Galen: The Emperor’s Doctor

When the coronavirus pandemic struck the United States, the White House called on Dr Anthony Fauci, one of the world’s leading experts on infectious diseases. Within weeks, Dr Fauci – director of the National Institute of Allergy and Infectious Diseases, the doctor who had worked to fight AIDS, SARS, and other illnesses during the course of his career – became a household name across the globe. Millions of Americans have followed Fauci’s advice, and in many other countries people have been taking action, through lockdowns, social distancing, and other measures. Indeed the world has come a long way in fighting life-threatening viruses, and already vaccines are being rolled out in some countries.

Such swift advances were hardly the case in antiquity. The Antonine Plague (named after the emperor Marcus Aurelius Antoninus, who ruled when it spread) struck first in AD 165, lasted for 15 years and then recurred in 189. It is now widely considered –though not with certainty – to have been smallpox, though experts today believe that it is a disease that has mutated so much over time that that same precise virus no longer exists. Historians estimate that it killed millions, devastated the civilian population and the army, and eviscerated the tax rolls in many cities where the death rate was impossibly high.

Though no one found a cure for the disease, the most prominent person who observed and wrote about its symptoms and possible treatments was the physician Galen (AD 129-c.216). Because of Galen’s accounts of the Antonine Plague, it is sometimes also known as the Plague of Galen. In Susan P Mattern’s well-regarded biography, The Prince of Medicine: Galen in the Roman Empire, she points out that Galen cited a number of possible treatments, which, he found, worked on some patients but not on others. These included using milk from Stabiae near Pompeii and earth from Armenia. Then there was the less appealing option of urine from boys in Syria.

The physician treated many other illnesses and, in a voluminous output of writing, he described various maladies that afflicted the Roman population, including what we now understand to be psychosomatic illnesses. He left much information in his many works that sheds light on what was known about medical treatment in antiquity. He was also, it appears, a talented surgeon, having honed his skills in the treatment of injured gladiators who suffered some of the most atrocious accidents. He became so established that he was named an imperial doctor to Marcus Aurelius.

Now a virtual exhibition at New York University’s Institute for the Study of the Ancient World (ISAW) examines just how sophisticated many aspects of ancient medicine were and how astute Galen was at diagnosing patients.

The ISAW is hardly alone in turning to the web in a period when coronavirus has closed museums or curtailed visiting in person. At the Metropolitan Museum of Art, Debbie Kuo, senior administrator for the department of Greek and Roman art, has been sending out a series of emails to friends and supporters, each with a different theme, like travel in the ancient world, masks, and gatherings, among other subjects, and each using artworks from the museum’s collection to illuminate how life was lived.

Meanwhile, the Getty Villa, which is currently closed, has been making use of images of papyri of the Book of the Dead (of which it has an enormous collection) with elucidating explanations of what the images mean and what they can teach about life in ancient Egypt. Since the papyri are too fragile for display, this discussion (available at https://artsandculture.google.com) is very useful. The institution has also brought together images from its exhibition of Assyrian palace art, largely borrowed from the British Museum, and a lengthy discussion of their exhibition on Mesopotamia (still yet to open due to the pandemic), with objects on loan from the Louvre.

The ISAW’s own COVID-safe offering is an entirely online exhibition, using images of objects from other institutions as well as videos to investigate Galen, his legacy, and the plague he worked through.

Galen did not set out to become a doctor and he was hardly self-made. The only son of a Greek architect, he grew up in Pergamon in the eastern part of the Roman empire (now in western Turkey), an ancient city that drew pilgrims for its sanctuary to the healing god Asclepius. His mother, as Galen described her, was irascible. In contrast, his father was devoted, loving, and knowledgeable, a man Galen revered. His adoring father managed every aspect of his son’s education and, early on, hired teachers of philosophy to educate the young boy. Then, when Galen was 16, his father, a true helicopter parent of the Roman era, had a dream that led him to decide his son should study medicine along with philosophy, and so the son’s path was set.

