CHAPTER XVCLAUDIUS GALEN

During the centuries immediately preceding the Christian era, Greek medicine was represented by a collection of treatises which had been written by Hippocrates and his followers on anatomical, physiological, pathological, therapeutical and ethical subjects, and which constituted a fairly complete but not always easily intelligible system. As time went on, however, and especially as new and useful facts were constantly being added to the existing stock of medical knowledge, the more thoughtful physicians began to feel that the system, which up to that day had proved acceptable, needed to be perfected in a number of respects; and accordingly, as a result of this feeling of dissatisfaction, and also as an expression of the prevailing desire for a more perfect knowledge of the truth, there developed, as has been stated in the preceding chapters, a number of different medical sects. When Galen first appeared in the field as a physician of unusual promise, these various sects were all still in a thriving condition. The Methodists, in particular, were very popular. Galen did not favor any special sect, but in his writings he made it manifest that he attached more importance to the teachings of Hippocrates than to those of any other author. “It was Hippocrates,” he said, “who laid the real foundations of the science of medicine.” It is therefore not surprising that Galen should have devoted so much time to the writing of elaborate commentaries on the works of Hippocrates. The service which he thus rendered to medicine, says Daremberg, was of very great value. But Galen, notwithstanding his great admiration for Hippocrates, did not hesitate tocriticise a number of his teachings, and especially those which, as he believed, were not stated with sufficient clearness. Valuable as was the service rendered to medicine by the writing of these commentaries, there still remained an urgent need for a service of a different and much more difficult kind, viz., that of welding together into a single clearly written and easily intelligible system of medicine, all that was good in the Hippocratic writings and in the disconnected and at times antagonistic teachings of the sects. To accomplish this successfully required the services of a man endowed with mental gifts of a most exceptional character—complete knowledge of medicine in all its departments, a mind thoroughly trained in philosophy, the power to express his thoughts in simple language, and an independence and fairness of judgment which would render him indifferent to the petty interests of the sects. Claudius Galen, as subsequent events showed, possessed these very gifts in a high degree, and he devoted the better part of his reasonably long lifetime to the accomplishment of this much-needed work. How greatly it was needed at that particular period of time, nobody then knew or could even suspect. It soon appeared, however, that all the vaunted civilization of the Graeco-Roman world—much of it of the purest gold and a great deal of the basest alloy—was to be swept so completely off the face of the earth that, for thirteen hundred or more years, almost no thought whatever could possibly be given to the science and art of medicine. Fortunate, most fortunate it was, therefore, that, before this wave of destruction reached Rome, all the best part of Greek medical literature—for such it was in truth—had been gathered together and carefully systematized by Galen and stowed away in the recesses and chambers of remotely situated monasteries and churches by clear-sighted monks for the benefit of later generations of physicians.

Brief Biographical Sketch.—Claudius Galen was born in Pergamum, an important Greek city of Asia Minor, about the year 131 A. D., under the reign of the Emperor Hadrian. His father, whose name was Nicon, was a manof ample means, well informed in philosophy, astronomy and geometry, and most liberal in providing for the thorough education of his son in every branch of useful knowledge. In two or three places in his writings Galen speaks of his father in terms of affection. On the other hand, he does not hesitate to state in the plainest language possible that his mother was a veritable Xanthippe. In her moments of bad temper she would not only shout and scream in a violent manner, but would sometimes go so far as to bite her serving-maids. Pergamum, at the time of which I am writing, offered unusually good opportunities for studying disease. Its Asclepieion, which was built during Galen’s boyhood, had already become one of the famous temples of Asia Minor, and the sick and maimed flocked to it in large numbers. Then, in addition, the city was well equipped with able physicians, who appear, according to Neuburger, to have been on very friendly terms with the priests of the temple. It was under the guidance of such men that Galen—at the early age of seventeen, and after a careful training in philosophy, mathematics, etc.—began the study of medicine. He speaks with special interest and respect of one of his instructors, a certain Quintus, who had the reputation of being an excellent anatomist and at the same time one of the most distinguished practitioners of that day. Another anatomist, Styrus, was also one of Galen’s teachers.

