Chapter IV: Galen (2)

[Sidenote: Did Galen ever dissect human bodies?]

It has usually been stated that Galen never dissected the human body and that his inferences by analogy from his dissection of animals involved him in serious error concerning human anatomy and physiology. Certainly he speaks as if opportunities to secure human cadavers or even skeletons were rare.[643] He mentions, however, the possibility of obtaining the bodies of criminals condemned to death or cast to beasts in the arena, or the corpses of robbers which lie unburied in the mountains, or the bodies of infants exposed by their parents.[644] It is not sufficient, he states in another passage,[645] to read books about human bones; one should have them before one’s eyes. Alexandria is the best place for the student to go to see actual exhibitions of this sort made by the teachers.[646] But even if one cannot go there, one may be able to procure human bones for oneself, as Galen did from a skeleton which had been washed out of a grave by a flooded stream and from the corpse of a robber slain in the mountains. If one cannot get to see a human skeleton by these means or some other, he should dissect monkeys and apes.

[Sidenote: Dissection of animals.]

Indeed Galen advises the student to dissect apes in any case, in order to prepare himself for intelligent dissection of the human body, should he ever have the opportunity. From lack of such previous experience the doctors with the army of Marcus Aurelius, who dissected the body of a dead German, learned nothing except the position of the entrails. Galen at any rate dissected a great many animals. Tiny animals and insects he let alone, for the microscope was not yet discovered, but besides apes and quadrupeds he cut up many reptiles, mice, weasels, birds, and fish.[647] He also gives an amusing account of the medical men at Rome gathering to observe the dissection of an elephant in order to discover whether the heart had one or two vertices and two or three ventricles. Galen assured them beforehand that it would be found similar to the heart of any other breathing animal. This particular dissection was not, however, performed exclusively in the interests of science, since it was scarcely accomplished when the heart was carried off, not to a scientific museum, but by the imperial cooks to their master’s table.[648] Galen sometimes dissected animals the moment he killed them. Thus he observed that the lungs always sensibly shrank from the diaphragm in a dying animal, whether he killed it by suffocation in water, or strangling with a noose, or severing the spinal medulla near the first vertebrae, or cutting the large arteries or veins.[649]

[Sidenote: Surgical operations.]

Surgical operations and medical practice were a third way of learning the human anatomy, and Galen complains of the carelessness of those physicians and surgeons who do not take pains to observe it before performing an operation or cure. He himself had had one case where the human heart was laid bare and yet the patient recovered.[650] As a young practitioner before he came to Rome Galen worked out so successful a method of treating wounds of the sinews that the care of the health of the gladiators in his native city of Pergamum was entrusted to him by several successive pontifices[651] and he hardly lost a life. In the same passage he again speaks contemptuously of the doctors in the war with the Germans who were allowed to cut open the bodies of the barbarians but learned no more thereby than a cook would. When Galen came from Pergamum to Rome he found the professions of physicians and surgeons distinct and left cases to the latter which he before had attended to himself.[652] We may note finally that he invented a new form of surgical knife.[653]

[Sidenote: Galen’s argument from design.]

In Galen’s opinion the study of anatomy was important for the philosopher as well as for the physician. An understanding of the use of the parts of the body is helpful to the doctor, he says, but much more so to “the philosopher of medicine who strives to obtain knowledge of all nature.”[654] In the _De usu partium_[655] he came to the conclusion that in the structure of any animal we have the mark of a wise workman or demiurge, and of a celestial mind; and that “the investigation of the use of the parts of the body lays the foundation of a truly scientific theology which is much greater and more precious than all medicine,” and which reveals the divinity more clearly than even the Eleusinian mysteries or Samothracian orgies. Thus Galen adopts the argument from design for the existence of God. The modern doctrine of evolution is of course subversive of his premise that the parts of the body are so well constructed for and marvelously adapted to their functions that nothing better is possible, and consequently of his conclusion that this necessitates a divine maker and planner.

In the treatise _De foetuum formatione_ Galen displays a similar inclination but more tentatively and timidly. He thinks that the human body attests the wisdom and power of its maker,[656] whom he wishes the philosophers would reveal to him more clearly and tell him “whether he is some wise and powerful god.”[657] The process of the formation of the child in the womb, the complex human muscular system, the human tongue alone, seem to him so wonderful that he will not subscribe to the Epicurean denial of any all-ruling providence.[658] He thinks that nature alone cannot show such wisdom. He has, however, sought vainly from philosopher after philosopher for a satisfactory demonstration of the existence of God, and is by no means certain himself.[659]

[Sidenote: Queries concerning the soul.]

Galen is also at a loss concerning the existence and substance of the soul. He points out that puppies try to bite before their teeth come and that calves try to hook before their horns grow, as if the soul knew the use of these parts beforehand. It might be argued that the soul itself causes the parts to grow,[660] but Galen questions this, nor is he ready to accept the Platonic world-soul theory of a divine force permeating all nature.[661] It offends his instinctive piety and sense of fitness to think of the world-soul in such things as reptiles, vermin, and putrefying corpses. On the other hand, he disagrees with those who deny any innate knowledge or standards to the soul and attribute everything to sense perception and certain imaginations and memories based thereon. Some even deny the existence of the reasoning faculty, he says, and affirm that we are led by the affections of the senses like cattle. For these men courage, prudence, temperance, continence are mere names.[662]

[Sidenote: No supernatural force in medicine.]

