|This was essentially how Claudius Galen was perceived during the middle|
ages, where his word on medicine was considered as the final word.
It is said by many historians that Galen became an eclectic physician, meaning he incorporated the best ideas of both schools of medicine: Dogmatism, Pneumatism, Methodism and Empiricism. Some say that he wasn't even an empiricist at all but simply an independent thinker, blending all the best ideas he learned from the sages as he traveled the world with his own ideas.
Yet first he had to learn about the great physicians. From Stratonicus he learned to appreciate the theories of Empedocles, Hippocrates and Aretaeus. From his Empiracist teacher Aeschrion, he learned to temper speculation in lieu of experience. (1, page 149) (14, page 11)
Like Aretaeus, a Pneumacist, he believed a vital force called pneuma was inhaled to the lungs, stored in the heart, and circulated through the body by the vessels. He was the first to prove that arteries contained blood as opposed to air, although he believed that blood contained a vital spirit that influenced all the organs of the body.
Galen believed that the body was a perfect machine created by god. He believed that all parts of the body, from the largest organ to the minutest detail...
...have all been determined by a faculty which we call the shaping or formative faculty; this faculty we also state to be artistic—nay, the best and highest art—doing everything for some purpose, so that there is nothing ineffective or superfluous, or capable of being better disposed. (11, pages 24-27)
He believed there were two basic forms of life: (11, page 2)
- Soul: Provides voluntary motion, which is particular to animals
- Nature: Provides growth and nutrition, which is particular to plants and animals (11, page 2)
The two forms of life are ultimately responsible for the two basic effects of nature: (11, page 2)
- Animals: Are governed at once by their soul and their nature
- Plants: Are governed by nature alone, not the soul. (11, page 2)
So Galen, therefore, gave us the two following definitions: (11, page 17)
- Effect: The result of the faculty, i.e. veins, blood, nutrition, growth, health
- Faculty: The cause of the effect, i.e. the soul and nature make life, the veins and liver make blood, the blood makes nutrition, nutrition is assimilated into the organ to make growth, and adequate growth assures continued life as long as possible, or good health. (11, page 17)
It's actually quite simple once you think about it. As noted by Galen:
The effects of nature, then, while the animal is still being formed in the womb, are all the different parts of its body; and after it has been born, an effect in which all parts share is the progress of each to its full size, and thereafter its maintenance of itself as long as possible. The activities corresponding to the three effects mentioned are necessarily three -- one to each -- namely Genesis, Growth and Nutrition." (11, page 17)So the three principle faculties of nature are, according to Galen: (11, page 18-19, 33)
- Genesis: This is the activity (alteration and shaping) of nature necessary to form effects such as bones, nerves, veins, arteries and organs necessary for the formation of the animal or plant as a whole
- Growth: The increase and expansion in length, breadth and thickness of the solid parts of the animal
- Nutrition: The addition to the parts without expansion. It is the substances held in the blood that are assimilated into the various parts of the body for genesis and growth. In other words, nutrition is the nutritive faculty that causes the effect of genesis and growth. (11, pages 18-19, 31)
So Genesis, Growth and Nutrition are the first or principle faculties that are responsible for forming and shaping the various parts of the body. In order for the body as a whole to function properly, each of these primary principles needs the help of the other principle faculties, and they also need the help of other faculties of nature, such as the faculty of breathing, of making blood, of motion of the blood, etc.
This blood was transported by the veins to the right ventricle of the heart to be purified. Here blood was turned into a light, frothy substance that entered the lungs. Once returned to the right ventricle, this purified blood was transported through the venous system to nourish the various parts of the body (such as the organs). (9, pages 58-60, 89)
Like Hippocrates before him, Galen believed in specific selection, whereby each organ had the ability, and therefor the affinity, to assimilate the exact nourishment it needed from the blood in order perform it's natural function for the body as a whole. (10, page xxvii, xxiv, 31, 49)
Some of this blood moved from the right ventricle to the left ventricle through invisible pores. Here the blood was mixed with the pneuma that was inhaled, and it became vital spirit. This vital spirit contained passions (such as anger, revenge, courage, desire, happiness, satisfaction, and confidence), and was supplied to the various organs of the body through the arterial system. (9, page 58-60, 87)
Some arterial blood went to the brain, where it was supplied with animal spirit, which contained sensation and intelligence. This animal spirit was sent through the body by the nerves. (9, page 58-60)
This animal spirit was essentially what made animals, and humans, different from plants.