On the death of his father Galen left his home and devoted the succeeding nine years to visiting all the different cities in which he believed he might gain some additional knowledge in medicine and surgery. A large part of this long period was spent in Alexandria, which still retained much of its importance as a home of all the sciences. On attaining his twenty-eighth year he left that city and returned to Pergamum, evidently with the purpose of establishing himself there in the regular practice of his profession. Through the influence of the temple officials, and especially of the High Priest, Galen received the appointment of physician to the gladiators, a position which he held with credit for a period of four years, andwhich afforded him excellent opportunities for cultivating his knowledge of surgery. It was while he was serving in this capacity that he devised and put into practice a method of saturating the dressings (in cases of severe wounds) with red wine, for the purpose of preventing the development of inflammation in the parts affected; and the success which he thus obtained was so great that not one of the gladiators intrusted to his care died from his wounds. History does not state the precise manner in which Galen carried out his method of utilizing wine in the dressing of wounds, and we are therefore unable to determine just how much credit he was entitled to receive for this crude but apparently effective means of securing local antisepsis. It is clear, however, that Galen’s treatment could only have been a modification of a much older method, for Jesus, in his answer to a question put to him by a lawyer, said: “But a certain Samaritan, as he journeyed, came where he (the injured man) was: and when he saw him, he had compassion on him, and went to him, and bound up his wounds, pouring in oil and wine, and set him on his own beast, ...” (St. Luke x., 33, 34).

At the end of four years there broke out in Pergamum a riot which rendered residence there, at least for a certain length of time, undesirable. Accordingly Galen, who was now thirty-two years old, and who was probably glad of an excuse for leaving a place where a physician of his education and talents had so few opportunities for gaining distinction, decided to visit Rome, and—if circumstances appeared to favor the plan—to settle there. His first impressions after arriving in that metropolis were favorable to the plan of establishing himself there permanently, but at the end of a few years he became conscious of the growing hostility of those practitioners who had been for a longer time than he well established in that city. This hostility increased as he rose in favor and esteem with people of position and influence. He had treated skilfully and with success Eudemus, a peripatetic philosopher of great celebrity, for a quartan fever. He had also cured the wife of Boëthus (a patrician who belonged to the consular class)of a serious illness and had received as an expression of appreciation a gift of four hundred pieces of gold. He had won the friendship and esteem of such men as Sergius Paulus, the Praetor; of Barbaras, the uncle of the Emperor Lucius; and of Severus, who was at that time Consul, but who later became Emperor. These very influential men took an active interest in Galen’s scientific work, having been invited by him on more than one occasion to witness his dissections of apes,—dissections which he made for the particular purpose of demonstrating the organs of respiration and of the voice. All these facts soon became known to Galen’s rivals and probably helped to fan the spark of their envy into a flame; but it is very doubtful whether he was justified in saying that the ill feeling thus engendered threatened to end in some act of personal violence, for which reason he decided to leave Rome and return to Pergamum. His secret manner of departure, without taking leave of anybody, and the fact that the Plague was just at that time rapidly approaching Rome, justify the belief, says Neuburger, that it was not fear of personal violence at the hands of his jealous rivals that drove Galen away so mysteriously from the city in which, in the short space of four or five years, he had won so great professional success, but an unwillingness to face his duty, which was, to remain and aid in the approaching fight against the great destroyer—the Plague. If Galen had been a simple physician, one of the great body of medical practitioners in Rome, no one would be disposed to question the justice of the criticism which the distinguished Viennese historian makes of his decision to abandon that city at the moment of her distress and peril. But, as a matter of fact, Galen was not a practitioner of medicine in the full sense of that term. He treated cases of illness because in no other way would it be possible for him to acquire the necessary familiarity with disease; but, almost from the very beginning, he seems to have fully realized that he was destined to devote his time and his energies to a very different kind of professional work,—work which was urgently needed, which promised to be of very greatvalue to medical science, and which probably no other physician then living was competent to do effectively. Furthermore, he was himself profoundly conscious that the work in question constituted the main object of his life. His own words (see his statement with reference to Archigenes, on page 174) show this plainly, and the huge mass of medical treatises which he wrote reveal in the most unmistakable manner with what untiring persistency he pursued the path which he believed it was his duty to follow. It being assumed, then, that such were the motives which actuated Galen, was it a mistake on his part to conclude that duty did not require him to remain in Rome? The question is a difficult one to answer, and I do not feel called upon to decide it. We do not, however, brand a general in the army a coward because he endeavors to protect himself as much as possible from danger during a battle, that he may be able, to the very end, to direct the soldiers under his command. Similarly, was not Galen justified in avoiding every risk which was likely to imperil the performance of duties which were of far greater value to medicine and to humanity at large than that of acting as a mere soldier in the ranks of medical men?