Galen became, as he himself described it, obsessed. Medicine, as it turned out, was a field for which Galen was perfectly suited. ‘When I began to study medicine, I repudiated all pleasure… I spent all my time in the study of medical practice, deliberating and reflecting on medicine,’ he wrote. ‘Generally I have gone without sleep at night in order to examine the treasures left to us by the ancients.’

To learn more, Galen travelled around the empire, including to Alexandria in Egypt. Because of its reputation, Alexandria had attracted some of the most famous medical minds. Since Galen’s strategy was to study with the best physicians, it was the ideal place to go. It was also a city where work that was unusual in the empire had been carried out. For example, the anatomists Herophilus and Erasistratus had done research hundreds of years earlier on human cadavers. By the time of Galen, dissections were done on animals because of a taboo on human dissection. There is later, however, an intriguing early Christian painting, found in the 4th-century AD catacomb of Via Latina, Rome, which has been described by some as the earliest depiction of what may be an anatomy lecture.

Galen’s big breakthrough, so to speak, came when he returned to Pergamon at the age of 29 and the city’s high priest appointed him to care for the gladiators. It was grisly work perhaps, but an enormous learning opportunity for a young physician who wanted to study the human body and how to cure its ills. Professor Mattern, now a distinguished research professor in the University of Georgia’s history department, writes that wounds on the lower front of the thigh were common to gladiators. Since they often fought in the summer, Galen learned to keep the wounds moist with wine-soaked cloths that he dampened continuously. Other physicians had used a mixture of wheat flour boiled in water and oil, an approach he viewed as harmful because it did not keep the wounds moist.

Treating vertical wounds, according to Galen’s writings, was less difficult than horizontal wounds because he could apply a bandage to vertical wounds, but for horizontal ones he had to draw the muscles together, suturing deep layers of muscle. A competitive and judgmental physician, Galen was also critical of colleagues who only joined the skin of the most superficial layer. Material evidence from the ancient world offers a glimpse at how the Romans treated wounds. A wall-painting from the so-called ‘House of the Surgeon’ in Pompeii, for instance, shows the Trojan hero Aeneas, with an arrow in his thigh, being tended to by the doctor Iapyx. Severe leg wounds could result in amputation of the limb, and one object featured in the virtual exhibition is an early 20th-century copy of an artificial leg from 300 BC; the original, which was in the Royal College of Surgeons in London, was destroyed by bombing during the Second World War.

But even as Galen explored new treatments for wounds and illnesses, he never ignored the role that emotions might play in medicine. I spoke recently to Claire Bubb, assistant professor at the ISAW, and she described a famous case in which Galen was asked to see a woman with severe insomnia. There were no other attendant symptoms. When Galen was at her home, a friend came to visit. They began discussing a particular performer at the theatre and the patient’s colour changed. Her pulse also shifted radically, suggesting to Galen that she might be infatuated with the dancer. His diagnosis, if one can call it that, was that her insomnia was probably psychosomatic. That view, that emotions can affect the behaviour of the body, was his position, and it put him in opposition with contemporaries who saw no relationship between psychology and the body.

Indeed, Dr Bubb explained that Galen approached medicine with the belief that there is a logical explanation for everything. He wanted to find the fact with which to build his theories. In contrast, the empiricists, another group of physicians at that time, were not interested in finding out how the body works. Their view was that we have to find things that work and use them, but not look beyond that. Galen wanted to know why something worked and what that said about the body. By fully knowing the cause, he believed, you can properly react, Dr Bubb explained. He was also at odds with the methodists, a group who simplified medicine so dramatically that they believed one could learn it in six months. They thought that one could treat a disease by observing its general symptoms, without knowing the underlying cause or the individual patient’s constitution and medical history (hence the briefer training).

One instance outlined by Galen reveals the differing approaches of the medics. A Syrian named Pausanias (not the great writer) had fallen from a carriage and hit his back. While the pain in his back eventually subsided, he found that his fingers were numb. Galen writes that other doctors treated only the fingers themselves to no avail. When he was consulted, however, he realised that a nerve in the back that connects to nerves in the fingers had been damaged by the fall. When Galen treated the back, Pausanias was cured, though he does not tell us how exactly.

