One and Only Physician

James Romm

  • The Prince of Medicine: Galen in the Roman Empire by Susan Mattern
    Oxford, 334 pp, £20.00, July 2013, ISBN 978 0 19 960545 3

How fortunate you would have been, as a Roman patient of the second century AD, to be attended by Galen, the greatest Greek physician of the age. Galen would have paid housecalls, several times a day if needed, and brought you food. He would have questioned you with earnest concern about the onset and progress of your symptoms. He would have supplied medicines mixed from as many as 64 ingredients. And for all this personal attention, you would not have been charged a fee.

If you were cured – which, to judge by Galen’s own accounts, would have been extremely likely – your recovery might well have been recorded for posterity. Galen loved to discuss successful case histories in his writings, and he was fantastically prolific. A modern tally of his known titles comes to 441, and though most of these works have been lost, the ones that survive still amount to a vast and variegated bibliography. In the prologue to The Prince of Medicine: Galen in the Roman Empire Susan Mattern includes this astounding sentence: ‘The most modern edition of his corpus runs to 22 volumes, including about 150 titles, making up one-eighth of all the classical Greek literature that survives.’ Galen’s productivity was such that some of his works – On My Own Books and On the Order of My Own Books, for example – were written simply to keep track.

Not many modern scholars have tried to navigate this sea of Greek prose, only a fraction of which has been translated into English. Even classicists tend to think of his writings as highly specialised and have paid him little attention in recent years. Mattern, originally a Roman historian, broke new ground in her 2008 study, Galen and the Rhetoric of Healing, by looking at his works in a broader context. She examined his self-presentation as a physician in his treatises and described the highly combative version of medicine practised in various public arenas: in the streets of Rome, in informal theatres set up for anatomical displays, and at the bedside of patients, crowded with friends, family members and slaves. In The Prince of Medicine Mattern reworks some of this material but adds much that is new, while addressing herself to a wider audience: the book is part biography, part popular history, part medical lore.

Galen spent his life in two great cities: in Pergamon, in what is now western Turkey, where he was born in 129 AD (just before the start of the Antonine dynasty, which Gibbon called the happiest and most stable era of human history), and then in Rome, where he moved in his early thirties. In Pergamon, he was physician to a company of gladiators, treating the wounds they received in combat; in Rome, he rose ever higher in reputation and finally entered the service of Marcus Aurelius. He was then nearing fifty and only midway through his remarkably long career, but Mattern can say little about what came next: ‘At this point we lose the narrative thread of Galen’s life,’ she writes. Only one other datable event, a fire in 192 AD that destroyed many of his works, is mentioned in his writings. Mattern can only guess at what he must have experienced at the courts of Commodus, Severus and Caracalla, or whether he survived into the reign of the dissolute Elagabalus.

That Mattern has been able to take her biography this far is a considerable achievement. She has recovered data from offhand references and anecdotes strewn randomly through works that have no chronological structure and often cannot themselves be dated. George Sarton’s slim 1954 volume, Galen of Pergamon, was no doubt useful, but several new Galenic texts have come to light since it was published, some of them so recently as to be available only in manuscript. Mattern must have read through reams of dense, technical Greek in order to turn up each new bit of information. Even so, the material she has found is too thin to form a true biography: it seems that Galen made few mentions in his extant works of his non-professional life, and rarely departed from the neutral tone of the clinician.

Mattern is thus forced to make more general observations, which constitute a tour of the Roman world in the mid-second century AD, as seen through the filter of disease. Plague struck twice during Galen’s lifetime; the second time, according to an estimate quoted by Mattern, a quarter of the empire’s inhabitants may have been killed. Even when infection was kept at bay, wars and gladiatorial combat dealt horrific wounds to adult males. The city of Rome, despite its architectural beauty and cultural sophistication, was a cesspool of disease.

Into this world strode Galen, a ‘diagnostician of almost supernatural ability’ according to Mattern (indeed it was the god Asclepius, communicating through a dream, who cured young Galen of abdominal pain and turned him towards the practice of medicine). Beginning in her prologue, in which Galen cures a gout sufferer with an invented mixture of rancid cheese and pickled pig’s leg, Mattern depicts her subject as a miracle worker. In one instance he detects a tumour merely by feeling a patient’s pulse; in another he successfully performs something approaching open-heart surgery. The latter feat ‘put the healing powers of Jesus and the early Christian saints … to shame’, Mattern comments. Again and again, Galen correctly predicts the exact course of a disease, even when the sufferer himself is desperate for him to be wrong.

Though her historical judgment is elsewhere quite sharp, Mattern can be faulted for accepting these tales at face value, even if she does once speak of ‘self-reported success’ and notes the suspicious absence of patient deaths in Galen’s writings. She says for example that she has ‘no doubt’ that the story of the open-heart surgery patient is true because the incident was witnessed by many, but goes on to mention that it is absent from one of the obvious works in which you would have expected to see it included. A more sceptical interpreter might suspect that Galen stretched the truth in one work, where he thought he could get away with it, and kept silent in another where he feared he couldn’t. Mattern doesn’t look critically enough at Galen’s motives as an author, even when noting that his case histories, some of them repeated over and over again in different treatises, routinely depict cheering crowds of onlookers hailing his medical wisdom. The problem becomes acute where he reports his success with cures that we now know would not work – like a skin salve applied to a damaged spine. Could it be that his presence had an immensely strong placebo effect?