It seems a great pity that one of the most inspiring figures in the history of medicine should be represented to posterity with such a blemish upon his character, and I have therefore ventured to suggest a possible defense of Galen’s action.

Not very long after he had returned to Pergamum, Galen was summoned by the Emperors Marcus Aurelius and Lucius Verus, who were then with the army at Aquileia, a few miles north of the present Trieste, to join them at that city; and he was, of course, obliged to obey. A fresh outbreak of the Plague had occurred and there had already been many fatal cases among the troops. It was therefore decided by the emperors, almost immediately after Galen’s arrival, to return to Rome with a part of the army. A start was accordingly made, and the company had already advanced some distance on their way, when Lucius Verus died. This unexpected event greatly increasedthe difficulties of the return journey, as it was deemed necessary to carry the remains of the deceased Emperor back to the imperial city. Thus Galen found himself once more settled in Rome, this time in the capacity of private physician to the Emperor Marcus Aurelius and his sons Commodus and Sextus. The position was extremely well adapted to the needs of Galen, who, from that time forward, for a period of several years, had at his disposal ample time for writing and for conducting his experimental work in anatomy and physiology, a privilege of which he appears to have made excellent use. He lived to be seventy years of age, his death occurring during the latter part of the reign of Severus, or at the beginning of that of Caracalla (about 201 A. D.).

All Galen’s critics agree that he possessed his full share of peculiarities,—not to call them by the harsher name of faults. He was constantly ready, for example, to praise his own doings and sayings, and he rarely lost an opportunity of holding up the physicians of Rome to ridicule and contempt. He was specially bitter in his criticisms of Methodism and its adherents—“the donkeys of Thessalus,” as he called them. At the same time, no other physician of ancient or modern times has manifested to an equal degree such extraordinary industry as a writer and original investigator in a great variety of departments of knowledge. Although many of his works have been lost,[39]those which have come down to our time are still very numerous—“a sufficient number,” says Neuburger, “to constitute a library by themselves.” I give here a few of the titles of these works, in order that the reader may get at least some idea of the great variety of medical topics which Galen has discussed in his writings. The more complete list furnished by Daniel Le Clerc contains nearly two hundred titles, and yet even this is believed to fall short of the actual number.

The numerous works of Galen, says Pagel, constitute a complete and very satisfactory encyclopaedia of medicine. The most available edition of his works in Greek is that of Karl Gottlob Kühn of Leipzig (1821–1828; 22 Vols. of about 1000 pages each). There is scarcely a department which this great physician has not treated quite fully. But, unfortunately, the translations into modern languages are relatively few, and they cover only small portions of the entire work. That of Daremberg, entitled “Oeuvres anatomiques, physiologiques et médicales de Galien, etc.” (Paris, 1854–1857; 2 Vols.), is in every way most satisfactory, and it is from this source that I have made a few extracts—just sufficient to give the reader some idea of Galen’s style of writing and of his competency to deal with such subjects as human anatomy and physiology. To attempt anything like a complete exposition of his views regarding pathology, therapeutics, hygiene, etc., would necessitate my devoting more space to this part of the history of medicine than I can afford to give. To those who desire to obtain more ample information about Galen’s views regarding pathology and therapeutics I would recommend a study of Daremberg’s admirable work and a perusal of the careful analysis made by Neuburger of certain portions of Galen’s text.