So you can see that in order for the nutrients of the blood to be properly absorbed and made useful for purposes of genesis and growth, various organs were necessary. Each organ uses the faculty of nutrition to stay healthy in order to perform its own faculty of nature. For instance, the heart assimilates the faculties of nutrients it needs to perform its faculty of mixing air and pneuma with blood, and the liver assimilates the faculties of nutrients it needs in order to perform its faculty of assisting veins turn chyle into blood. (11, page 33-34)
It must be understood that Galen had no concept that the blood circulated through the body, instead he believed the blood moved in a to-and-for movement. For example, purified blood was transported from the right ventricle to the liver and then back to the right ventricle. It moved from the right heart to the brain and back to the right heart. It moved from the left ventricle to the brain an then back to the left ventricle. (10, page xxxvi)
The lungs had four functions: (9, pages 58-60
- Inhale air and pneuma
- Allowed air to flow from it to the heart in order to cool the heart
- Mixed air with its pneuma with purified blood in the left ventricle of the heart
- Acted as filters for the venous blood from right ventricle of the heart (9, pages 58-60
The heart also had four functions:
- Right ventricle acted as filter for venous blood
- Left ventricle blended air and pneuma with blood
- Created the passions of the body
- Controlled the temperature of the body (it was the furnace for the body)
Health and sickness were determined by a separate theory.
He was a Dogmatist in that believed in the four elements of Empedocles: (1, page 164)
- Water (1, page 164)
- Humid. (1, page 164)
- Black bile
- Yellow bile (1, page 164)
Since God created the body as a perfect machine, each organ functioned perfectly in order to maintain the natural balance. This natural balance was maintained by nature maintaining a natural (albeit unique for each body) balance of the elements, qualities and humors. (1, pages 163-164)
Galen, like Hippocrates before him, believed nature could be assisted in maintaining this balance through good hygiene, or by doing simple things such as getting regular exercise at the gymnasium, cleansing daily in the baths, wearing clean clothing, sleeping in a comfortable bed, and eating a healthy diet.
Since each person has a unique blend of the elements, qualities and humors, each person would have a unique personality or temperament, which can be seen by the following chart:
The Four Humors of Hippocrates
Red, Hot, Moist
So as a perfect balance of these caused health, sickness was caused when something occurred that threw of this balance, thereby disturbing the pneuma.
Hippocrates believed the body as a whole was sick, and therefore treatment emphasized a general remedy aiding nature to re-establish the natural balance of that person's body.
Galen, on the other hand, believed one organ, or one part, of the body could be sick, and this would throw off the chemistry of the unity as a whole, causing the symptoms that were observed. In this way, Watson said that Galen was the first to link symptoms with a specific organ. (1, page 168)
Fourgeaud said that as an empiric he thought diseases had a natural cause: (3, page 23)
As disease, according to Galen, consists in 'vel operationis vel structurae oblaesio,' he urged the importance of tracing the general symptoms to the parts or organs primarily affected.(3, page 23)For example, Watson said that inflammation occurred when blood entered an areas of the body that normally did not contain blood. When such blood combines with phlegm, it becomes "aedematous." (1, page 169)
So when pure blood enters the lungs it can lead to inflammation of the lungs, or pneumonia. It can also mix with phlegm and cause an accumulation of fluid in the lungs called dropsy or hydropsy. An accumulation of phlegm may cause the symptoms (diseases) of dyspnea, orthopnea, tachypnea or asthma.
