Claudius Galen of Pergamum: authority of medieval medicine.

Claudius Galen and his scholarly teachings defined the practice of medicine in Western Europe for 1500 years (Figure 1). His empiric approach, based on original animal experimentation, and his reputation for miraculous cures had an enormous influence on Western medicine during the Middle Ages and Renaissance until William Harvey’s discovery of the circulation of blood in the early seventeenth century.1–7 Galen was born in 129 A.D. in Pergamum, a city with its great temple to Asclepius, God of healing and a library of 50,000 volumes. His father, Aelius Nicon, was a wealthy cultured architect and landowner who provided young Galen with an education in philosophy and politics.1 He counseled his son to not compete for wealth and to pursue the truth regardless of the opinions of others.2 Galen idealized his father’s noble and level-headed nature, while condemning his mother for her short temper. By his teens, he was well-acquainted with Plato, Aristotle, the Stoics, and the Epicureans.1,2 Galen wrote that when he was 17, Asclepius appeared to his father in a dream, forecasting that his son’s destiny was medicine. Though he ceased to study philosophy after his teens, Galen retained the background of his original academic pursuit. He marveled at elegantly simple biological systems and attributed nature’s wonders to a creative force.2 He often referenced Plato’s Dialogues, and said that they had similar minds.3 Galen also relied on the teachings of Hippocrates, whom he thought to be nearly divine.3 He believed that a physician should be well-rounded and familiar with other arts and scientific fields, including music, rhetoric, geometry, and astronomy.4 When Galen was 20, his father died leaving him an inheritance which he used to travel throughout the Mediterranean and Near East to study medicine. He also searched for medicinal ingredients in foreign lands, not trusting the purity or freshness of the local drugs.1 He returned to Pergamum from Alexandria in 157 A.D. and was appointed physician to the gladiators when only 28 years old, an honor given to him by the high priest of Asia.1 Because the gladiators’ performances were often dedicated to the Emperor, maintaining their ability to fight was critical. Thanks to his experience in dissection, which gave him extensive knowledge of the skeletal and muscular systems, he was proficient in caring for the injuries that the gladiators received in combat.5 Galen was 33 years old when he first came to Rome, where he held public lectures and dissections through which he became increasingly well known. Since dissection of humans was illegal in Rome, Galen performed diverse animal dissections from which he sometimes extrapolated inaccurate ideas about human anatomy.2 His reputation also grew through his seemingly magical cures and skills as a diagnostician. Marcus Aurelius complimented his accurate diagnosis of a medical problem in the emperor that no other doctor had recognized. He was one of the few empiricist physicians of his times who sought to educate the public with his ideas, despite the trend that doctors did not disseminate their findings because of jealousy that others would profit from their work.2 Galen espoused moderation and poverty while observing much avarice in his contemporaries.5 At that time, socialite physicians in Rome courted the friendship of the wealthy and were followed by entourages who bolstered their importance.2 Galen offended these physicians by comparing them to brigands.4 Tension grew when he discredited their theories by his demonstrations.6 Galen left Rome in the summer of 166 A.D., possibly to escape the plague.1 Two years later Marcus Aurelius summoned him to travel to Germany with his army. Galen convinced the emperor to allow him to remain in Rome, where he was physician to Commodus, the heir to the throne. He stayed in the city until 192 A.D. when he was about 62 years old.2,5 He never married. There are no extant statues or coins of his image. Few details are known about the final years of Galen’s life, but he probably stayed in his native Pergamum, dying around 200 A.D. at age 70.2 The practice of medicine during medieval times and early Renaissance was based largely on Galen’s methods. He was thoroughly conversant with the prior body of medical knowledge, including the doctrines of the Empiricists, Methodists, and Dogmatists, about which he wrote critical analytical works.2 He sought past authority, primarily Hippocrates, Herophilus, and Erasistratus, and tried to combine his ideas with existing theories. He believed that Hippocrates was always right. Galen’s high regard for these authors contributed to his failure to discover the circulation of blood, despite his stress on experimentation and his accurate identification of the function of valves in preventing ‘‘matter from flowing backwards.’’