In commenting upon the works of Hippocrates, Galen insists that in speaking of “something divine” in diseases Hippocrates could not have meant supernatural influence, which he never admits into medicine in other passages. Galen tries to explain away the expression as having reference to the effect of the surrounding air.[663] Thus while Galen might look upon nature or certain things in nature as a divine work, he would not admit any supernatural force in science or medicine, or anything bordering upon special providence. In the _De usu partium_ Galen states that he agrees with Moses that “the beginning of genesis in all things generated” was “from the demiurge,” but that he does not agree with him that anything is possible with God and that God can suddenly turn a stone into a man or make a horse or cow from ashes. “In this matter our opinion and that of Plato and of others among the Greeks who have written correctly concerning natural science differs from the view of Moses.” In Galen’s view God attempts nothing contrary to nature but of all possible natural courses invariably chooses the best. Thus Galen expresses his admiration at nature’s providence in keeping the eyebrows and eyelashes of the same length and not letting them grow long like the beard or hair, but this is because a harder cartilaginous flesh is provided for them to grow in, and the mere will of God would not keep hairs from growing in soft flesh. If God had not provided the cartilaginous substance for the eyelashes, “he would have been more careless, not merely than Moses but than a worthless general who builds a wall in a swamp.”[664] As between the views on God of Moses and Epicurus, Galen prefers to steer a middle course.

[Sidenote: Galen’s experimental instinct.]

Already in describing Galen’s dissections and tests with the pulse we have seen evidence of the accurate observation and experimental instincts which accompanied his zest for hard work and zeal for truth. In one of his treatises he confesses that it was a passion of his always to test everything for himself. “And if anyone accuses me of this, I will confess my disease, from which I have suffered all my life long, that I have trusted no one of those who narrate such things until I have tested it myself, if it was possible for me to have experience of it.”[665] Galen also recognized that general theories were not sufficient for exact knowledge and that specific examples seen with one’s own eyes were indispensable.[666] He maintains that, if all teachers and writers would realize and observe this, they would make comparatively few false statements. He saw the danger of making absolute assertions and the need of noting the particular circumstances of each individual case.[667] Galen more than once declared that things, not names, were important and refused to waste time in disputing about terminology and definitions which might be spent in “pursuing the knowledge of things themselves.”[668] Thus we see in Galen a pragmatic scientist intent upon concrete facts and exact knowledge; but at the same time it must be recognized that he accepted some universal theorems and general views.

[Sidenote: Attitude towards authorities.]

Galen did not believe in merely repeating in new books the statements of previous authorities. Ever since boyhood, he writes in his _Anatomical Administrations_, it has seemed to him that one should record in writing only one’s new discoveries and not repeat what has been said already.[669] Nevertheless in some of his writings he collects the prescriptions of past physicians at great length, and a previous treatise by Archigenes is practically embodied in one of Galen’s works on compound medicines. On another occasion, however, after stating that Crito had combined previous treatises upon cosmetics, including the work of Cleopatra, into four books of his own which constitute a well-nigh exhaustive treatment of the subject, Galen says that he sees no profit in copying Crito’s work again and merely reproduces its table of contents.[670] On the other hand, as this passage shows, Galen thought that the ancients had stated many things admirably and he had little patience with contemporaries who would learn nothing from them but were always ambitiously weaving new and complicated dogmas, or misinterpreting and perverting the teachings of the ancients.[671] His method was rather first to “make haste and stretch every nerve to learn what the most celebrated of the ancients have said;”[672] then, having mastered this teaching, to judge it and put it to the test for a long time and determine by observation how much of it agrees and how much disagrees with actual phenomena, and then embrace the former portion and reject the latter.

[Sidenote: Adverse criticism of past writers.]

This critical employment of past authorities is frequently illustrated in Galen’s works. He mentions a great many names of past physicians and writers, thereby shedding some light upon the history of Greek medicine; but at times he criticizes his predecessors, not sparing even Empedocles and Aristotle. Although he cites Aristotle a great deal, he declares that it is not surprising that Aristotle made many errors in the anatomy of animals, since he thought that the heart in large animals had a third ventricle.[673] As we have already seen in discussing the topic of weights and measurements, Galen especially objects to the vagueness and inaccuracy of many past medical writers,[674] or praises individuals like Heras who give specific information.[675] He also shows a preference for writers who give first-hand information, commending Heraclides of Tarentum as a trustworthy man, if there ever was one, who set down only those things proved by his own experience.[676] Galen declares that one could spend a lifetime in reading the books that have already been written upon medicinal simples. He urges his readers, however, to abstain from Andreas and other liars of that stamp, and above all to eschew Pamphilus who never saw even in a dream the herbs which he describes.

[Sidenote: Galen’s estimate of Dioscorides.]

