital with the idea of furthering the sectriddcn Capital.10 his scientific knowledge by association As in Pergamum, on his return with the intellectual lights about from Alexandria, so now in Rome; whom he was constantly hearing. On within one year he was the most conclusion of hostilities when condi- talked of man in the city. And the tions became normal, he returned to diversion produced by the opposition Pergamum with the intention of tak- of the medical men to his new dis- ing up again the interrupted work. coveries made half of officialdom, His continued regard for his native and three-quarters of the physicians city, as manifested in later actions, forget for days at a time an actual shows that his reception was not as a war was waging on the frontier. In coward or deserter, but as a distin- front of the book-stalls on the Sandal- guished citizen.15 arium just to the north of the Official Rome was at the time an forum, in front of the apothecary Academy with the saintly Marcus shop on the Sacra Via to the cast of Aurelius as head master, and at his the Forum, in the huge and magnifi- feet consuls, prefects and senators cent baths of Trajan where they went earnest in their pursuit of virtue and to exercise and bathe each afternoon, philosophy. Into this Academy burst and finally in the Temple of Peace the brilliantly educated Galen, with a which was the recognized Assembly virtue equal to that of the renowned Hall of Physicians, the medical men Emperor, with a biological knowledge aided by the sophists wrangled with Galen aided by his pupils and the methodologist. The first he condemned philosophers, until there was scarcely principally for its silly notion that all an intellectual person in the Capital, diseases could be reduced to two, namely, diseases with a constriction and with a relaxation of the pores of the body. The Thessalian methodologists went a broad step further. Since all diseases could be reduced to two, six months were all that was necessary for the study of medicine, and this school was turning out physicians right and left who six months before had been barbers, weavers, shoemakers and clerks. In view of Galen’s conviction that it was necessary for him to study eleven years, it is not difficult to imagine his feeling toward Thessalian- ism. And with a courage that cannot be too highly commended, considering how numerous this sect was in Rome, he denounced it day in and day out, who was not taking sides, and until and with Thessalians within hearing the very tufa blocks of the pavements called their founder, who in his entire must have been saturated with the behavior is strongly reminiscent of dissensions.17 And everywhere people certain founders of sects today, im- smiled with amusement when they pudent, insolent, stupid, barbarous recollected that the Assembly Hall and asinine (x, 7 et. seq.). of Physicians was euphemistically call- Raging with passion they retaliated ed the Temple of Peace. that his remarkable prognoses were The physicians of Rome were at made not through a knowledge of the time divided into the sects of medicine, but an evil knowledge of dogmatists, empirics, methodologists, divination, that his wonderful cures Thessalian methodologists, - were made not by drugs, but by magic. tists, eclectics, Hippocrateans, Praxa- Sorcerer they called him, and magi- gorcans, Herophileans and Erasis- cian (xiv, 615), but it was not possible trateans. It would appear that in to call him coward. Pergamum there were practically only Not a few commentators, having two sects, dogmatists and empirics, only Galen’s addresses in mind, with- with a small sprinkling of pneumatists. out taking into account the educa- It is also likely Galen himself so tional conditions he was berating, dominated medicine in his native consider he went greatly to excess. city that almost all followed his lead. With the high-class empirics and There were two sects in Rome methodologists, however, tainted with which he properly and constantly a skepticism,18 or more nearly a condemns, the methodologist, and nihilism in regard to learning and with added vehemence the Thessalian research, and the low-class methodolo- gists insisting that all medicine could of deserter he would not have been be learned in six months, excess was received and extended the hand of impossible. At most Galen’s attitude friendship by the highest imperial was the natural extreme of the re- officials. former who in his anxiety to correct is Few men when actually put to the unconsciously carried beyond the goal. test have the courage to sacrifice Confronted with the idea that worldly interests to ideas. Galen not knowledge was a bauble and educa- only sacrificed the friendship of the tion futile, that research in anatomy medical men, among whom he hoped and physiology added nothing to to promulgate his great discoveries, medicine, he pleaded day after day but even put his life in jeopardy at for study, and then more study, for the hands of the low-principled Thes- experiment, and then more experi- salians. For in spite of his friend ment. Eudemus’ assurance that there were From this time comes the