However miraculous a healer he was, Galen seems to have been a genuine virtuoso in the matter of anatomy. It was common at the time for physicians to attempt feats of vivisection before crowds of spectators, using pigs, goats and monkeys tied down to boards to immobilise their limbs. Often these displays became contests between two or more doctors, each seeking to outdo the other in daring and skill. Galen generally won hands down, to judge by On Anatomical Procedures. He devised special dissecting tools for fine work, and must have had immensely good hands, not to mention the steady nerves needed to operate on screaming, writhing animals. But he often saw only what the great ancient authority, Hippocrates, had trained him to see. Despite having laid bare the beating hearts of monkeys and pigs, and even held them in his hands, he didn’t recognise the heart’s role in pumping blood and vehemently refuted a contemporary, Erasistratus, on this point. The western world would remain satisfied with Galen’s view for fifteen centuries.

Though he revered the Hippocratic treatises (only some of which, as the Roman world recognised, were written by Hippocrates of Cos in the fifth century BC), Galen avoided attachment to a school or dogma. Mattern describes the competing medical sects of his day: Empiricists, who favoured the use of trial and error in the treatment of disease, battled Methodists, who derived their cures from abstract theories and disdained dissections and case histories. Somewhere between the two were the Dogmatists or Rationalists; others followed leaders such as Erasistratus. Galen was trained as an Empiricist but later insisted on his independence and nonconformity. He defined his own positions by polemics against rivals, and hurled invective at contemporaries like Martianus and Lycus when he felt they were on the wrong track. In On Venesection: Against Erasistratus, he seems to have gone too far, and he issued a follow-up pamphlet with a more moderate tone and a more general target: On Venesection: Against the Eristrateans at Rome. But another treatise, now lost, shows by its title, On Lycus’ Ignorance of Anatomy, that Galen was not above ad hominem invective.

As in medical matters, so in metaphysical ones, Galen knew what he was against more clearly than he knew what he believed in. His best-known work, On the Usefulness of the Parts, refutes Jewish and Christian ideas about creation and the God who set it in motion, comparing their doctrinaire adherents to the school-bound physicians he reviled elsewhere. To him, the complexity of anatomy, the perfect function of organs and limbs observed in dissection, was the result of a more careful engineering process than that found in Genesis. Yet in a work with the pleasingly self-assured title On My Own Opinions, he admitted to a profound ignorance in such matters: ‘Whether the universe is uncreated or created, or whether there is something outside it or not, I say that I don’t know … I also do not know what kind of being is the creator of all things in the universe.’ Even on such a fundamental question as the immortality of the soul, on which every school of ancient philosophy had a firm opinion, Galen proclaimed himself agnostic, and, more surprisingly, uninterested. ‘He professed a lack of curiosity on these questions, declaring them irrelevant to medical science,’ Mattern writes.

Towards the end of her book Marcus Aurelius, on his way to fight the barbarians on Rome’s northern frontier, drafts Galen into his service. But hopes of an action sequence are quickly disappointed. Galen, for unknown reasons, declined to accompany the emperor; he stayed in Rome attending Commodus, the emperor’s son and heir, along with other physicians, a sinecure that helped make possible his huge outpouring of prose. He recorded only one face-to-face encounter with Marcus, in 176 after the emperor had returned to Rome. The episode follows a familiar pattern: Galen coolly produced a correct diagnosis of Marcus’ digestive ailments where other palace physicians had failed, and, after prescribing a cure of hot compresses and peppered wine, won his acclaim: ‘We have one physician only,’ Marcus declared, in the hearing of his entire medical staff. One suspects that Galen’s rivals would give a different account. But it is noteworthy that, in his surviving works at least, Galen did little to trumpet his imperial appointment, which may have extended for up to four decades after that encounter with Marcus. It seems possible that he really did, as he claimed, regard time spent in the palace as ‘time wasted … which I not only did not want, but even when fate was dragging me forcefully towards it, I resisted not once or twice, but many times.’

Mattern looks at her subject through a wide-angle lens, pausing to discuss questions such as what pathogen caused the Antonine plague (probably smallpox), why bloodletting endured so long as a treatment for illness (no one knows), and whether Marcus Aurelius was addicted to opium (probably not, since the quantity of the drug he took in his daily dose of theriac was too small to have much effect). Indeed, though she shows us many scenes of Galen’s intellectual triumphs, we do not come away with much sense of who the man was or what drove him to pursue medicine with such fanatical zeal. ‘Galen practically never expresses sympathy, revulsion, weariness, sadness, or any emotion other than outrage at the poor performance of his rivals or pride in accomplishing a cure,’ Mattern notes. He appears, paradoxically, to have had little concern with the alleviation of suffering. His defining trait seems rather to have been what the Greeks call philoneikia, a need to prove himself by besting others. ‘He was honest and sincere but egotistic, vain, complacent, irritable and jealous,’ was Sarton’s verdict in Galen of Pergamon. ‘His colleagues did not love him.’ Neither can we, but we can follow with interest his path through Antonine Rome.