Of all previous writers upon _materia medica_ Galen preferred Dioscorides. He writes, “But Anazarbensis Dioscorides in five books discussed all useful material not only of herbs but of trees and fruits and juices and liquors, treating besides both all metals and the parts of animals.”[677] Yet he does not hesitate to criticize certain statements of Dioscorides, such as the story of mixing goat’s blood with the _terra sigillata_ of Lemnos. Dioscorides had also attributed marvelous virtues to the stone Gagates which he said came from a river of that name in Lycia; Galen’s comment is that he has skirted the entire coast of Lycia in a small boat and found no such stream.[678] He also wonders that Dioscorides described butter as made of the milk of sheep and goats, and correctly states that “this drug” is made from cows’ milk.[679] Galen does not mention its use as a food in his work on medicinal simples, and in his treatise upon food values he alludes to butter rather incidentally in the chapter on milk, stating that it is a fatty substance and easily recognized by tasting it, that it has many of the properties of oil, and in cold countries is sometimes used in baths in place of oil.[680] Galen further criticizes Dioscorides for his unfamiliarity with the Greek language and consequent failure to grasp the significance of many Greek names.

[Sidenote: Galen’s dogmatism: logic and experience.]

Daremberg said of Galen that he represented at the same time the most exaggerated dogmatism and the most advanced experimental school. There is some justification for the paradox, though the latter part seems to me the truer. But Galen was proud of his training in philosophy and logic and mathematics; he stood fast by many Hippocratic dogmas such as the four qualities theory, he thought[681] that in medicine as in geometry there were a certain number of self-evident maxims upon which reason, conforming to the rules of logic, might build up a scientific structure. In the _De methodo medendi_[682] he makes a distinction between the discovery of drugs and medicines, simple or compound, by experience and the methodical treatment of disease which he now sets forth and which should proceed logically and independently of mere empiricism, and he wishes that other medical writers would make it clear when they are relying merely on experience and when exclusively upon reason.[683] At the same time he expresses his dislike for mere dogmatizers who shout their _ipse dixits_ like tyrants without the support either of reason or experience.[684] He also grants that the ordinary man, taught by nature alone, often instinctively pursues a better course of action for his health than “the sophists” are able to advise.[685] Indeed, he is of the opinion that some doctors would do well to stick to experience alone and not try to mix in reasoning, since they are not trained in logic, and when they endeavor to divide or analyze a theme, perform like unskilled carvers who fail to find the joints and mutilate the roast.[686] Later on in the same work[687] he again affirms that persons who will not read and profit by the books of medical authorities and whose own reasoning is defective, should limit themselves to experience.

[Sidenote: Galen’s account of the Empirics.]

Normally, however, Galen upholds both reason and experience as criteria of truth against the opposing schools of Dogmatics and Empirics. The former attacked experience as uncertain and impossible to regulate, slow and unmethodical. The latter replied that experience was consistent, adaptable to art, and proof enough.[688] Galen’s chief objection to the Empirics is that they reject reason as a criterion of truth and wish the medical art to be irrational.[689] “The Empirics say that all things are discovered by experience, but we say that some are found by experience and some by reason.”[690] Galen also objects to Herodotus’s explanation of the medical art as originating in the conversation of patients exposed at crossroads who told one another of their complaints and recoveries and thus evolved a fund of common experience.[691] Galen criticizes such experience as irrational and not yet put into scientific form (οὔπω λογική). Of the Empirics he tells us further that they regard phenomena only and ignore causes and put no trust in reasoning. They hold that there is no system or necessary order in medical discovery or doctrine, and that some remedies have been discovered by dreams, others by chance. They also accepted written accounts of past experiences and thus to a certain extent trusted in tradition. Galen argues that they should test these statements of past authorities by reason.[692] His further contention that, if they test them by experience, they might as well reject all writings and trust only to present experience from the start, is a sophistical quibble unworthy of him. He adds, however, that the Empirics themselves say that past tradition or “history” (ἱστορία) should not be judged by experience, but it is unlikely that he represents their view correctly in this particular. In another passage[693] he says that they distinguish three kinds of experience, chance or accidental, offhand or impromptu, and imitative or the repetition of the same thing. In a third passage[694] he repeats that they held that observation of one or two instances was not enough, but that oft-repeated observation was needed with all conditions the same each time. In yet another place[695] he says that the Empirics observe coincidences in things joined by experience. He himself defines experience as the comprehending and remembering of something seen often and in the same condition,[696] and makes the good point that one cannot observe satisfactorily without use of reason.[697] He also admits in one place that some Empirics are ready to employ reason as well as experience.[698]

[Sidenote: How the Empirics might have criticized Galen.]

Having noted Galen’s criticism of the Empirics, we may imagine what their attitude would be towards his medicine. They would probably reject all his theories—which we, too, have finally discarded—of four elements and four qualities and the like, and would accept only his specific recommendations for the cure of disease based upon his medical experience; except that they would also be credulous concerning anything which he assured them was based upon his own or another’s experience, whether it truly was or not. They would, however, have probably questioned much of his anatomical inference from the dissection of the lower animals, since he tells us that they “have written whole books against anatomy.”[699] Considering the state of knowledge in their time, their refusal to attempt any large generalizations or to hazard any scientific hypotheses or to build any risky medical system was in a way commendable, but their credulity as to particulars was a weakness.

[Sidenote: Galen’s standard of reason and experience.]