Galen’s Contributions to Anatomy and Physiology.—Atthe period of time about which I am now writing, and for many centuries afterward, there existed among all classes of the community a very strong prejudice against dissecting human corpses. And even Galen himself appears to have shared this prejudice, for, in spite of his intense eagerness to gain a more perfect knowledge of human anatomy, he apparently did not dare to undertake any such investigation, even when a favorable opportunity for so doing presented itself, as it did on the occasion to which he refers in the following brief extract taken from one of his treatises:—

A carelessly constructed sepulchre on the banks of a river had been undermined during a season of flood, and the corpse thus set free had floated down stream a short distance, until it finally lodged on the shore of a small cove. Passing near by I had the opportunity of inspecting this corpse. The fleshy parts had already disappeared to a great extent through the process of decomposition, but the bones were still held together by their fibrous connections. The picture presented to the eye was that of a human skeleton specially prepared for the instruction of young physicians. On another occasion, a few steps from the main road, I came across the dead body of a robber who had been killed by the traveler whose money he had attempted to steal. The peasants of that neighborhood were not willing to bury the corpse of such a bad man, and they accordingly allowed it to remain at the spot where it was first discovered. In the course of the following two days, as might be expected, the vultures removed every particle of flesh from the bones, so that, when I saw what remained of the body, the only thing visible was a nicely cleaned skeleton.(Le Clerc:Histoire de la Médecine, p. 711.)

(Le Clerc:Histoire de la Médecine, p. 711.)

Here were two excellent opportunities for gaining the additional knowledge of human anatomy which Galen so much desired, but he evidently was not at all disposed to avail himself of them—doubtless because his mind was deeply imbued with the feeling that any such interference on his part would be a sacrilegious act. Under the circumstances, therefore, there was nothing left for him to do but to utilize animals for purposes of dissection, and more particularly apes, whose anatomy very closely resemblesthat of the human being. Several of Galen’s books on anatomy have come down to our time, but quite a number of others have been lost. From those which we possess, and especially from the one entitled “Anatomical Administrations,” it is permissible to conclude that he was a most skilful dissector and an extremely close and careful observer, and that he was very particular to set down the results of his observations in admirably clear language. Indeed, Le Clerc assures us that Vesalius, the great Flemish anatomist of the sixteenth century, bestowed high praise upon Galen’s anatomical descriptions; and that, too, notwithstanding the fact that the latter sometimes erred in his statements regarding the similarity between certain parts observed in dissections of an animal and the corresponding parts in man. In one of his treatises[40]Galen states distinctly that the arteries contain blood. In another he gives a remarkably full and accurate description of the nervous system, including the brain, spinal cord, and many of the nerves.

He describes the optic nerve, the oculo-motorius and trochlearis, the different ramifications of the trigeminus, the acusticus and facialis, the vagus and glossopharyngeus, the nerves of the pharynx and larynx, the sympatheticus (with the accompanying ganglia), and the radial, ulnar, median, crural and ischiatic nerves. (Puschmann.)

