The greatest of the Eclectics, however, was

Claudius Galen

of Pergamus' (A. D. 131-201 or 210), who, though he did not consider himself an Eclectic, and is not usually classed as such, yet distinguished himself above all others by advancing a complete "Eclectic System" of his owna system which for more than a thousand years enjoyed undisputed sway. Galen was in the medical, as Aristotle in the philosophical, departinent the leading lawgiver of both Christians and Arabians during the whole Middle Ages, and he has therefore attained the widest importance of all the ancient physicians. "He belonged ", as Schlosser says, "to a period, in which, as in all times of laxity and over-refinement, the institutions of instruction were excellently arranged, instruction was learned and profound, and the struggle for those branches of knowledge, which every man of breeding was expected to possess, was generally diffused. Hence much attention, indeed, more attention than at other times, was bestowed upon those branches which demand no flight of fancy, no independence of mind, but which offer immediate profit. These branches, as we know, are the mathematical, medical, physical, geographical and legal sciences. In after ages Galen's influence, not only as a medical, but also as a rhetorical and philosophical, writer was exercised most beneficially on a class which despised the ancient sources of genuine wisdom, and while it continually preached about supersensible things, of divine revelations and of the renunciation of humanity through monastic discipline, was yet incapable of any genuine enthusiasm. This influence of Galen shows itself particularly in that treatise which bears the title "Suasoria ad artes oratio" and was most frequently read."

Galen was the son of Nicon, an architect, whom he paints as the most excellent of fathers, while he has fixed upon his mother the stain of a second Xantippe. The former instructed him at first himself, as was the rule among the Ancients; for in a few places only were there any arrangements like our primary and intermediate schools. He then had him in his 15th year instructed in the most prominent philosophical systems, and later devoted him to the medical profession in consequence of a dream, a superstitious tendency which explains the same peculiarity in the son. Galen received instruction in anatomy from Satyrus at Pergamus, and in pathology from Stratonicus the Hippocratist, Ennius Meccius, and Æschrion the Empiric. After the death of his father, however, he went in his 21st year to Smyrna where he received further anatomical instruction from Pelops; thence he went to Corinth, where he had Numesianus as his teacher. In order to improve himself also in pharmacology by his own observation, he made long tours in Asia Minor und Palestine, and sought e. g. the jet-stone in in a boating expedition along the entire Lycian

3

1. In Mysia, one of the educational and artistic centers of the world at that time. 2. The mothers of great men among the Ancients, in consequence of their want of education, did not and could not have that influence upon the career of their sons, which is so common among modern peoples.

3. Latin "

gagates", Greek payázɛs, a stone said to be found in Lycia or Cilicia, which, when exposed to the fire, burns and emits a bituminous odor. It was recommended in epilepsy, hysteria and gout. (H.)

coast.

After studying anatomy especially for a long time at Alexandria,- he names as his teacher a certain Heraclianus, and mentions as a piece of good fortune that he saw there a human skeleton - he returned in his 28th year to his native city, and began to practice as a gladiatorial physician. At the age of 34 he went to Rome, where he speedily acquired reputation, especially by his physiological lectures and his practice. Galen fought especially against the school of Methodism, which was the most influential in his day, and in behalf of Hippocrates, who was not in fashion, and he relates how some of his "colleagues" even poisoned each other—a matter limited to glances at the present day! The envy of these fellows drove him, however, from Rome, and with disgust for the practice of his profession in his heart, in the 37th year of his age he went again upon his travels, and returned to his home. After a year, however, he was recalled to Rome by Marcus Aurelius, and returned to the metropolis on foot. When he arrived, he was requested to accompany the emperor in the war against the Marcomanni, but declined the position, superstitiously influenced by a dream, and so became physician-in-ordinary to Commodus. Of his subsequent life nothing is known, though he is supposed to have lived to the age of 70-80 years.

Galen was an author of immense fertility (and not alone in the field of medicine), a fact only partially explained by the circumstance that he began to write in very early youth.'

1. Of Galen's works there were on philosophical, grammatical, mathematical and legal subjects

Of independent medical works still extant: genuine

125

83

19

48

275

15

19

309

80

Total

Under Galen's name there exist 45 other writings, distinguished as

389 spurious".

