Medicine in the Graeco-Roman world researched and written by library volunteer Ken Smith.
Over time, the Greek-Roman doctor Claudius Galen (129-c.216 AD) has become one of the best-remembered figures of the classical world. Thus, I was surprised to see that Salisbury Cathedral library has only three copies of his works in their catalogue. From this, I assume that the subject matter, i.e. medicine, was not of particular interest or relevance to the majority of donors to the library. It is possible that the Galenic books in the library reflect the more diverse interests of Bishop Seth Ward who was also an astronomer and mathematician and gifted some three hundred books to the library following his death in 1689.
Claudius Galen was born in Pergamon (now Bergama in Turkey) into a relatively wealthy family. His education involved travel to various places in the ancient world, including Alexandria, where medicine was studied. When he was older, Galen moved to Rome where he served prominent members of Roman society before becoming personal physician to several Roman emperors. Galen’s medical training was influenced by the ideas of the ancient Greek doctor Hippocrates. Hippocrates had systemised the belief in Humourism in ancient Greece. This idea advocated that a balance existed in all human bodies between four humours or liquids: blood, black bile, yellow bile and phlegm. The theory held that each person’s ratio of these humours was specific to them.
In his medical practice, Galen promoted and extended this idea. Whilst Hippocrates had taught that imbalances in the humours affected human moods, Galen took this further to suggest that such imbalances corresponded with a particular human temperament. Thus, an excess of blood produces a sanguine personality (extroverted and social). An excess of black bile produces a melancholic temperament (creative, kind and considerate) whereas too much yellow bile produces a choleric individual (energetic, passionate and charismatic). Finally, an excess of phlegm produces a phlegmatic person (dependable, kind and affectionate). It is worth noting that modern usage of these terms often differ from these definitions, i.e. melancholic has a less positive meaning today. Although these imbalances produced an individual’s personality, other imbalances could produce ill health. So a sanguine personality, if producing too much phlegm, or too little yellow bile, could become ill.
Galen based many of his treatments on these beliefs, advocating bleeding, and the use of emetics or purging to re-balance the ratio of humours. His experience as a young man working in an asclepion (a spa or sanitorium) in Pergamon, where doctor/priests used sacred snakes to treat patients, along with rest, bathing and good diet, added to his repertoire of techniques. His later experience of being physician to the gladiators also increased his skills in dealing with traumatic wounds. He referred to some of the more serious wounds as offering “windows into the body”. His treatments seem to have been effective, as it was recorded that only five deaths occurred amongst the gladiators whilst he was physician, compared to sixty deaths under his predecessor.
Galen lived at a time when human dissection was forbidden by religious laws. To satisfy his fascination with anatomy he dissected animals instead, particularly monkeys and pigs. Although this experience was useful, his reliance on animal dissection meant that he made some errors in his beliefs about how human bodies worked. For example, although he was the first physician to recognise the difference between venous (dark) and arterial (bright) blood, he incorrectly surmised that the blood flowed around the body in two distinct one-way systems rather than a single unified circulatory system.
Galen regarded himself as much a philosopher as a physician and wrote widely on topics as diverse as anatomy, logic, physiology, pathology, neurology and philosophy. For example, he was not only able to show the difference between motor and sensory nerves, but also how agonist and antagonist muscles worked. He also developed a theory of a tri-partite soul and treated people suffering from psychological problems with counselling.
After the fall of the Roman Empire in the west, the study of Galen’s works declined as few Latin scholars could then read Hebrew. However, in Byzantium, Galen’s books continued to be studied and after about 750AD Arab Muslim scholars began to translate and use Galenic texts. The Arab doctors did not accept Galen’s ideas uncritically, but incorporated them into their practices with experimentation. Thus, it was that in 1221, Ibn-al-Nafis discovered the pulmonary circulation disproving Galen’s theory of the heart. From the 11th century onwards, Latin translations of Arabic medical texts began to appear in the west. Textbooks such as Ibn Sina’s “Canon of Medicine” became the mainstays of medical training in universities. The Cathedral library has a magnificent 2-volume edition of this work dating from 1595.
The final defeat of Galenism came in the Renaissance when anatomists such as Vesalius were able to disprove many of Galen’s assertions. Famously this included Vesalius’ inability to find, after repeated dissections, the pores that Galen had said existed between the two sides of the human heart. Some Galenic ideas did persist well into the 19th century. These included the practice of bloodletting as a remedy for many ailments and the idea of “miasma” or gaseous exhalations from drains and swamps as being the cause of infectious disease. It is difficult to find another individual who, despite some errors, has had a more profound effect on the development of western medicine than Claudius Galen.