Although it is true that certain important anatomical and physiological facts are found recorded for the first time in the works of Galen, this must not be accepted as evidence that Galen himself is the real discoverer of these facts. The most that can be claimed for him is that he is the first writer to bring the facts in question to the knowledge of us moderns. When the ancient books that have been lost are once more brought to light, as they very well may be at any time, we shall be able, perhaps, to give credit where credit is due. But there is one department in which Galen did experimental work of an entirely original character and for which he deserves unstinted praise. I refer to the experiments which he made concerning the physiology ofthe brain and spinal cord. They are related in the following extract, which has been translated from the account given by Neuburger (op. cit., Vol. I., p. 380):—

The brain itself is not sensitive; it expands and contracts synchronously with the respiratory movements, the purpose of which action is to drive the pneuma from the cavities of that organ into the nerves. The function of the meninges is to hold the parts firmly together and to unite the blood-vessels. Pressure upon the brain causes stupor. An injury of the tissues surrounding the fourth ventricle or of those which constitute the beginning of the spinal cord produces death. The seat of the soul is in the substance of the brain, and not in its membranes. The spinal cord serves as a conductor of sensation and of motor impulses, and it also plays the part of a brain for those structures of the body which lie below the head. It gives off nerves like streamlets. Division of the spinal cord longitudinally in its median axis does not give rise to paralysis. Transverse division, on the other hand, causes symmetrical paralyses. If the cord is divided between the third and fourth cervical vertebrae, respiration is arrested, and if the division is made between the cervical and the thoracic portions of the spinal column, the animal breathes with the aid only of its diaphragm and of the upper muscles of the trunk of the body. Division of the recurrent nerves produces aphonia; if the fifth cervical nerve is divided, the scapular muscles on the corresponding side will be paralyzed. Galen considers the ganglia to be organs for reinforcing the energy of the nerves. The fact that both cerebral and spinal-cord nerve-filaments enter into the composition of the sympathetic nerve explains the extraordinary sensitiveness of the abdominal organs.

When we consider that these experiments are the first of their kind of which history makes mention, that they were carried out nearly seventeen hundred years ago, and that—so far as we know—they sprang entirely from the brain of the experimenter, we may well express unlimited admiration for Claudius Galen.

Daniel Le Clerc says that Galen’s principal treatise on human physiology, entitled “Utility of the Different Parts of the Human Body,” constitutes achef-d’oeuvrewhich has challenged the admiration of physicians and philosophers in all ages. Christians, however, he adds, areparticularly gratified to learn from this work that “Galen, although classed as a Pagan, unhesitatingly recognizes that it was an all-wise, an all-powerful, an all-good God who created man and all the other animals.” Further on, Le Clerc refers to another statement which was made by Galen and which will be found on page 261 of Daremberg’s version. It reads as follows:—

If I were to spend any more time in talking about such brutes—by which term he designates men who cannot appreciate the wisdom of God in distributing the different parts of the body in the manner in which He has done this—I should justly incur the blame of sensible persons. They would accuse me of desecrating the account which I am writing, an account which is intended as a hymn of sincere praise of the Creator of man. I believe that true piety consists, not in sacrificing numberless hecatombs nor in burning unlimited quantities of incense and a thousand perfumes, but in first searching out and then making known to my fellow men how great are the wisdom, the power, and the goodness of the Creator.

Galen’s work on “The Utility of the Different Parts of the Human Body” is composed of seventeen books, all of which exist to-day in a complete state. Taken together they form, as may be seen by the following list of contents, a remarkably complete treatise on physiology. Books I. and II. are devoted to the hand, forearm and arm (105 pages); Book III. to the thigh, leg and foot (62 pages); Books IV. and V. to the alimentary organs and their accessories (101 pages); Book VI. to the respiratory organs (78 pages); Book VII. to the organs of the voice (67 pages); Book VIII. to the head, the encephalon and the organs of special sense (45 pages); Book IX. to the cranium, the encephalon and the cranial nerves (38 pages); Book X. to the eyes and their accessories (45 pages); Book XI. to the face and more particularly the jaws (55 pages); Book XII. to the neck and the rest of the spinal column (46 pages); Book XIII. to the shoulder and the structure of the spinal column in detail (40 pages); Books XIV. and XV. to the genital organs and the parts in which the foetus develops (70 pages); Book XVI. to the nerves, arteries and veins (43 pages); and Book XVII. Epilogue (11 pages).