The most complete edition of Galen's works is that of Kühn in 22 volumes. The most important treatises are: "De usu partium corporis humani"; "De notu musculorum"; "De locis affectis"; "De differentiis morborum"; "De pulsibus"; 'Ars parva"; De ratione medendi"; "Methodus medendi"; "De crisibus"; "De differentiis febrium"; "De sanitate tuenda"; De compositione medica

mentorum"; "De morborum causis"; The commentaries etc.

Those treatises of the preceding list whose titles are printed in italics have been distinguished as the "canonical" writings of Galen, and during the Middle Ages these were first expounded to the students. A complete translation from the Greek of the entire works of Galen has never been made.

In spite of the facility with which he wrote, Galen received but slight honoraria from the booksellers. Martial for the first book of his epigrams received only about 75 cents. On the other hand large bids were made by private individuals: e. g. Pliny was offered $60,000 for his work. Shorthand writers received about 10 cents for each of our pages of the present day, or the same sum per hour. At that period there were booksellers in England, Spain etc., and of course bookfauciers, as well as waste paper (for dealers in fish and sausage).

The philosophico-physiological and general pathological views of Galen are founded upon the four elements, to which are attached the primary qualities: to air, coldness, to fire, warmth, to water, moisture, to earth, dryness. To these correspond four cardinal humors, among which latter the element water predominates in the mucus, which is secreted by the brain; fire, in the yellow bile, which has its origin in the liver; earth, in the black-bile formed by the spleen; while in the blood, which is prepared in the liver (an important error, not discarded until the 17th century), the elements are uniformly mixed. Mucus is cold and moist; yellow bile, warm and dry; black-bile, cold and dry; the blood, warm and moist.

This coincidence of the primary qualities is the cause of the secondary, so that the latter arise from the mixture of the former. The primary qualities are not cognizable by the senses, but only the secondary. The life-giving principle is the soul, understood as a primitive force, which as "spiritus", "pneuma", is taken from, and constantly renewed by, the general world-soul in the respiration, taken in its widest sense. Arrived in the body the pneuma becomes in the brain (to which it penetrates through the nose) and the nerves the "animal spirits" (sopa dozziv, spiritus animalis); in the arteries and the heart (to which it comes by way of the lungs) the vital spirits" (zvečpa Cwrizóv, spiritus vitalis); and in the liver and the renal veins, the "natural spirits" (viona quazó, spiritus naturalis). The three fundamental faculties (vapets, facultates), the "animal" (uzzy), "vital" (ortz) and "natural" (coatz), which bring into action and keep in operation the corresponding functions, originate as an expression of the primal force, "soul" (pneuma), existing in these three modalities within the body. Besides these, there are for special functions of the body other faculties, subordinate to these three and acting occasionally, as the "attractive" (3. Ezriz), the "propulsive "(§. apawartz), the "retentive" (6. za@sztizi) and the “secreting" (ô. àzozpizizy).

Upon these depend nutrition, assimilation, secretion, muscular contraction, in general all the ordinary functions of the body, in which each organ has the property of appropriating to itself by means of these faculties that which is necessary for its own existence. There are, besides these, "special forces", which are not derived from the three already named, and which are therefore supernatural. Everything, however, which exists and displays activity in the human body, originates in, and is formed upon, an intelligent plan, so that the organ in structure and function is the result of that plan. Thus the human frame is adapted to the solution of a teleological problem. Indeed Galen is the father of teleology in medicine.

"It was the Creator's infinite wisdom which selected the best means to attain his beneficent ends, and it is a proof of his omnipotence that he created every good thing according to his design, and thereby fulfilled his will", an expression which accords with the Christian ideas that were then forced by the spirit of the age upon the very heathen. (Schlosser.)

As in what precedes we find, besides views peculiar to Galen, a mixture of Hippocratic, Platonic, Aristotelian and Stoic ideas, so in what follows we observe a similar selection from the older views, besides those of purely Galenic origin.

