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© 2024 Jeffrey W. Bulger

Chapter 66: Galen

Chapter 66: Galen of Pergamum (GAY-len, 129-216 CE) — The Medical Synthesizer: Humoral Theory and Medical Ethics

Galen’s blend of rationalism and empiricism in medical research established foundational principles for the scientific method and medical ethics. However, his contributions also included inaccuracies that influenced medical practice for over 1,500 years.

Abstract: Galen of Pergamum, a towering figure in ancient medicine and philosophy, profoundly shaped Western medical and scientific traditions. Championing a blend of rationalism and empiricism, he emphasized observational data and logical reasoning, laying the groundwork for modern scientific inquiry. His meticulous research, including animal dissections and vivisections, pioneered evidence-based inquiry. Galen’s extensive writings on anatomy, physiology, and pharmacology became foundational texts, shaping medical discourse for centuries in Europe and the Islamic world. However, his adherence to the humoral theory and certain anatomical misconceptions perpetuated false beliefs that negatively impacted medical practice for over 1,500 years. His implicit adherence to medical ethics, evident in his respect for the Hippocratic Oath and emphasis on physicians’ moral duty, set early ethical standards in medicine. Despite his contributions, modern ethical standards such as those outlined by the Institutional Animal Care and Use Committee (IACUC) would not condone many of his practices.

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Introduction: Galen of Pergamum is one of antiquity’s most influential figures in medicine and philosophy. Born in the vibrant city of Pergamum, in what is today modern-day Turkey, Galen’s prodigious contributions fundamentally shaped medical understanding for nearly fifteen centuries. Trained in the rich medical traditions of Greece and the broader knowledge realms of the Roman Empire, he authored an astonishing array of works encompassing areas from anatomy and physiology to philosophy and ethics. His extensive dissections of animals, primarily monkeys and pigs, paved the way for breakthrough insights into the workings of various organs and systems within the body. While some of his conclusions were later revised with modern medical techniques and understanding, Galen’s rigorous methodologies, holistic approach, and emphasis on empirical observation solidified his position as a cornerstone of Western medicine’s foundation.

Rationalism: In the context of his time, Galen showcased a distinctively rationalist approach to medicine and science. Rather than solely relying on superstitions, divine intervention, or anecdotal accounts, as many of his contemporaries might, Galen emphasized the importance of empirical observation and logical reasoning. However, it is ironic that Galen, often celebrated as a critical thinker, fully embraced the Hippocratic corpus’ humoral theory—a framework with no rational or empirical basis other than Galen’s own rational and observational biases. The humoral  theory posited that health depended on the balance of four bodily fluids (blood, phlegm, yellow bile, and black bile), was then continued to be accepted and perpetuated as medical doctrine, due to Galan’s revered and unquestionable authority, for another 1,500 years. This irony highlights the complexities and limitations of even the most influential scientific minds.

Empiricism: Galen’s commitment to empiricism, the philosophical doctrine that knowledge is derived from sensory experience, was a defining characteristic of his medical practice. Unlike those who might place unquestioned trust in ancient texts or inherited wisdom, such as was done with Galen himself, Galen championed the direct observation and experiential study of the natural world. His extensive dissections of animals testify to this orientation, as he sought to gain firsthand knowledge of anatomy and physiology, even when such practices were controversial or challenging. For Galen, genuine understanding arose from tangible evidence rather than abstract theorization. His clinical methods also underscored this empiricist approach. As exemplified in the Hippocratic corpus, Galen carefully observed patients, recording symptoms, progressions of diseases, and the effects of various treatments, using these observations to refine his medical theories and practices. For example:

Fever Treatment: Galen’s observations led him to oppose the use of excessive cooling methods for treating fevers, advocating instead for balanced approaches that took into account the patient’s overall condition.

Fracture Treatment: Galen improved the methods for treating bone fractures, recommending the use of splints and proper alignment, which significantly reduced healing complications.