There are very few modern text books in which the author treats the subject in as exhaustive a manner as Galen has done in these seventeen books. As may readily be imagined from the great number and length of his writings, he often wanders off into side issues and thus lays himself open to the charge of being a diffuse writer. At the same time he cannot be accused of dullness, for in reading Daremberg’s version one is seldom tempted to omit any of the text, and his style is interesting. The following brief extracts, to which should be added that given on a previous page, may be taken as fair samples of his manner of treating questions in the department of physiology:—

Reasons why the Alae Nasi are Cartilaginous and why they may be Moved by Voluntary Muscular Action.—We have already explained in some measure the reasons why the alae nasi should be composed of cartilage and why it should be possible for the animal to move them at will.[41]It is an established fact that the movements of these parts are competent to aid in no small degree the somewhat forcible inspirations and expirations. This is the reason why the alae are constructed in such a manner as to be easily movable. They are made of cartilage because this substance is hard to fracture or to tear apart. The placing of these alar movements under the control of the will, and not under that of some other bodily force (like the arterial impulse, for example), is certainly an excellent arrangement; and, if one does not appreciate this without any further explanation, it must be because my previous reasonings about such matters have fallen upon inattentive ears.(Translated from Book XI., Chapter XVII., of Daremberg’s French version of Galen’s works.)

(Translated from Book XI., Chapter XVII., of Daremberg’s French version of Galen’s works.)

Another brief extract may be given here. It forms a part of the chapter relating to the action of the sigmoid valves of the pulmonary artery, etc., and merits special attention because it furnishes additional evidence of thecorrectness of Daremberg’s statement that Galen was the leader of the most advanced school of experimentation:—

The more strongly the thorax, in its exertion of a compressing force, tends to drive the blood (out of the heart), the more tightly do these membranes (the sigmoid valves) close the opening. Invested in a circular manner from within outward, extending throughout the entire circumference of the interior of the vessel, these membranous valves are, each one of them, so accurately patterned and so perfectly fitted that when they are put upon the stretch by the column of blood, they constitute a single large membrane which closes (watertight) the orifice. Pushed back by the return flow of the blood, they fall back against the inner surface of the vein, and permit an easy passage of the blood through the amply dilated orifice (which they, an instant before, closed so perfectly).(Translated from Book VI., Chapter XI., of Daremberg’s French version of the works of Galen.)

(Translated from Book VI., Chapter XI., of Daremberg’s French version of the works of Galen.)

In his comments upon the account of the sigmoid valves which I have just quoted, Daremberg says that the description of these structures given by Erasistratus at least four hundred years earlier is admitted by Galen to be so correct that it would scarcely be possible to furnish a better one.

Galen’s Remarks upon the Subject of Diagnosis.—In the treatise entitled “On the parts of the Body Affected” (Book II., Chapter X.) Galen gives the following advice with regard to the method which it is desirable to adopt when one wishes to ascertain which part or organ is affected, what is the nature of the disease there located, and whether it is primary in its nature or secondary to some affection of earlier development:—