sentiment no depths of villainy to which the which he frequently repeats: The road sectarians in Rome were not willing of investigation is long and arduous, to descend, even murder (xiv, 623), but leads to truth; the road of asser- since ten years before a physician tion is easy, but leads nowhere.19 acting similarly had been thus dis- The friends who stood by him in posed of, Galen stopped only for a these discussions, without whose in- time his antisectarian addresses, and fluence he would possibly have been then continued them till he died. assassinated by the Thessalians, were W e know of twenty-three1" articles Barbarus, the uncle of the Co-Em- from his pen against sectarianism, peror ; Sergius Paulus, the majority transcripts of lectures one of the two consuls; Flavius Boe- delivered in Rome. In these he minced thus, an ex-consul, and later appointed neither words nor phrases. When his Governor of Palestine; Sev- opponents became vituperative he erus, one of the philosophical teachers followed suit, not dissimilarly to Ori- and the closest intimate of Marcus gen, TertuIIian, Sylvius, Vesalius, Aurelius; and Adrian, at the time Pasteur, Metchnikoff, Roosevelt and assistant to the philosopher Boethus, innumerable others. and later the most popular orator in Yet the enmity of the physicians the Roman Empire.5 preyed on his mind, and after his If Galen left Pergamum under powerful friend Boethus left the Capi- discreditable circumstances, especially tal to take up his governorship of under the stigma of cowardice on Palestine, Galen deemed it wise to account of failure to enlist in the war, cease temporarily participation in he would assuredly not have chosen public discussions and devote himself as the place of his exile the Capital solely to practice. He also renewed of the Empire, from which the war his resolve to return to Pergamum as was being conducted; he would as- soon as conditions became sufficiently suredly not have put himself into normal to take up again his research prominence by opposing most of the (xiv, 622, 624). Roman physicians, many of whom This was his state of mind when in had the car of the court and the July, 165, about six months before authorities. Laboring under the odium he left Rome, while wrestling in the gymnasium of the bath, he suffered would have him appointed regardless, an upward dislocation of the acromial he packed up hastily and made over- end of the clavicle (xvinb 401). Both land for Brindisi. To several knowing he and his surrounding friends, among of his departure, he said he was in whom were several physicians, as need of a rest and was going to well as the wrestling master, believing Campania (the country around the it a dislocation of the head of the Bay of Naples). He did not, however, humerus downward, endeavored to stop at Campania, but went through reduce it. Before the nature of the to Brindisi and took the very first injury was recognized such damage vessel crossing the Adriatic. From had been done to the tissues by their the brief history here given, it must efforts, that he had a long and painful be evident that the thrill of the boat convalescence. as it was loosed from the wharf pro- Embittered by the enmity of the duced the first real relief from weari- medical men, disconsolate at what he ness and vexation of spirit experienced considered his failure to promulgate over many months.21 the new discoveries of which he was This departure, he definitely states so proud, physically and mentally in a work written thirteen years later, exhausted by the foolishly tight band- took place shortly before the Com- age in which his arm had been slung mander-in-Chicf Lucius Verus returned over forty days, ennuied on account of from the East. Quoting his exact his non-participation in public affairs words we read (xiv, 648, 649): “When after giving up visiting the Temple of I understood the war was ended I set Peace, he looked forward day after out immediately from Rome . . . day to the time when he could end the Not long after Lucius Verus return- bickering he detested and return to ed.” Since the triumphal entry of this the research he loved so much. Commander and his victorious army Eventually the day came. The war into Rome occurred in March 166,22 was finished. The articles of peace it is evident Galen withdrew before were signed. Lucius Verus, the Com- this time. mander, was on his way back to Rome. Unconsciously to the departing Per- Full of elation at the prospect, he was gamite the glance he threw back at dreaming of departure when a new the gradually receding Capital as he complication arose, highly complimen- sped down the Via Appia to Brindisi, tary in one way, mentally upsetting was the last view by a historical in another. personage of Rome at the height of its His friends the philosophers, many splendor23 for Lucius and his all- of them officials or intimates of offi- conquering army brought back some- cials about the court of Marcus thing else in addition to victory. Aurelius suggested him for a govern- Accompanying them along the line ment position (xiv, 648).20 Flattering of march from Babylon24 in