On the whole Galen’s attitude towards experience seems an improvement upon theirs. He was apparently more critical towards the “experiences” of past writers than the average Empiric, and in his combination of reason and experience he came a little nearer to modern experimental method. Reason alone, he says, discovers some things, experience alone discovers some, but to find others requires use of both experience and reason.[700] In his treatise upon critical days he keeps reiterating that their existence is proved both by reason and experience. These two instruments in judging things given us by nature supplement each other.[701] “Logical methods have force in finding what is sought, but in believing what has been well found there are two criteria for all men, reason and experience.”[702] “What can you do with men who cannot be persuaded either by reason or by practice?”[703] Galen also speaks of discovering a truth by logic and being thereby encouraged to try it in practice and of then verifying it by experience.[704] This, however, is not quite the same thing as saying that the scientist should aim to discover new truth by purposive experiments, or that from a number of experiences reason may infer some general law of nature.

[Sidenote: Simples knowable only from experience.]

It is perhaps in his work on medicinal simples that Galen lays most stress upon the importance of experience. Indeed he sees no other way to learn the properties of natural objects than through the experience of the senses.[705] “For by the gods,” he exclaims, “how is it that we know that fire is hot? Are we taught it by some syllogism or persuaded of it by some demonstration? And how do we learn that ice is cold except from the senses?”[706] And Galen sees no advantage in spending further time in arguments and hair-splitting where one can learn the truth at once from the senses. This thought he keeps repeating through the treatise, saying, for example, “The surest judge of all will be experience alone, and those who abandon it and reason on any other basis not only are deceived but destroy the value of the treatise.”[707] Moreover, he restricts his account of medicinal simples to those with which he is personally acquainted. In the three books treating of plants he does not mention all those found in all parts of the world, but only as many as it has been his privilege to know by experience.[708] He proposes to follow the same rule in the ensuing discussion of animals and to say nothing of virtues which he has not tested or of substances mentioned in the writings of past physicians but unknown to him. He dares not trust their statements when he reflects how some have lied in such matters. In the middle ages Albertus Magnus talks in much the same strain in his works on animals, plants, and minerals, and perhaps he was stimulated to such ideals, consciously or unconsciously, directly by reading Galen or indirectly through Arabic works, by Galen’s earlier expression of them. Galen mentions some virtues ascribed to substances which he has tested by experience and found false, such as the medicinal properties attributed to the belly of a seagull[709] and some of those claimed for the marine animal called torpedo.[710] Anointing the place with frog’s blood or dog’s milk will not prevent eyebrows that have been plucked out from growing again, nor will bat’s blood and viper’s fat remove hair from the arm-pits.[711] Also the brain of a hare is only fairly good for boys’ teeth.[712]

[Sidenote: Experience and food science.]

In beginning his work on food values[713] Galen states that many have discussed the properties of aliments, some on the basis of reason alone, some on the basis of experience alone, but that their statements do not agree. On the whole, since reasoning is not easy for everyone, requiring natural sagacity and training from childhood, he thinks it better to start from experience, especially since not a few physicians are of the opinion that only thus can the properties of foods be learned.

[Sidenote: Experience and compounds.]

The Empirics contended that most compound medicines had been hit upon by chance, and Galen grants that the Dogmatics usually are unable to give reasons for the ingredients of their doses and find difficulty in reproducing a lost prescription.[714] But he holds that reasons can be given for the constituents of the compound and that the logical discovery of such remedies differs from the empirical.[715] His own method was to learn the nature of each disease and the varied properties of simples, and then prepare a compound suited to the disease and to the patient.[716] On the other hand, we see how much depends upon experience from his confession that sometimes he has hastily prepared a compound from a few simples, sometimes from more, sometimes from a great variety. If the compound worked well, he would continue to use it, sometimes making it stronger and sometimes weaker.[717] For as you cannot put together compounds without rational method, so you cannot tell their strength certainly and accurately without experience.[718] He admits that no one can tell the exact quantity of each ingredient to employ without the aid of experience,[719] and says, “The proper proportions in the mixture we shall find conjecturally before experience, scientifically after experience.”[720] In these treatises upon compound medicines, unlike that on medicinal simples, Galen gives the prescriptions of former physicians as well as some tested by his own experience.[721] Sometimes, however, he expresses a preference for the medicines of those writers who were “most experienced”; and once says that he will give some compounds of the more recent writers, who in their turn had selected the best from older writers of long experience and added later discoveries.[722] We suspect, however, that some of these prescriptions had not been tested for centuries.

[Sidenote: Suggestions of experimental method.]

Galen gives a few directions how to regulate medical observation and experience, although they cannot be said to carry us very far on the road to modern laboratory research. He saw the value of “long experience,” a phrase which he often employs.[723] He states that one experience is enough to learn how to prepare a drug, but to learn to know the best medicines in each kind and in different places many experiences are required.[724] Medicinal simples should be frequently inspected, “since the knowledge of things perceived by the senses is strengthened by careful examination.”[725] Galen advises the student of medicine to study herbs, trees, and fruit as they grow, to find out when it is best to pluck them, how to preserve them, and so on. But elsewhere he states that it is possible to estimate the general virtue of the simple from one or two experiences.[726] However, he suggests that their effect be noted in the three cases of a perfectly healthy person, a slightly ailing patient, and a really sick man.[727] In the last case one should further note their varying effects as the disease is marked by any excess of heat, cold, dryness, or moisture. Care should be taken that the simples themselves are pure and free from any admixture of a foreign substance.[728] “It is also essential to test the relation to the nature of the patient of all those things of which great use is made in the medical art.”[729] One condition to be observed in experimental investigation of critical days is to count no cases where any slip has been made by physician or patient or bystanders or where any other foreign factor has done harm.[730] Galen was acquainted with physical experiments in siphoning, for he says that, if one withdraws the air from a vessel containing sand and water, the sand will follow before the water, which is the heavier (_sic?_).[731]

[Sidenote: Difficulty of medical experiment.]