It should have been the special duty of Archigenes, who appeared on the scene next in order after a series of the most illustrious physicians,[42]to infuse more light into medical teaching. Unfortunately,he did the very opposite; for we who have grown old in the exercise of the art (and should therefore find it easy to comprehend what is written about medicine), are at times unable to understand what he says. Such being the true state of affairs, I now propose to undertake what Archigenes failed to accomplish. I shall commence by indicating in a general way what is the proper method to adopt when one wishes to ascertain in what part or organ the disease is located and how one should proceed when it is proposed to teach the method to others. This method may be stated in the following terms:—In the first place, the part should be carefully examined in order that we may ascertain whether it presents any signs of special value as indicating the nature of the disease. In the next place, it is important in such an examination to know beforehand what are the particular signs which belong to each of the diseases that may affect the part or organ in question, and also whether these signs vary according to the particular section of the organ involved. In inflammation of the lung, for example, there are: difficulty in breathing (dyspnoea) and great general distress (malaise), the patient being obliged to remain in a sitting posture (orthopnoea)—all of which are signs indicating the possibility of suffocation. Furthermore, the air expired from the infected lung is sensibly hot, especially if the inflammation is of the erysipelatous variety, and, as a consequence, the patient shows a disposition to draw long breaths, knowing that the cold air which he thus draws into his lungs will afford him some measure of relief. The sputa expectorated when he coughs are differently colored; some being red, yellowish, or of a rusty appearance, while others are almost black, livid, or frothy. The patient also often experiences the sensation of a heavy weight in his chest, together with more or less pain, which seems to be located deep down in that region and which shoots backward into his spinal column or forward toward the sternum. Add to these manifestations a high fever and a pulse such as we have already described on another page, and you will have....(Translated from Daremberg’s French version of Galen’s works.)

In the first place, the part should be carefully examined in order that we may ascertain whether it presents any signs of special value as indicating the nature of the disease. In the next place, it is important in such an examination to know beforehand what are the particular signs which belong to each of the diseases that may affect the part or organ in question, and also whether these signs vary according to the particular section of the organ involved. In inflammation of the lung, for example, there are: difficulty in breathing (dyspnoea) and great general distress (malaise), the patient being obliged to remain in a sitting posture (orthopnoea)—all of which are signs indicating the possibility of suffocation. Furthermore, the air expired from the infected lung is sensibly hot, especially if the inflammation is of the erysipelatous variety, and, as a consequence, the patient shows a disposition to draw long breaths, knowing that the cold air which he thus draws into his lungs will afford him some measure of relief. The sputa expectorated when he coughs are differently colored; some being red, yellowish, or of a rusty appearance, while others are almost black, livid, or frothy. The patient also often experiences the sensation of a heavy weight in his chest, together with more or less pain, which seems to be located deep down in that region and which shoots backward into his spinal column or forward toward the sternum. Add to these manifestations a high fever and a pulse such as we have already described on another page, and you will have....

(Translated from Daremberg’s French version of Galen’s works.)

It has been said that Galen possessed more than the ordinary share of vanity with regard to his cleverness asa diagnostician; and certainly some of the accounts which he gives, in his clinical and scientific treatises, of his own experiences, seem to bear out this accusation. One hesitates to expose the weak spots in the character of one of the really great men of antiquity lest such exposure may convey a wrong impression; at the same time it would be an error to represent him as a man entirely free from the foibles common to humanity,—even to the best and wisest of men. I therefore repeat here Galen’s own account of a professional visit which he made to a brother physician whose malady presented to himself and to his friends many obscure features.