His magnum opus, “On the Usefulness of the Parts of the Body,” exemplifies his empirical method, where he intricately detailed the functions and interrelations of bodily parts based on direct study. Through this unwavering commitment to empirical inquiry, Galen not only enhanced the medical knowledge of his time but also laid the groundwork for future generations to question, experiment, and learn through observation.

The Scientific Method: While the scientific method as we understand it today evolved much later, Galen’s approach to medicine and inquiry can be seen as an embryonic form of this rigorous investigation process. He ardently advocated for direct observation, experimentation, and systematic documentation, principles that are fundamental to the contemporary scientific method. Galen’s insistence on confirming or refuting established beliefs through hands-on study set a precedent for later scholars. His detailed animal dissections, for instance, were not mere academic exercises but rigorous attempts to understand the inner workings of the body, challenge prevailing notions, and correlate structure with function. When he made medical claims, they were often based on repeated observations and the outcomes of therapeutic interventions. By placing evidence at the heart of knowledge, as opposed to unchallenged acceptance of traditional beliefs or speculative reasoning, Galen sowed the seeds of an empirical approach that would, over time, evolve into the structured methodology of hypothesis testing and validation. Thus, while Galen himself did not conceptualize the “scientific method” in its modern form, his commitment to empirical inquiry and systematic experimentation undoubtedly influenced its eventual formation and the evolution of scientific inquiry.

Medicine: Galen’s legacy in medicine is complex. As one of antiquity’s most prolific medical writers, he penned numerous treatises encompassing various topics, from anatomy and physiology to therapeutics and philosophy. His groundbreaking animal dissections allowed him to elucidate and document aspects of the cardiovascular, nervous, and respiratory systems, offering insights that remained canonical until the Renaissance. However, these contributions must be viewed critically:

Pharmaceutical Preparations: Galen developed complex formulas for drug compounding, many of which formed the basis of medicinal recipes for centuries. While innovative for his time, these formulas often lacked the scientific rigor and understanding of pharmacodynamics that modern medicine requires.

Surgical Techniques: His detailed descriptions of surgical procedures, such as the removal of cataracts and treatment of spinal injuries, set standards for surgical practice that persisted until modern advancements. However, these were often based on limited anatomical understanding and lacked aseptic techniques.

Although Galen provided significant contributions, his adherence to certain erroneous beliefs had a huge negative impact on medical practice that would last for over 1,500 years. For example, his support of the humoral theory, which posited that health depended on the balance of four bodily fluids, led to treatments that were often ineffective and sometimes harmful. Practices such as bloodletting and the use of purgatives persisted because of Galen’s authority, causing suffering and harm to countless patients. His incorrect theories about the circulatory system, believing that blood was continuously produced and consumed rather than circulated, delayed the correct understanding of human physiology until the work of William Harvey in the 17th century.

Ethics: Galen’s influence on medical ethics, though less extensively documented than his clinical or anatomical work, offers glimpses into early thinking about the principles that guide the medical profession. Rooted in the Hippocratic oath and the ancient Greco-Roman tradition, his philosophy emphasized the physician’s moral duty to prioritize the patient’s well-being. While he didn’t explicitly delineate the modern principles of patient autonomy (informed consent), practitioner beneficence (do good), practitioner nonmaleficence (do no harm), and public justice (be fair), these elements can be inferred from his writings. Beneficence and nonmaleficence are evident in his passionate advocacy for accurate knowledge and skill in practice, asserting that a physician’s prime directive is to benefit the patient and avoid harm. His writings, emphasizing the importance of a doctor’s moral character, hint at respect for patient autonomy, as the ethical physician would not deceive or coerce a patient. Galen’s reverence for the Hippocratic Oath, which he believed every physician should uphold, showcases early considerations of the four principles of bioethics, patient autonomy (informed consent), practitioner beneficence (do good), practitioner nonmaleficence (do no harm), and public justice (be fair). While Galen’s direct discourse on these ethical principles is scant, his broader philosophy and commitment to the Hippocratic tradition undeniably shaped the moral landscape of medicine in its formative stages.