Galen also points out some of the difficulties of medical experimentation. One is the extreme unlikelihood of ever being able to observe in even two cases the same combination of symptoms and circumstances.[732] The other is the danger to the life of the patient from rash experimenting.[733] Thus Galen more than once tells us of abstaining from testing some remedy because he had others of whose effects he was surer.

[Sidenote: Empirical remedies.]

In the treatise on easily procurable remedies ascribed to Galen,[734] in which we have already seen evidence of later interpolation or authorship, some recipes are concluded by such expressions as, “This has been experienced; it works unceasingly,”[735] or “Another remedy tested by us in many cases.”[736] This became a custom in many subsequent medical works, including those of the middle ages. One recipe is introduced by the caution, “But don’t cure anybody unless you have been paid first, for this has been tested in many cases.”[737] But we are left in some doubt whether we should infer that remedies tested by experience are so superior that they call for cash payment rather than credit, or so uncertain that it is advisable that the physician secure his fee before the outcome is known. In the middle ages the word _experimentum_ was used a great deal as a synonym for any medical treatment, recipe, or prescription. Galen approaches this usage, which we have already noticed in Pliny’s _Natural History_, when he describes “a very important experiment” in bleeding performed by certain doctors at Rome.[738]

[Sidenote: Galen’s influence upon medieval experiment.]

Indeed Galen appears to have exerted a great influence in the middle ages by his passages concerning experience in particular as well as by his medicine in general. Medieval writers cite him as an authority for the recognition of experience and reason as criteria of truth.[739] Gilbert of England cites “experiences from the book of experiments experienced by Galen,”[740] and we shall find more than one such apocryphal work ascribed to Galen in the middle ages. John of St. Amand seems to have developed seven rules[741] which he gives for discovering experimentally the properties of medicinal simples from what we have heard Galen say on the subject, and in another work, the _Concordances_, John collects a number of passages about experience from the works of Galen.[742] Peter of Spain, who died as Pope John XXI in 1277, cites Galen in his discussion of “the way of experience” and “the way of reason” in his _Commentaries on Isaac on Diets_.[743] We have already suggested Galen’s possible influence upon Albertus Magnus, and we might add Roger Bacon who wrote some treatises on medicine. But it is hardly possible to tell whether such ideas were in the air, or were due to Galen individually either in their origin or their transmission. But he made a rather close approach to the medieval attitude in his equal regard for logic and for experimentation.

[Sidenote: His more general medieval influence.]

The more general influence of Galen upon all sides of the medicine of the following fifteen centuries has often been stated in sweeping terms, but is difficult to exaggerate. His general theories, his particular cures, his occasional marvelous stories, were often repeated or paraphrased. Oribasius has been called “the ape of Galen,” and we shall see that the epithet might with equal reason be applied to Aëtius of Amida. Indeed, as in the case of Pliny, we shall find plenty of instances of Galen’s influence in our later chapters. Perhaps as good a single instance of medieval study of Galen as could be given is from the _Concordances_ of John of St. Amand already mentioned, which bear the alternative title, “Recalled to Mind” (_Revocativum memoriae_), since they were written to “relieve from toil and worry scholars who often spend sleepless nights in searching for points in the books of Galen.”[744] Or we may note how the associates of the twelfth century translator from the Arabic, Gerard of Cremona, added a list of his works at the close of his translation of Galen’s _Tegni_, “imitating Galen in the commemoration of his books at the end of the same treatise,” as they themselves state.[745]

Not that medieval men did not make additions of their own to Galen. For instance, the noted Jewish philosopher, Moses Maimonides, in adding his collection of medical _Aphorisms_ to the many previous compilations of this sort by Hippocrates, Rasis (Muhammad ibn Zakariya), Mesuë (Yuhanna ibn Masawaih), and others, states that he has drawn them mainly from the works of Galen, but that he supplements these with some in his own name and some by other “moderns.”[746] Not that Galen was not sometimes criticized or questioned. A later Greek writer, Symeon Seth, ventured to devote a special treatise to a refutation of some of Galen’s physiological views. In it, addressing himself to those “persons who regard you, O Galen, as a god,” he endeavored to make them realize that no human being is infallible.[747] Among the medical treatises of Gentile da Foligno, who was papal physician and performed a public dissection at Padua in 1341,[748] is found a brief argument against Galen’s fifth aphorism.[749] But such criticism or opposition only shows how generally Galen was accepted as an authority.