Central though it was Galen was in no humor Asia through Syria, Asia Minor and to accept, and he requested they do Greece,25 and even into the Capital nothing further until he saw and itself stalked the ghastly figure of talked with them again. Convinced pestilence. Seeded along the way it after consideration that they would spread throughout the Empire and pay no attention to his wishes, but produced a holocaust. This is the epidemic which the and its wranglings, and wished to historian Niebuhr associates in a avoid refusing the public office his causal fashion with the initiation of friends were soliciting for him. Ilcleft the decline and fall of the Roman at the time the great pest was begin- Empire. It is considered to have ning, that is at the time it was spread- carried off twenty-live million of its ing over the Empire, though it had hundred million population.26 Becom- not yet reached Rome. That it was ing known soon after as the Great coming to Rome he had no more idea Pest, it furnished a landmark in the than we had that the influenza epi- life of every citizen, an unforgettable demic in Europe in 1918 was coming time from which to date all happen- to the United States and would cause ings. It broke out in Rome sometime its desolating havoc. The statement between the spring of 166 and the could not be plainer. He left Rome spring of 167, but all authorities where the epidemic had not yet begun agree that it was at least after Lucius and no one expected it, and actually Verus’ return.27 went into the regions where it was After narrating in the work written already a menace. thirteen years later that he left before Unacquainted with the surrounding Lucius Verus and his army returned circumstances, his detractors inter- from the East (and therefore before preted his statement to mean: Having the pest broke out in the Capital), sojourned three years in Rome, the Galen states in another work written great pest breaking out I hastily and thirty years later (xix, 15), “having eagerly left the city in order to avoid sojourned three years in Rome, the it. Nothing can be further from the great pest beginning, I hastily set out truth, and the previous narrative, as from the city, going eagerly to my well as the actions of his entire life native country.”28 can be marshalled against it. This sentence is one of the most In an earlier part of this article frequently quoted in biographies,29 I showed Galen standing up against scarcely any biographer, even in the the medical profession of Rome in the shortest sketch30 failing to notice it, endeavor to inculcate ideas necessary and all insist that he ran away from to the progress of medicine. His dis- the epidemic. In the light of our actual play of courage is almost unique since knowledge of the circumstances, it is he even went so far as to jeopardize quite amusing to read some of the his life at the hands of the uneducated accounts of his departure from Perga- and unprincipled Thessalians. mum and his later departure from In addition he was a pious Pagan, Rome. It would be even more amus- and an ardent follower of ing, except they have proved so which demanded the most rigid up- tragic for the reputation of one of the rightness, regardless of danger or most courageous of physicians, and harm to self. His life was consecrated are the cause of some of the present- early to Aesculapius, and to the end day ill-feeling against him. of his days he never wavered in his From what we know, the statement devotion. Almost no work of impor- is plain: he remained three years in tance came from his pen without Rome, he hastily and eagerly left containing the name of this patron because he was weary of the Capital and an expression of his homage. No matter to what friend dedicated, it man frontier, where a new war was was inscribed also to the god of medi- in progress, who was cine. And not without results. In in command sent to Pergamum for his pagan piety Galen saw the hand Galen. Two reasons naturally occur of Aesculapius helping him over rough to us for this action, the high regard and perplexing places many times (iii , the Emperor had for his work in 812; x, 609; xi, 314; xvi, 222; xix, 19). Rome, or special success in the treat- In his work on “Hygiene,” written ment of the pest in Asia. about the age of forty-six (176 a .d .) Shortly after his arrival at the he says (vi, 308): “I have never Camp, a very severe winter setting in, shirked duty even when hard, but the army with the physician in its have done my utmost, watching pa- train returned to the Capital. Here tients when necessary even throughout the Emperor put the Pergamite in the night, sometimes for their sake, charge of the little Prince though sometimes also merely for for the next six years, while he himself what I could learn.” was six hundred miles away lighting About the age of sixty-three he the German barbarians. tells us (v, 42 et seq.)31 of the virtues No ruler in history surpasses Mar- enjoined by his father forty-four years cus Aurelius in love of virtue, resolute before: Justice, temperance, fortitude courage and devotion to duty. It is and prudence; to despise honor and unthinkable that he would engage glory, to seek only truth and to fear as a caretaker for his beloved son a no danger. These I have followed, he physician so deficient in character says, to the present day. And a study and philosophic stoicism as to prove of his career brings forth no reason a deserter in time of danger. No! This for doubt. appointment alone demonstrates the In confirmation we know that two esteem in which the Pergamite was and a half years later, in the fall of held in the Capital, not only for his 168 a . d ., when the epidemic was knowledge of medicine, but for his raging among the troops on the Ger- qualities as a man.32