Ethically, it is important to note that in Galen’s research, he performed vivisections, or dissections of live animals, to understand the functions of various organs and systems. He primarily used animals such as pigs, monkeys, and dogs. These practices provided real-time observations of physiological processes but would be considered highly unethical by modern standards. Today, the Institutional Animal Care and Use Committee (IACUC) sets strict guidelines to minimize animal suffering and ensure ethical treatment in research. Galen’s methods, which involved significant animal suffering, would not be permissible under these guidelines. The necessity of these vivisections is debatable; while they contributed to anatomical knowledge, they also reflect a darker aspect of early medical experimentation, where the suffering of animals was not a significant ethical consideration.

Conclusion: Galen of Pergamum’s legacy is a testament to the complexities of historical progress in medicine and science. While his meticulous approach to observation, dissection, and documentation laid foundational stones for the scientific method and significantly advanced medical knowledge of his time, his adherence to the humoral theory and certain anatomical misconceptions perpetuated harmful practices for centuries. The irony of his rationalist and empiricist methods coexisting with unscientific doctrines underscores the limitations and biases inherent in all scientific inquiry. Furthermore, his use of vivisection highlights ethical challenges that remain relevant today. Galen’s contributions, both positive and negative, serve as a critical reminder of the evolving nature of scientific understanding and the importance of continually reassessing medical practices and ethical standards. His work, therefore, remains a crucial chapter in the history of medicine, reflecting both the strides and the stumbles on the path to modern scientific and ethical principles.

Galen’s Legacy: Consolidated and expanded upon the medical knowledge of his time, emphasizing the humoral theory, which became the definitive medical reference in Europe and the Islamic world for centuries, shaping medical practice and education. However, his adherence to incorrect theories also perpetuated false beliefs that negatively impacted patient care for many generations.

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Review Questions:

True/False Questions:

1. Galen of Pergamum is known for pioneering the continuous blood circulation theory.
True or False?

2. Galen’s methodology included detailed animal dissections to understand human anatomy better.
True or False?

Multiple-Choice Questions:

3. Which of the following works is primarily attributed to Galen of Pergamum?
a) “De Materia Medica"
b) “Enchiridion"
c) “Natural History"
d) “On the Usefulness of the Parts of the Body"

4. Galen’s contributions to medicine included expanding which ancient medical theory?
a) Germ theory
b) Humorism
c) Vitalism
d) Evolution

Clinical Vignette:

5. A physician is consulting historical texts to understand ancient methods of diagnosing and treating imbalances in the body’s humors. Which ancient medical practitioner’s works would be most relevant to this research?
a) Hippocrates
b) Epictetus
c) Galen
d) Dioscorides

Basic Science Vignette:

6. A medical student is studying the contributions of Galen of Pergamum to the understanding of human anatomy. Which of the following practices best exemplifies Galen’s empirical approach to medical science?
a) Reliance on ancient texts without verification
b) Performing animal dissections to observe internal organs
c) Consulting astrological signs for diagnosis
d) Using divination to predict patient outcomes

Philosophy Vignette:

7. In considering Galen’s influence on medical ethics, which principle aligns most closely with his emphasis on a physician’s moral duty to benefit the patient and avoid harm?
a) Patient autonomy (informed consent)
b) Practitioner beneficence (do good)
c) Public justice (be fair)
d) Practitioner nonmaleficence (do no harm)

Correct Answers:

1. False
2. True
3. d) “On the Usefulness of the Parts of the Body,”
4. b) Humorism
5. c) Galen
6. b) Performing animal dissections to observe internal organs
7. b) Practitioner beneficence (do good)

Beyond The Chapter
Galen of Pergamum (GAY-len, 129-216)

• Galen: On the Constitution of the Art of Medicine translated by Peter N. Singer
• Galen: Method of Medicine translated by Ian Johnston and G. H. R. Horsley (3 Volumes)
• Galen and the World of Knowledge edited by Christopher Gill, Tim Whitmarsh, and John Wilkins

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