In his book "Semeiotics II: A Concise Treaties on the Pulse for Students," he said:
The heart and arteries have a uniform pulsation, though not equally sensible in all the arteries; wherever it is capable of being felt, it is equally adapted for observation; but some parts are superior to others, and of these the carpus is best... Each one may learn his own pulse by experience. (15, page 601)The pulse is also indicative of various diseases. He said:
Of the pulse of syncopal affections; of anger, pleasure, grief, fear, pain, and its varieties; of the pulse of inflammation; its locality and character, as of the diaphragm, in pleurisy, and its varieties; in empyema, marasmus, the hectic pulse in it, and in phthisis; pulse of peripneumony; of lethargy; phrenitis; catalepsy; catochos; convulsions; palsy; epilepsy; angina; orthopnoea; hysteria;— the pulse, and its diversity in various affections of the stomach; in dropsy, and its varieties; in elephantiasis, jaundice, and in those who have taken hellebore, &c. (5, page 601)Throughout Semiotics he described various conditions that could cause the pulse to vary, such as from man to woman, in infancy and adulthood, and youth and old age. It may also be different based on the whether a person lives in the country or city, whether it's fall, winter, spring or summer, and dependent on the health of the patient. It changes during pregnancy, while walking, running, and sleeping. It also changes when the person eats certain foods, bathes, drinks wine, and any changes in habit. Various habits could also change the pulse: anger, sorrow, grief, fear, joy, and pain. (15, page 601, 602, 607-613)
Along with feeling the pulse he would perform a full assessment of the patient. He would ask questions, and he would study the patient's surroundings. He would place his ears to the patient's chest to listen to lung sounds and heart beat. He would place his hand upon the patient's forehead to feel for a temperature*.
If he noticed an imbalance, yet the patient still appeared healthy, he would try to assist nature to maintain good health by treating similars with similars. (1, page 167-170)
For example, if a person was phlegmatic, by adding phlegm; if a person was sanguine, by adding blood; if a person was choleric, by adding yellow bile; if a person was melancholy by adding more black bile. (1, page 167-170)
This task could be performed by using remedies that contained the desired humor, or, more likely, through improved hygiene (diet, sleep, exercise, cleanliness). (1, page 167-170)
Essentially, as noted by Garrison, he combined the "humoral ideas of Hippocrates with the Pythagorean theory of the four elements and his own conception of a spirit or 'pneuma' penetrating all the parts." (8, page 103)
He likewise incorporated into this the anatomical wisdom learned by the Alexandrian physicians Erasistratus and Herodotus. (10, page xxxii)
Regarding disease, Bradford said he copied the Hippocratic idea of categorizing all diseases as follows: (7, page 43)
- Acute (it's happening now) or chronic (it's permanent) (7, page 43)
- Endemic (found among certain people), Epidemic (widespread), or sporadic (randomly occurring) (7, page 43)
- Produced external (outside the body) or internal (inside the body (7, page 43)
- External causes were air, food, drink, motion, rest, sleeping, walking, retention, excretion, and passion (7, page 43)
- Internal causes were hidden, and set in motion by the external causes (7, page 43)
However, this was an idea that was similar to that of Athenaeus of Attaleia, who lived around 50 A.D. and was the creator of the Pneumatic School of Medicine.
Regardless, an example of treating opposites with opposites is, if the disease was caused by an increase in the element of phlegm due to an increased in the quality hot and dry, the remedy must consist of the opposite qualities, such as hot, fiery pepper. (7,page 44)
For instance, since increased phlegm was believed to cause asthma, the treatment would be something that would decrease phlegm. Since increased blood caused fever, decreasing blood through bleeding was the cure.
Galen, like Hippocrates, believed that each nostrum (drugs, natural remedy, herbal remedy) had a specific humor that it was attracted to or drew from the body. In this way, each remedy was specific to healing the symptoms caused by illness to a particular organ. For instance, purgatives were useful for attracting phlegm from the lungs.(11, page 69-70)
Unlike Hippocrates, who mostly advocated simple cures to assist nature in the healing process, Bradford said Galen was a proponent of nostrums, often recommending, among others cures, things like:
- Bleeding for congestion of the blood (dropsy, hydropsy)
- Purgatives for dyspnea and asthma because they drew out some of the excess phlegm
- Opiates for pain and to ease the mind
- Ashes of crabs for hydrophobia (fear of water). (7, page 44)
Watson said that he tended to use the lancet (perhaps in bleeding) and purgatives to "extremes." However, while leaches were recommended by Themison and commonly used by Methodists (solidists), he did not recommend them as a treatment.