III. _His Attitude Towards Magic_

From Galen’s habits of critical estimation rather than blind acceptation of authority, of scientific observation, careful measurement, and personal experiment, from his brilliant demonstrations by dissection, and his medical prognostication and therapeutics, sane and shrewd for his time,—from these we have now to turn to the other side of the picture, and examine what information his works afford us concerning the magic and astrology in ancient medicine, concerning the belief in occult virtues, suspensions, characters, incantations, and the like. We may first consider what he has to say concerning magic and divination as he understands those words, and then take up his attitude to those other matters which we look upon as almost equally deserving classification under those heads.

[Sidenote: Accusations of magic against Galen.]

Apollonius of Tyana and Apuleius of Madaura were not the only celebrated men of learning in the early Roman Empire to be accused of magic; we have already alluded to the charges of magic made against Galen by the envious physicians of Rome during his first residence in that city. It is hard to escape the conviction that at that time learned men were very liable to be suspected or accused of magic. Indeed, Galen makes the general assertion that when a physician prognosticates aright concerning the future course of a malady, this seems so marvelous to most men that they would receive him with great affection, if they did not often regard him as a wizard.[750] Soon after saying this, Galen begins the story of the prognostications he made and the cure he wrought, when all the other doctors took an opposite view of the case.[751] One of them then jealously suggested that Galen’s diagnosis was due to divination.[752] When asked by what kind of divination, he gave different answers at different times and to different persons, sometimes saying by dreams, sometimes by sacrificing, again by symbols, or by astrology. Afterwards such charges against Galen kept multiplying.[753] As a result, Galen says that since then he has not gone about advertising his prognostications like a herald, lest the physicians and philosophers hate him the more and slander him as a wizard and diviner, but that he now reveals his discoveries only to his friends.[754] In another treatise he represents Hippocrates as saying that a proficient doctor should be able to prognosticate the course of diseases, but adds that contemporary physicians call such a doctor a sorcerer and wonder-worker (γόητά τε καὶ παραδοξολόγον).[755] Again in his work on medicinal simples[756] he states that he abstained from testing the supposed virtue of crocodile’s blood in sharpening the vision, and the blood of house mice in removing warts, partly because he had other reliable eye-medicines and cures for warts—such as _myrmecia_, a gem with wart-like lumps, partly because by employing such substances he feared to incur the reputation of a sorcerer, since jealous physicians were already slandering his medical prognostications as divination. This last passage affords a good illustration of the close connection with magic of certain natural substances supposed to possess marvelous virtues, while Galen’s wart stone also seems magical to the modern reader.

[Sidenote: His charges of magic against others.]

Galen himself sometimes calls other physicians magicians. Certain men with whom he does not agree are called by him “liars or wizards or I don’t know what to say,”[757] and another man who used mouse dung to excess he calls superstitious and a sorcerer.[758] In the same work on simples[759] he says that he will list herbs in alphabetical order as Pamphilus did, but that he will not like him descend to old wives’ tales, Egyptian sorceries and incantations, amulets and other magical devices, which not only do not belong in the medical art but are utterly false. Pamphilus never saw most of the herbs he mentioned, much less tested their virtues, but copied anything he found, piling up names, incantations, and wizardry. Galen accuses Xenocrates Aphrodisiensis also of not having eschewed sorcery, and he notes that medical writers have either said nothing about sweat or what is superstitious and bordering upon magic.[760]

[Sidenote: Charms and wonder-workers.]

Philters, love-charms, dream-draughts, and imprecations Galen regards as impossible or injurious, and intends to have nothing to do with them. He thinks it ridiculous to believe that by such spells one can bewitch one’s adversaries so that they cannot plead in court, or conceive or bear children. He considers it worse to advertise and perpetuate such false or criminal notions in writings than to practice such a crime but once.[761] In one passage,[762] however, to illustrate his theory that the gods prepare the sperms of plants and animals, and set them going as it were, and afterwards leave them to themselves, Galen compares them to the wonder-workers—who were perhaps not magicians but men similar to our sidewalk fakirs who exhibit mechanical toys—who start things moving and then go away themselves while what they have prepared moves on artificially for a time.

[Sidenote: Animal substance inadmissible in medicine.]

Galen’s own works are not entirely free from the magical devices of which he accuses others. We may begin with animal substances, since he himself has testified that the use of sweat, crocodile’s blood, and mouse’s dung is suggestive of magic. Moreover, he attributes more bizarre virtues to the parts of animals than to herbs or stones. In a passage somewhat similar to that in which Pliny[763] expressed his horror at the use of human blood, entrails, and skulls as medicines, Galen declares that he will not mention the abominable and detestable, as Xenocrates and some others have done. The Roman law has long forbidden eating human flesh, while Galen regards even the mention of certain secretions and excrements of the human body as offensive to modest ears.[764] Nevertheless, before long he offends against his own standard and describes how he administered to patients the very substance which he had before characterized as most unmentionable.[765] It may also be noted that he repeats unquestioningly such a tale as that the cubs of the bear are born unformed and licked into shape by their mother.[766]

[Sidenote: Nastiness of ancient medicine.]

Further milder illustrations of the fact that such nasty substances were then not merely recommended in books but freely employed in actual medical practice, are seen in the frequent use by one of Galen’s teachers of the dung of dogs who for two days before had eaten nothing but bones,[767] in Galen’s own wonderfully successful treatment of a tumor on a rustic’s knee with goat dung—which is, however, too sharp for the skins of children or city ladies,[768] and in his discovery by repeated experience that the dung of doves who take little exercise is less potent than that of those who take much,[769] Galen also says that he has known of doctors who have cured many persons by giving them burnt human bones in drink without their knowledge.[770]

[Sidenote: Parts of animals.]