Upon the occasion of my first visit to Rome I completely won the admiration of the philosopher Glaucon by the diagnosis which I made in the case of one of his friends. Meeting me one day in the street he shook hands with me and said: “I have just come from the house of a sick man, and I wish that you would visit him with me. He is a Sicilian physician, the same person with whom I was walking when you met me the other day.” “What is the matter with him?” I asked. Then coming nearer to me he said, in the frankest manner possible: “Gorgias and Apelas told me yesterday that you had made some diagnoses and prognoses which looked to them more like acts of divination than products of the medical art pure and simple. I would therefore like very much to see some proof, not of your knowledge but of this extraordinary art which you are said to possess.” At this very moment we reached the entrance of the patient’s house, and so, to my regret, I was prevented from having any further conversation with him on the subject and from explaining to him how the element of good luck often renders it possible for a physician to give, as it were off-hand, diagnoses and prognoses of this exceptional character. Just as we were approaching the first door, after entering the house, we met a servant who had in his hand a basin which he had brought from the sick room and which he was on his way to empty upon the dung heap. As we passed him I appeared not to pay any attention to the contents of the basin, but at a mere glance I perceived that they consisted of a thin sanio-sanguinolent fluid, in which floated excrementitious masses that resembled shreds of flesh—an unmistakable evidence of disease of the liver. Glaucon and I, not a word having been spoken by either of us, passed on into the patient’s room. When I put out my hand to feel of thelatter’s pulse, he called my attention to the fact that he had just had a stool, and that, owing to the circumstance of his having gotten out of bed, his pulse might be accelerated. It was in fact somewhat more rapid than it should be, but I attributed this to the existence of an inflammation. Then, observing upon the window sill a vessel containing a mixture of hyssop and honey and water, I made up my mind that the patient, who was himself a physician, believed that the malady from which he was suffering was a pleurisy; the pain which he experienced on the right side in the region of the false ribs (and which is also associated with inflammation of the liver) confirming him in this belief, and thus inducing him to order for the relief of the slight accompanying cough the mixture to which I have just called attention. It was then that the idea came into my mind that, as fortune had thrown the opportunity in my way, I would avail myself of it to enhance my reputation in Glaucon’s estimation. Accordingly, placing my hand on the patient’s right side over the false rib, I remarked: “This is the spot where the disease is located.” He, supposing that I must have gained this knowledge by simply feeling his pulse, replied with a look which plainly expressed admiration mingled with astonishment, that I was entirely right. “And”—I added simply to increase his astonishment—“you will doubtless admit that at long intervals you feel impelled to indulge in a shallow, dry cough, unaccompanied by any expectoration.” As luck would have it, he coughed in just this manner almost before I had got the words out of my mouth. At this Glaucon, who had hitherto not spoken a word, broke out into a volley of praises. “Do not imagine,” I replied, “that what you have observed represents the utmost of which medical art is capable in the matter of fathoming the mysteries of disease in a living person. There still remain one or two other symptoms to which I will direct your attention.” Turning then to the patient I remarked: “When you draw a longer breath you feel a more marked pain, do you not, in the region which I indicated; and with this pain there is associated a sense of weight in the hypochondrium?” At these words the patient expressed his astonishment and admiration in the strongest possible terms. I wanted to go a step farther and announce to my audience still another symptom which is sometimes observed in the more serious maladies of the liver (scirrhus, for example), but I was afraid that I might compromise the laudation which had been bestowed upon me. It then occurred to me that I might safely make the announcement if I put it somewhat in the formof a prognosis. So I remarked to the patient: “You will probably soon experience, if you have not already done so, a sensation of something pulling upon the right clavicle.” He admitted that he had already noticed this symptom. “Then I will give just one more evidence of this power of divination which you believe that I possess. You, yourself, before I arrived on the scene, had made up your mind that your ailment was an attack of pleurisy, etc.”Glaucon’s confidence in me and in the medical art, after this episode, was unbounded.

Glaucon’s confidence in me and in the medical art, after this episode, was unbounded.

Thirty or forty years elapsed after Galen’s death before the Profession began to realize how great an authority he had become in all matters relating to medicine; not perhaps among the majority of physicians, but among the better educated and those more given to reasoning about the various problems in physiology and pathology. Then came the invasion of Rome by the Barbarians, and with it the scattering of nearly all those who were at the time practicing medicine in that great city. This was the beginning of the long period known as the Middle Ages, a period during which, so far as Italy and Gaul were concerned, the science of medicine made no advance whatever. The physicians living in a precarious manner in the towns, and the monks who practiced medicine in the country districts, took very little interest, as may readily be imagined, in the achievements of Galen. Through all those years they clung to the doctrines of the Methodists, as revealed to them in the work of Caelius Aurelianus, the favorite medical treatise of that period. It was only during the latter part of the Middle Ages that Galen’s teachings began once more to be appreciated at their true value; and, as time went on, they gained a stronger and stronger hold on the minds of medical men, until finally they held undisputed sway. Friedlaender, speaking of medicine in those dark times, uses these words: “Galen’s colossal personality loomed up throughout that long night as a brilliant guiding star to light the intricate pathways of medicine.”

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