If Galen was among those who were looking for rational causes for changes in the body, nowhere is that more evident than in some of his most noted studies: vivisections done on pigs, for example. In one famous experiment on a pig, Galen, working with assistants, tied the spinal nerves that control the thoracic muscles with a needle and thread and then untied them to show that the voice could be stopped and then brought back at will. At that time, there had been debate about what controlled the body, with some believing that it was the heart. Galen’s experiment provided a concrete demonstration that the brain is in charge via the nerves and they control the muscles that control the breathing, as Dr Bubb explained. The procedure, he immodestly wrote, amazed his audience.

Since audiences included not just doctors, but the cultural elite as well, that exposure helped build Galen’s reputation and he came to the attention of Emperor Marcus Aurelius. However, his exposure to other physicians in the cut-throat culture of the capital in particular left Galen cynical about the quality of doctors. He wrote that when wicked men realised how foolish others were, they determined it unnecessary to learn medicine, instead resorting to ‘hunting rich men’ – an approach he likened to ‘hunting beasts’, as he wrote in On Choosing the Best Physicians. Aware that the rich sought pleasure, should a patient become ill, the treatment would not necessarily be what was best for the patient, but what was most pleasurable. And with a wry touch, Galen wrote that, should the patient survive, the physician could take credit, but if the patient died, no one would know the cause, or even the name of the physician because Rome was such a large city.

Working in Rome, Galen was aware that life in the medical world meant that it was not beyond the realm of possibility that a successful doctor might be poisoned by jealous rivals. Ultimately, Galen left the city. It is not entirely clear why, whether it was from fear of poison or of the plague, which he alludes to in one of his writings, On My Own Books. Nonetheless, his reputation had soared by this time, and in AD 169 Emperor Marcus Aurelius summoned him to Aquileia. As seen in a votive relief of a heroised doctor highlighted in the online exhibition, the deeds and status of doctors could be so great that they were revered. Galen was treated in a not dissimilar fashion.

When the emperor headed north to war that same year, he wanted Galen to accompany him as his court physician. The doctor, however, relied on higher powers as a defence against that trip. Dreams were powerful instruments in the ancient world and, to avoid being obliged to join the army, Galen told the emperor that he had dreamt the god Asclepius told him not to go. Instead, Galen was charged with looking after Commodus, the son of Marcus Aurelius, a duty he fulfilled for some years.

Treating the imperial family brought a range of challenges, some of them quite pedestrian. In one rather amusing instance, after Marcus Aurelius had returned to Rome, he fell ill with pain in his abdomen and diarrhoea. In that era, any illness brought with it the fear of death. The emperor’s doctors prescribed rest and porridge, but he did not recover. So Galen was sent for, and while the other doctors were probably wringing their hands, he interpreted the emperor’s symptoms as indigestion. Had he been proven wrong, that fault could have grievously damaged his reputation. Much to the chagrin of his rivals, Galen was correct.

Such results burnished his name, but it would be his extraordinary output of surviving writing that solidified his place in history. And had it not been for a fire in AD 192 that destroyed an enormous amount of his work, his impact would have been even more significant. Still, it continues to grow. As recently as 2005 a manuscript of a text by the physician entitled On Consolation from Grief, in which he talks about the loss from that fire, was found, along with other of his writings, in a monastery in Thessaloniki.

Despite the destruction of a significant amount of his work, Galen’s remaining oeuvre was more than enough to become the cornerstone of medieval medicine. One early 6th-century manuscript of a medical text by Dioscorides (the Vienna Dioscorides) illustrates this well: a folio shows a group of seven physicians, with Galen taking pride of place, enthroned in the centre. Galen’s anatomical studies in particular were referred to up to the 16th century, a remarkably long usage. That was his legacy.

Further Information
The ISAW’s digital exhibition The Empire’s Physician: prosperity, plague, and healing in ancient Rome launches on 26 February. It can be found at https://isaw.nyu.edu/exhibitions.