Refer enc es

1. He was born in September, 130 a . d . See, pire, could be found statesmen, philoso- Wal sh , J. Date of Galen’s birth. phers, sophists and merchants awaiting Ann . M. Hist ., n. s., 1: 378-382, 1929. the heaven-sent directions of the god. 2. In spite of the fact that the uprising The broadest education, even of scien- Galen speaks of he very definitely tific investigators like Galen, deemed describes as the great Parthian War the cures too frequent to be doubted. of the period, it is astonishing how Impressed as he was, the fact of his many modern detractors got the idea return from Alexandria at this time it was a local sedition or revolt in the and the dream make it likely that town of Pergamum itself. finding himself seriously ill, he came 3. The figures in parenthesis refer to the home for the express purpose of visiting volume and page of the handiest and the temple and believed himself best known edition of Galen’s works, rewarded. namely, Kuhn’s “Galeni Opera 5. Prend erga st , J. S. The background of Omnia,” Leipzig, 1821. Galen’s life and activities, and its in- 4. In the hospital-like wards of this shrine, fluence on his achievements. Proc. Poy. the Mecca for the pious sick of the em- Soc. Med., 23: 1131-1148, 1930; also Wals h , J. Galen’s discovery and pro- 13. Since there was no medical practice mulgation of the function of the re- act in our sense of the term, anyone current laryngeal nerve. Ann . M. feeling so inclined could call himself a Hist ., 8: 176-184, 1926. physician. Not all such, however, 6. Simon , M. Sieben Bucher Anatomie enjoyed the privileges of freedom des Galens. Leipzig, Hinrichs, 1906, from conscription, immunity to certain 2: 78 and 188. taxes, etc., but only a well-defined 7. Paul Barron Watson in “Marcus limited number in each city or town Aurelius Antoninus,” N. Y., Harper, holding specified public offices. These 1884, p. 63, says an entire legion which corresponded more or less with our would be about 7,000, or with its health officials who watched over auxiliaries, about 11,000. Charles sanitation, took care of the poor, Merivale in “History of the Romans,” free or for a small fee, or were suffi- N. Y., Appleton, 1875, 7: 455, says ciently highly regarded to hold the one legion. B. G. Niebuhr in “Lectures positions of physician to the gladiators, on the History of Rome,” Ed. 2, dramatic theaters, temples, vestal vir- London, Taylor, Walton and Maberly, gins and certain public associations. 1849, 3: 250, says one or two legions. Unnecessary to say with the privileges 8. Wat son . Op. cit., pp. 64, 139. were associated definite obligations. 9. Watson, op. cit., p. 63, says immediately Galen was exempt as physician to the after the accession of the Co-Emperors gladiators, but also likely as a teacher. Marcus Aurelius and Lucius Verus 14. Wat son . Op. cit., p. 142. which was on March 7, 161, and pp. 15. This is particularly shown by the fact 150, 151, that Lucius Verus, the that though he was afterwards called Commander-in-Chief of the Roman by Marcus Aurelius to the German forces returned in March, 166, after the War, and accompanied him from Aqui- war was finished having been absent leia to Rome where he remained ten from Rome nearly five years. Niebuhr, years, he did not remove his library op. cit., p. 250, states, commencement to the Capital (xix, 34), since he still of reign of Marcus Aurelius. Merivale, desired, and expected to return again op. cit., p. 455, asserts, the Parthians to his native city. seized the moment of a change in the 16. Physiology, and even anatomy, belonged succession of Emperors. at the time to the study of philosophy 10. He tells us he came to Rome at the age rather than medicine. It is on account of thirty-two (xvnii, 347); he tells us of accomplishments in these branches again that he remained in the Capital that he became known as a philosopher three years (xix, 15) and left it not as well as physician. The medical long before the Emperor Lucius Verus men rose against him not only on arrived from the East (xiv, 649). account of his antisectarianism, but Lucius Verus made his triumphal because he insisted on making anatomy entry into Rome in March, 166. Allow- and physiology a requirement in the ing anything within three months to study of medicine. It may be said, be included in Galen’s term “not long though the majority of physicians were before,” then he left about, or after opposed to him, he had a small follow- January 1, 166; and if he remained in ing, and though the majority of Rome three years, he arrived about philosophers were friendly, a few were January 1, 163, or more than a year not (xiv, 650). and a half after the Parthian War had 17. Wal sh , J. Galen clashes with the medical begun. sects at Rome. M. Life, 35: 408-443, 11. Gibbon says 375,000 “History of the 1928. Decline and Fall of the Roman Em- 18. Pat rick , M. M.: and pire,” N. Y., Burt, I: 236. Greek Skepticism. Cambridge, Deigh- 12. Those marked with an asterisk were ton Bell & Co., 1899; also The Greek quite insignificant, but the remaining Sceptics, N. Y., Columbia Univ. Press, six were very serious. 