Galen’s medicinal simples include the bile of bulls, hyenas, cocks, partridges, and other animals.[771] A digestive oil can be manufactured by cooking foxes and hyenas, some alive and some dead, whole in oil.[772] Galen discusses with perfect seriousness the relative strength of various animal fats, those of the goose, hen, hyena, goat, pig, and so forth.[773] He decides that lion’s fat is by far the most potent, with that of the pard next. Among his simples are also found the slough of a snake, a sheepskin, the lichens of horses, a spider’s web,[774] and burnt young swallows, for whose introduction into medicine he gives Asclepiades credit.[775] Of Archigenes’ prescriptions for toothache he repeats that which recommended holding for some time in the mouth a frog boiled in water and vinegar, or a dog’s tooth, burnt, pulverized, and boiled in vinegar.[776] Cavities may be filled with toasted earthworms or spiders’ eggs diluted with unguent of nard. Teething infants are benefited, if their gums are moistened with dog’s milk or anointed with hare’s brains.[777] For colic he recommends dried cicadas with three, five, or seven grains of pepper.[778]

[Sidenote: Some scepticism.]

Galen is less confident as to the efficacy for earache of the multipedes which roll themselves up into a ball, and which, cooked in oil, are employed especially by rural doctors.[779] He is still more sceptical whether the liver of a mad dog will cure its bite.[780] Many say so, and he knows of some who have tried it and survived, but they took other remedies too.[781] Galen has heard that some who trusted to it alone died. In one treatise[782] Galen discusses the strange virtues of the basilisk in much the usual way, but in his work on simples[783] he remarks drily that it is obviously impossible to employ it in pharmacy, since, if the tales about it be true, men cannot see it and live or even approach it without danger. He therefore will not include it or elephants or Nile horses (hippopotamuses?) or any other animals of which he has had no personal experience.

[Sidenote: Doctrine of occult virtue.]

Galen tries to find some satisfactory explanation of the strange properties which he believes exist in so many things. The attractive power of the magnet and of drugs suggests to him that nature in us is divine, as Homer says, and leads like to like and thus shows its divine virtues.[784] Galen rejects Epicurus’s explanation of the magnet’s attractive power.[785] It was that the atoms flowing off from both the magnet and iron fit one another so closely that the two substances are drawn together. Galen objects that this does not explain how a whole series of rings can be suspended in a row from a magnet. Galen’s teacher Pelops, who claimed to be able to tell the cause of everything, explained why ashes of river crabs are used for the bite of a mad dog as follows.[786] The crab is efficacious against hydrophobia because it is an aquatic animal. River crabs are better for this purpose than salt water crabs because salt dries up moisture. He also thought the ashes of crabs very potent in absorbing the venom. But this type of reasoning is unsatisfactory to Galen, who finds the best explanation of all such action in the peculiar property, or occult virtue, of the substance as a whole. Upon this subject[787] he proposes to write a separate treatise, and in the fragment _De substantia facultatum naturalium_ (περὶ οὐσίας τῶν φυσικῶν δυνάμεων) he again discusses the matter.[788]

[Sidenote: Virtue of the flesh of vipers.]

Among parts of animals Galen regarded the flesh of vipers as especially medicinal, particularly as an antidote to poisons. Of the following cures wrought by vipers’ flesh which Galen narrates[789] two were repeated without giving him credit by Aëtius of Amida in the sixth, and Bartholomew of England in the thirteenth century, and doubtless by other writers. When Galen was a youth in Asia, some reapers found a dead viper in their jug of wine and so were afraid to drink any of it. Instead they gave it to a man near by who suffered from the terrible skin disease elephantiasis and whom they thought it would be a mercy to put quietly out of his misery. He drank the wine but instead of dying recovered from his disease. A similarly unexpected cure was effected when a slave wife in Mysia tried to kill her husband by offering him a like drink. A third case was that of a patient whom Galen told of these two previous cures. After resorting to augury to learn if he too should try it and receiving a favorable response, the patient drank wine infected by venom with the result that his elephantiasis changed into leprosy, which Galen cured a little later with the usual drugs. A fourth man, while hunting vipers, was stung by one. Galen bled him, extracted black bile with a drug, and then made him eat the vipers which he had caught and which were prepared in oil like eels. A fifth man, warned by a dream, came from Thrace to Pergamum. Another dream instructed him both to drink, and to anoint himself with, a concoction of vipers. This changed his disease into leprosy which in its turn was cured by drugs which the god prescribed.

[Sidenote: Theriac.]

