Chapter XVIII: Book XIII: to the shoulder and the structure of the spinal column in

detail (40 pages); Books XIV. and XV. to the genital organs and the parts in which the foetus develops (70 pages); Book XVI. to the nerves, arteries and veins (43 pages); and Book XVII. Epilogue (11 pages).

There are very few modern text books in which the author treats the subject in as exhaustive a manner as Galen has done in these seventeen books. As may readily be imagined from the great number and length of his writings, he often wanders off into side issues and thus lays himself open to the charge of being a diffuse writer. At the same time he cannot be accused of dullness, for in reading Daremberg’s version one is seldom tempted to omit any of the text, and his style is interesting. The following brief extracts, to which should be added that given on a previous page, may be taken as fair samples of his manner of treating questions in the department of physiology:--

_Reasons why the Alae Nasi are Cartilaginous and why they may
be Moved by Voluntary Muscular Action._--We have already
explained in some measure the reasons why the alae nasi should
be composed of cartilage and why it should be possible for the
animal to move them at will.[41] It is an established fact that
the movements of these parts are competent to aid in no small
degree the somewhat forcible inspirations and expirations. This
is the reason why the alae are constructed in such a manner as
to be easily movable. They are made of cartilage because this
substance is hard to fracture or to tear apart. The placing
of these alar movements under the control of the will, and
not under that of some other bodily force (like the arterial
impulse, for example), is certainly an excellent arrangement;
and, if one does not appreciate this without any further
explanation, it must be because my previous reasonings about
such matters have fallen upon inattentive ears.

(Translated from Book XI., Chapter XVII., of Daremberg’s French
version of Galen’s works.)

Another brief extract may be given here. It forms a part of the chapter relating to the action of the sigmoid valves of the pulmonary artery, etc., and merits special attention because it furnishes additional evidence of the correctness of Daremberg’s statement that Galen was the leader of the most advanced school of experimentation:--

The more strongly the thorax, in its exertion of a compressing
force, tends to drive the blood (out of the heart), the more
tightly do these membranes (the sigmoid valves) close the
opening. Invested in a circular manner from within outward,
extending throughout the entire circumference of the interior
of the vessel, these membranous valves are, each one of them,
so accurately patterned and so perfectly fitted that when they
are put upon the stretch by the column of blood, they constitute
a single large membrane which closes (watertight) the orifice.
Pushed back by the return flow of the blood, they fall back
against the inner surface of the vein, and permit an easy
passage of the blood through the amply dilated orifice (which
they, an instant before, closed so perfectly).

(Translated from Book VI., Chapter XI., of Daremberg’s French
version of the works of Galen.)

In his comments upon the account of the sigmoid valves which I have just quoted, Daremberg says that the description of these structures given by Erasistratus at least four hundred years earlier is admitted by Galen to be so correct that it would scarcely be possible to furnish a better one.

_Galen’s Remarks upon the Subject of Diagnosis._--In the treatise entitled “On the parts of the Body Affected” (Book II., Chapter X.) Galen gives the following advice with regard to the method which it is desirable to adopt when one wishes to ascertain which part or organ is affected, what is the nature of the disease there located, and whether it is primary in its nature or secondary to some affection of earlier development:--

It should have been the special duty of Archigenes, who
appeared on the scene next in order after a series of the most
illustrious physicians,[42] to infuse more light into medical
teaching. Unfortunately, he did the very opposite; for we who
have grown old in the exercise of the art (and should therefore
find it easy to comprehend what is written about medicine), are
at times unable to understand what he says. Such being the true
state of affairs, I now propose to undertake what Archigenes
failed to accomplish. I shall commence by indicating in a
general way what is the proper method to adopt when one wishes
to ascertain in what part or organ the disease is located and
how one should proceed when it is proposed to teach the method
to others. This method may be stated in the following terms:--

In the first place, the part should be carefully examined in
order that we may ascertain whether it presents any signs of
special value as indicating the nature of the disease. In the
next place, it is important in such an examination to know
beforehand what are the particular signs which belong to each
of the diseases that may affect the part or organ in question,
and also whether these signs vary according to the particular
section of the organ involved. In inflammation of the lung,
for example, there are: difficulty in breathing (dyspnoea) and
great general distress (malaise), the patient being obliged to
remain in a sitting posture (orthopnoea)--all of which are signs
indicating the possibility of suffocation. Furthermore, the
air expired from the infected lung is sensibly hot, especially
if the inflammation is of the erysipelatous variety, and, as
a consequence, the patient shows a disposition to draw long
breaths, knowing that the cold air which he thus draws into
his lungs will afford him some measure of relief. The sputa
expectorated when he coughs are differently colored; some
being red, yellowish, or of a rusty appearance, while others
are almost black, livid, or frothy. The patient also often
experiences the sensation of a heavy weight in his chest,
together with more or less pain, which seems to be located
deep down in that region and which shoots backward into his
spinal column or forward toward the sternum. Add to these
manifestations a high fever and a pulse such as we have already
described on another page, and you will have....

(Translated from Daremberg’s French version of Galen’s works.)

It has been said that Galen possessed more than the ordinary share of vanity with regard to his cleverness as a diagnostician; and certainly some of the accounts which he gives, in his clinical and scientific treatises, of his own experiences, seem to bear out this accusation. One hesitates to expose the weak spots in the character of one of the really great men of antiquity lest such exposure may convey a wrong impression; at the same time it would be an error to represent him as a man entirely free from the foibles common to humanity,--even to the best and wisest of men. I therefore repeat here Galen’s own account of a professional visit which he made to a brother physician whose malady presented to himself and to his friends many obscure features.