While he had experience with sprains, fractures, cuts, and bruises during his time in the gymnasium and coliseum of Pergamum, and with serious injuries during his time with the Roman military, he rarely recommended surgeries. Although when they were necessary, he performed them with exemplary skill and a gentle hand. (1, page 170-171) (9, page 7)
This was a good thing in a way, because while the works of most ancient physicians were lost to time and forgotten, Galen's works were immortalized. His words were worshiped as the Bible for the next 1800 years, and in this way Greek medicine -- the key to all medical wisdom -- was saved for posterity.
This was bad in a way too, because his words created a paradigm of ideas that enveloped the medical profession until well into the 19th century. This, in effect, slowed down medical progress. But, as we will see, it did not stop it.
*John Redman Cox, who translated the works of Galen, said many times that he wondered if Galen didn't at least, for a brief moment, think that the blood might circulate as opposed to moving in a to and fro motion back and forth between organs. He said that there are times, by reading Galen's work, that it appears that he was very close to this discovery. He said that it might be possible, that by the writings of Galen's that are lost, there might be a link to conclude Galen did have such knowledge. (15, pages 469, 495, 501, 515, 526,527, 536, 541, 547, 639, etc.)
- Watson, John, "The Medical Profession from the Earliest Times: an anniversary discourse delivered before the New York Academy of Medicine November 7, 1855," 1856, New York, Baker & Godwini
- Meryon, Edward, "The History of Medicine," Volume I, 1861, London,
- Fourgeaud, V.J., "Historical Sketches: Galen," Pacific Medical and Surgical Journal," 1864, Vol VII, San Francisco, J. Thompson & Co., pages 22-29
- Jackson, Mark, "Asthma: A Biography," 2009, Oxford University Press, the quote from Jackson comes from On the Affected Partsby Galen
- Young, Thomas, "A Historical and Practical Treaties on Consumptive Diseases: Deduced From Original Observations, And Collected From Authors Of All Ages," 1815, London, B.R., page 145
- Adams, Francis, "The Medical Works of Paulus Agineta: The Greek Physician; translated into English with a Copious Commentary," vol. I, London, page 407-8, 1834, Adams gives a long list of ancient physicians who wrote about asthma
- Bradford, Thomas Lindsley, writer, Robert Ray Roth, editor, “Quiz questions on the history of medicine from the lectures of Thomas Lindley Bradford M.D.,” 1898, Philadelphia, Hohn Joseph McVey
- Garrison, Fielding Hudson, "Introduction to the history of medicine, 3rd edition, 1922, Philadelphia and London, W.B. Saunders Company
- Bendick, Jeanne, "Galen and the gateway to medicine," 2002, U.S., Bethlehem Books Ignatius Press
- Brock, Arthur John, translator and author of introduction, Galen, author, "Galen on the natural faculties," 1916, London, New York, William Heinemann, G.P. Putnam's Sons
- Galen, author, Arthur John Brock, translator, "Galen on the natural faculties," 1916, London, New York, William Heinemann, G.P. Putnam's Sons
- Gill, M. H., "Review and Bibliographic Notices: "On the spasmotic asthma of adults," by Bergson, published Gill's book, "The Dublin Quarterly Journal of Medical Science," volume X, August and November, 1850, Dublin, Hodges and Smith, pages 373-388
- Freudenthal, Wolff, "Bronchial Asthma," New York Medical Journal: A Weekly Review of Medicine, edited by Edward Swift Dunster, James Bradbridge Hunter, Frank Pierce Foster, Charles Euchariste de Medicis Sajous, Gregory Stragnell, Henry J. Klaunberg, Félix Martí-Ibáñez, volume CV, January-June, 1917 (Saturday, January 6, 1917), New York, A.R. Elliot Publishing, Co., pages 1-5