The flesh of vipers was an important ingredient in the famous antidote and remedy called theriac, concerning which Galen wrote two special treatises[790] besides discussing it in his works on simples and antidotes. Mithridates, like King Attalus in Galen’s native land, had tested the effects of various drugs upon condemned criminals, and had thus discovered antidotes against spiders, scorpions, sea-hares, aconite, and other poisons. He then combined the results of his research into one grand compound which should be an antidote against any and every poison. But he did not include the flesh of the viper, which was added with some other changes by Andromachus, chief physician to Nero.[791] The divine Marcus Aurelius used to take a dose of theriac daily and it had since come into general use.[792] Galen gives a long list of ills which it will cure, including the plague and hydrophobia,[793] and adds that it is beneficial in keeping a man in good health.[794] He advises its use when traveling or in wintry weather, and tells Piso that it will prolong his life.[795] He explains more than once[796] how to prepare the viper’s flesh, why the head and tail must be cut off, how it is cleaned and boiled until the flesh falls from the backbone, how it is mixed with pounded bread into pills, how the flesh of the viper is best in early summer. Galen also accepts the legend,[797] quoting six lines of verse from Nicander to that effect, that the viper conceives in the mouth and then bites off the male’s head, and that the young viper avenges its father’s death by gnawing its way out of its mother’s vitals. The _Marsi_ at Rome denied the existence of the _dipsas_ or snake whose bite causes one to die of thirst, but Galen is not quite sure whether to agree with them.

[Sidenote: Magical compounds.]

Already we have had occasion to refer to Galen’s two works on compound medicines which occupy the better part of two bulky volumes in Kühn’s edition and contain a vast number of prescriptions. It is not uncommon for one of these to contain as many as twenty-five ingredients. It seems unlikely that such elaborate concoctions would have been discovered by chance, as the Empirics held, but the modern reader is ready to agree that it was chance, if anyone was ever cured of anything by one of them. Yet Galen, as we have seen, believes that reasons can be given for the ingredients and would not for a moment admit that they are no better than the messes of witches’ cauldrons. He argues that, if all diseases could be cured by simples, no one would use compounds, but that they are essential for some diseases, especially such as require the simultaneous application of contrary virtues.[798] Also where a simple is too strong or weak, it can be toned up or down to just the right strength in a compound. Plasters and poultices seem always to be compounds. Of panaceas Galen is somewhat more chary, except in the case of theriac; he opines that a medicine which is good for a number of ills cannot be very good for any one of them.[799]

[Sidenote: Amulets.]

Procedure as well as substances suggestive of magic is found to some extent in Galen’s works. He instructs, for example, to pluck an herb with the left hand before sunrise.[800] He also recommends the suspension of a peony to cure epilepsy.[801] He saw a boy who wore this root remain free from that disease for eight months, when the root happened to drop off and the boy soon fell in a fit. When another peony root was hung about his neck, he remained in good health until Galen for the sake of experiment removed it a second time, whereupon another epileptic fit ensued as before. In this case Galen suggests that perhaps some particles from the root were drawn in by the patient’s breathing or altered the surrounding air. In another passage he holds that there is no medical reason to account for the virtues of amulets, but that those who have tested them by experience say that they act by some marvelous antipathy unknown to man.[802] A ligature recommended by Galen is to bind about the neck of the patient a viper which has been suffocated by tying several strings, preferably of marine purple, about its neck.[803] Galen marvels that _stercus lupinum_, even when simply suspended from the neck, “sometimes evidently is beneficial.”[804] It should not have touched the ground but should have been taken from trees or bushes. It also works better, as Galen has found in his own practice, if suspended by the wool of a sheep who has been torn by a wolf.

[Sidenote: Incantations and characters.]

While Galen thus employs ligatures and suspensions and sanctions magic logic, he draws the line at use of images, characters, and incantations. In the passage just cited he goes on to say that he has found other suspended substances efficacious, but not the barbarous names such as wizards use. Some say that the gem jasper comforts the stomach if bound about the abdomen,[805] and some wear it in a ring engraved with a dragon and rays,[806] as King Nechepso directs in his fourteenth book. Galen has employed it suspended about the neck without any engraving upon it and found it equally beneficial. In illustrating the virtue of human saliva, especially that of a fasting man, Galen tells of a man who promised him to kill a scorpion by means of an incantation which he repeated thrice. But at each repetition he spat on the scorpion and Galen afterwards killed one by the same procedure without any incantation, and more quickly with the spittle of a fasting than of a full man.[807]

[Sidenote: Belief in magic dies hard.]

The preceding paragraph gives a good illustration of the slow progress of human thought away from magic and towards science. Men are discovering that marvels can be worked as well without characters and incantations. Similar passages may be found in Arabic and Latin medieval writers. But while Galen questions images and incantations, he still clings to the notions of marvelous virtue in a fasting man’s spittle or in a gem suspended about the neck. And these and other passages in which he clung to old superstitions were unfortunately equally influential upon succeeding writers, who sometimes, we fear, took them as an excuse for further indulgence in magic. Indeed, we shall find Alexander of Tralles in the sixth century arguing that Galen finally became a believer in the efficacy of incantations. Thus the old notions and practices die hard.

[Sidenote: _On easily procurable remedies._]

In the treatise on easily procurable remedies, where popular and rustic remedies enter rather more largely than in Galen’s other writings, superstitious recipes are also met with more frequently, and, if that be possible, the doses become even more calculated to make one’s gorge rise, it being felt that the unfastidious tastes and crude constitutions of peasants and the poorer classes can stand more than daintier city patients. Another reason for separate consideration of the contents of this treatise is the possibility, already mentioned, that it is interpolated and misarranged, and the fact that it is in part of much later date than Galen.

[Sidenote: Specimens of its superstitious contents.]