1929- 19. This generalization is expressed by Galen 22. Watson, op. cit., p. 151, says “towards in almost every book of his “Dogmas the end of Winter 166,” which would of Hippocrates and ,” and the make it at least not later than March. “Use of the Parts.” Succinctness not 23. On Galen’s return three years later being one of his virtues, as is shown in the cortege of Marcus Aurelius the by his twenty-one volumes of literary decline was already in progress, and legacy, it is always expressed at great from this time it sank till the period length and not in my epigrammatic three centuries later when it had form. become a wilderness though a wilder- 20. He gives us no idea as to the nature of ness of marble, with only 500 people this position. Archiater (corresponding within its almost totally demolished with that of our Surgeon-General) walls (Procopius quoted by Gregoro- has been suggested, but this is vius, Rome in the Middle Ages, George doubtful. Bell & Sons, 1894, 1: 433). 21. Speaking to his friend the peripatetic 24. Capitolinus (cited by Watson, op. cit., philosopher Eudemus, Galen says (xiv, p. 158) tells us the epidemic began in 622): Babylon, where one of the Roman What I have resolved you have often heard, soldiers broke open a golden casket namely, to make in Rome only a brief stay, and in the Temple of Apollo, and there when the revolt in my fatherland comes to an end depart in order to avoid further association with arose from it an exhalation producing these unscrupulous rascals [meaning the Roman the plague, which spread at once physicians]. through Parthia and the entire world. Later in connection with a mention of He goes on to say that the disease was the Emperor Marcus Aurelius, he tells an infliction of the gods as retribution us (xiv, 647): “At this time Lucius for the General Avidius Cassius’ break- Verus was absent from the city on ing his sworn promise to the citizens account of the Parthian War, which of when they surrendered. was being carried on by Vologeses.” 25. Niebuh r . Op. cit., p. 251. The Co-Emperor Lucius Verus was 26. Merivale, op. cit., p. 463, says “it so Commander-in-Chief. devastated the whole of Italy that Still later he states (xiv, 648): villas, towns and lands were every- where left without inhabitant or culti- Understanding the desire [of my friends] in regard to the honor they were soliciting for me, vation, and fell to ruin or relapsed and fearing lest their action would prevent my into wildernesses.” An epidemic which return to Asia, I asked them to defer it for a historians believe to have been the time. When I learned that the war was ended I set out immediately from Rome going to same disease returned twenty-two years Campania. I proceeded thence to Brindisi later (189 a . d .) during the reign of where I resolved to take the first ship going Commodus, causing a loss of life not either to Dyrrhachium or to Greece, fearing that some of my friends in power, or even the Emperor dissimilar. The two visitations are himself, hearing of my departure, a fugitive as sometimes considered as one epidemic, it were, might send an officer to order my return. After one day in Brindisi I sailed to Cassiope and it is probable the twenty-five [the principal city on the Island of Corfu, midway million deaths constitute the sum of between Brindisi and Greece] . . . Not long both. after Lucius Verus returned. 27. Simonde de Sismondi, “Rome,” London, Comparing these three quotations, it is Longman, Rees, Orme, Brown, Green evident from the first that he left & Longman, 1835, 2: P- 2O3> states Pergamum on account of a revolt, and that the pest was brought by Lucius from the other two that this revolt Verus from the East. Eutropius (trans, was the Parthian War begun by by Rev. John S. Watson, London, Vologeses, the ruler of the Parthians. George Bell & Sons, 1902, p. 510) says From the first and third it is evident it arose after the victory over the he left Rome on account of the enmity Parthians. Niebuhr, op. cit., p. 251 of the physicians, and left hastily to asserts: In a . d . 