Upon the occasion of my first visit to Rome I completely won the
admiration of the philosopher Glaucon by the diagnosis which I
made in the case of one of his friends. Meeting me one day in
the street he shook hands with me and said: “I have just come
from the house of a sick man, and I wish that you would visit
him with me. He is a Sicilian physician, the same person with
whom I was walking when you met me the other day.” “What is the
matter with him?” I asked. Then coming nearer to me he said,
in the frankest manner possible: “Gorgias and Apelas told me
yesterday that you had made some diagnoses and prognoses which
looked to them more like acts of divination than products of the
medical art pure and simple. I would therefore like very much to
see some proof, not of your knowledge but of this extraordinary
art which you are said to possess.” At this very moment we
reached the entrance of the patient’s house, and so, to my
regret, I was prevented from having any further conversation
with him on the subject and from explaining to him how the
element of good luck often renders it possible for a physician
to give, as it were off-hand, diagnoses and prognoses of this
exceptional character. Just as we were approaching the first
door, after entering the house, we met a servant who had in his
hand a basin which he had brought from the sick room and which
he was on his way to empty upon the dung heap. As we passed
him I appeared not to pay any attention to the contents of the
basin, but at a mere glance I perceived that they consisted of a
thin sanio-sanguinolent fluid, in which floated excrementitious
masses that resembled shreds of flesh--an unmistakable evidence
of disease of the liver. Glaucon and I, not a word having been
spoken by either of us, passed on into the patient’s room. When
I put out my hand to feel of the latter’s pulse, he called my
attention to the fact that he had just had a stool, and that,
owing to the circumstance of his having gotten out of bed, his
pulse might be accelerated. It was in fact somewhat more rapid
than it should be, but I attributed this to the existence of
an inflammation. Then, observing upon the window sill a vessel
containing a mixture of hyssop and honey and water, I made up
my mind that the patient, who was himself a physician, believed
that the malady from which he was suffering was a pleurisy; the
pain which he experienced on the right side in the region of
the false ribs (and which is also associated with inflammation
of the liver) confirming him in this belief, and thus inducing
him to order for the relief of the slight accompanying cough
the mixture to which I have just called attention. It was then
that the idea came into my mind that, as fortune had thrown the
opportunity in my way, I would avail myself of it to enhance
my reputation in Glaucon’s estimation. Accordingly, placing my
hand on the patient’s right side over the false rib, I remarked:
“This is the spot where the disease is located.” He, supposing
that I must have gained this knowledge by simply feeling his
pulse, replied with a look which plainly expressed admiration
mingled with astonishment, that I was entirely right. “And”--I
added simply to increase his astonishment--“you will doubtless
admit that at long intervals you feel impelled to indulge in
a shallow, dry cough, unaccompanied by any expectoration.” As
luck would have it, he coughed in just this manner almost before
I had got the words out of my mouth. At this Glaucon, who had
hitherto not spoken a word, broke out into a volley of praises.
“Do not imagine,” I replied, “that what you have observed
represents the utmost of which medical art is capable in the
matter of fathoming the mysteries of disease in a living person.
There still remain one or two other symptoms to which I will
direct your attention.” Turning then to the patient I remarked:
“When you draw a longer breath you feel a more marked pain, do
you not, in the region which I indicated; and with this pain
there is associated a sense of weight in the hypochondrium?”
At these words the patient expressed his astonishment and
admiration in the strongest possible terms. I wanted to go a
step farther and announce to my audience still another symptom
which is sometimes observed in the more serious maladies of the
liver (scirrhus, for example), but I was afraid that I might
compromise the laudation which had been bestowed upon me. It
then occurred to me that I might safely make the announcement
if I put it somewhat in the form of a prognosis. So I remarked
to the patient: “You will probably soon experience, if you have
not already done so, a sensation of something pulling upon the
right clavicle.” He admitted that he had already noticed this
symptom. “Then I will give just one more evidence of this power
of divination which you believe that I possess. You, yourself,
before I arrived on the scene, had made up your mind that your
ailment was an attack of pleurisy, etc.”

Glaucon’s confidence in me and in the medical art, after this
episode, was unbounded.

Thirty or forty years elapsed after Galen’s death before the Profession began to realize how great an authority he had become in all matters relating to medicine; not perhaps among the majority of physicians, but among the better educated and those more given to reasoning about the various problems in physiology and pathology. Then came the invasion of Rome by the Barbarians, and with it the scattering of nearly all those who were at the time practicing medicine in that great city. This was the beginning of the long period known as the Middle Ages, a period during which, so far as Italy and Gaul were concerned, the science of medicine made no advance whatever. The physicians living in a precarious manner in the towns, and the monks who practiced medicine in the country districts, took very little interest, as may readily be imagined, in the achievements of Galen. Through all those years they clung to the doctrines of the Methodists, as revealed to them in the work of Caelius Aurelianus, the favorite medical treatise of that period. It was only during the latter part of the Middle Ages that Galen’s teachings began once more to be appreciated at their true value; and, as time went on, they gained a stronger and stronger hold on the minds of medical men, until finally they held undisputed sway. Friedlaender, speaking of medicine in those dark times, uses these words: “Galen’s colossal personality loomed up throughout that long night as a brilliant guiding star to light the intricate pathways of medicine.”