167 the real oriental avoid the official position about to plague was carried into Europe by be thrust on him. the army returning from the Parthian War, and spread all over the western London, Johnson, 1799; Robins on , V. world, Asia Minor, Greece, Italy and Pathfinders in medicine, Galen and Gaul. Watson, op. cit., p. 158 says, Greek medicine. M. Rev. Rev., 18: 775, the pest broke out in 166, not indicat- 1912, and Thornd ike , L. Galen, the ing whether he means in the East, man and his times. Scient. Monthly, or in Rome, though he possibly means 14: 83-93, I922- the latter. J. B. Bury “History of 31. For the time at which his various works Rome,” New York, Harper & Bros., were written see Johannes Ilberg, 1893, p. 541 declares “the plague was Ueber die Schriftstellerei der Klaudios carried to the West by the legions who Galenos, Rheinisch. Museum f. Pbilol., returned with Verus.” 44: 207, 1889; 47: 489, 1892, 51: 165, Even better evidence than any of the 1896; 52: 591, 1897. foregoing appears to me the fact that 32. Opinions in regard to the nature of the the triumphal procession of Marcus Great Pest are at variance. Since Galen Aurelius and Lucius Verus in the spring followed a special classification of of 166 a .d . was one of the most elabo- diseases corresponding to the existing rate (Watson, op. cit., p. 151) ever seen knowledge, his description is insuffi- in the Capital. It is scarcely possible cient for accurate diagnosis, though this could be so with a great epidemic he mentions it innumerable times and in progress, and hence it must have treated many cases. The reason is begun later. easily explained. Merivale, op. cit., p. 463, affirms, “it On coming to Rome he found the com- was still raging when the emperors monest classification to be that of the left Rome for the war against the Methodologists who divided all inter- Germans in 167,” which would point nal diseases into two, strictum and to its beginning late rather than early Iaxum, diseases due to the minute in 166. canals of the body being too constricted 28. This statement is made in a catalogue or too relaxed. This he was unwilling of his works which he compiled at the to tolerate and argued against it age of sixty-eight on the request of a throughout life. With the desire for favorite pupil. He is speaking of the simplicity in the air, however, the books written in Rome, and then of most he could accomplish was improve- the later work he did in Pergamum. ment. He separated many diseases, At the conclusion of the quoted sen- yet continued to include a variety of tence there is a period followed by the others under special heads. word p-qSevt and then a lapse in the text Under the classification “Ulcers of the succeeded by a change of subject. lung” he included tuberculosis, abscess, It is useless to speculate whether or pneumoconiosis, bronchiectasis and all not this statement was explained in conditions associated with protracted the lapsed part, because his pupil cough and expectoration, especially Bassus knew all the circumstances if they manifested hemoptysis. Some as well as we do, or even better, with- cases of the pest showing blood-spit- out explanation. ting, he gives us in a discussion of 29. Cha rti er , R. Vita Galeni in the Charter- pulmonary ulcers a description of iana edition of Galen’s Works, Paris, two (x, 361 and 367). From these we 1638; Neub urge r , M. History of derive the following symptomatology: Medicine, tr. by Ernest Playfair, Pustules appeared over the whole body London, 1910; Figu ier , L. Vies des accompanied by fever and sometimes Savants, Paris, Hachette et Cie, 1870; by vomiting and diarrhea. If the Singer , C. The Evolution of Anatomy, pustules broke, which occurred about N. Y., Knopf, 1925; and Wright , J. the ninth day there was a better The Man Galen and His Times, New chance for recovery. Involvement of York State J. Med., 114: 557-562; the respiratory tube associated with 677-682, 1921. soreness, cough and expectoration of 30. Hut chi nson , B. Biographia Medica, little crusts about the tenth day some- times occurred and these cases likewise 112, believes the Galen epidemic was showed a good prognosis. smallpox; Councilman, in Osier’s In another place (hi , 186) he also men- “Modern Medicine,” Phila., Lea Bros., tions gangrene of the feet as an occa- 1907, possibly smallpox; Immermann sional accompaniment. in Nothnagel’s “Encyclopedia,” Phila., Again in a discussion of drugs (xn, 191) Saunders, 1902, denies it was smallpox, he tells us: but expresses no opinion in the way of diagnosis. Neuburger, op. cit., p. 247, During the great pest which showed the same characteristics as that memorialized by Thucy- states the epidemic lasted about fifteen dides, practically all the patients who used this years and its manifestations chiefly remedy [Armenian bolus which he describes, resembled smallpox or dysentery. Nie- xii , 189] became rapidly well; the remainder who derived no benefit gradually succumbed because buhr, op. cit., p. 251, without good they likewise found nothing else capable of grounds says, more or less offhand, helping them. Hence we may conclude that when it was not effective the patient was incurable. that it was oriental plague; Arthur Shadwell, in the “Encyclopedia Britan- It is popularly believed the Thucy- nica,” and many others, insist it was didean pest was smallpox. not bubonic plague. Personally from Osler in “Principles and Practice of Galen’s description, I am inclined to Medicine,” N. Y., Appleton, 1909, p. agree with Osler that it was smallpox.