Health is to be regarded as that condition in which all the functions of the body are performed without pain and without disturbance (effecting thereby the so-called euexia), the possibility of which depends upon the proper proportion of the solid and fluid constituents, and the correct mixture (crasis, eucrasis) of the humors. Conse

quently disease is that "unnatural" condition, in which a contrary state exists. Now diseases may affect:

1. The four elements and their corresponding cardinal fluids (general diseases), in the form of dyscrasiae, of which there may consequently be eight, while one or two are especially conspicuous.

2. The similar parts (general tissues: muscles, nerves, bones, ligaments etc.), in which either abnormal tension or relaxation (views of the Methodists!), or disturbance of the fundamental qualities (warmth, cold, moisture, dryness-Hippocratic!) through abnormal predominance of the one or the other, arises.

3. The organs (local diseases), in which the number, form, mass or position of the parts may be disturbed.

To the two latter classes of disease the abolition of the constant performance of the functions of the undisturbed condition is common.

Galen divides the causes of disease into the proximate and the remote, the latter of which again are subdivided into the external (occasional), and internal (predisposing) causes. The predisposing causes consist for the most part, in an overflow, or corruption, of the humors, for which latter condition Galen retained the "putrefaction" of the Pneumatists. This he considered a general cause of fever (the essential phenonenon of which was an elevation of the temperature-as it is to-day-more rarely moisture), with the exception of ephemeral fever. which arises from injury of the pneuma.-The influx of the blood into unusual places (error loci of Erasistratus!) is the cause of inflammation, with its cardinal symptoms, redness, heat, swelling and pain. Galen divides inflammation into the following curious classes, some of which are still current : a. erysipelatous, where the yellow bile mingles with the misplaced blood; b.-pneumatous, where the pneuma unites with the misplaced blood; c.--phlegmatous, where mucus mixes with the blood; d.-phlegmonous, when it depends purely on misplacement of the blood; e.-scirrhous, when black bile meets with the blood. The results of inflammation are resolution, exudation and suppuration.

Symptoms (epigenemata) are the visible results of disease. They are distributed (in opposition to the theoretical view of crudeness, coction and crisis, of Hippocrates) over the four stadia of disease recognized by Galen: the stadium initiale, incrementi, acmes and decrementi.

The course of disease becomes chronic through the influence of mucus and black bile, acute, through blood and yellow bile.

Galen, like Hippocrates, taught the doctrine of crises, but associated therewith the course of the sun and moon.

Galen is of peculiar importance in special pathology from the fact that he first, designedly, and extensively employed experiment for its basis. He was the first physiologist (if we except the accounts of the Hippocratists in embryology) to experiment and vivisect upon scientific principles. Thus he founded the physiology of the nervous system by section of the fifth cervical nerve, after which he saw the motility of the supra- and infra-spinatus muscles cease; similarly, after section of the recurrent nerve, (together with the intercostal muscles), and after destruction of the spinal marrow, he observed loss of the voice. Nerves of motion, which as such are "hard", are represented by the 60 spinal nerves; those of sensation ("soft") by the nerves of the brain. Of the latter he recognized seven: the optic; oculomotorius and trochlearis; 1st. branch of the trigeminus; 2d. and 3d. branches of the trigeminus; acoustic and facial; vagus, and glossopharyngeus. The nerves of the medulla oblongata were of mixed function.-Galen was acquainted with the movement of the brain, and assumed that by it the impurities of the "animal spirits", brought to the brain by the carotids, were expelled through the lamina cribrosa, while its more refined portions, the nervous spirits, were prepared in the plexus of the ventricles,

and thence borne by the nerves throughout the body.-The great sensibility of the intestines depends upon the sympathetic nerve. The perception of light he locates in the retina. According to Galen the secretion of milk depends upon pressure of the pregnant uterus upon the vessels of the abdomen, with which those of the breast anastomose. -Respiration and the pulse serve one purpose, the reception of air. The latter in inspiration comes first into the lungs, and thence into the left heart and arteries. On the other hand, during the diastole of the arteries air is sucked into them through the pores of the skin. During the systole of the lungs and arteries the "soot" escapes. The air or pneuma received by the lungs is not sufficient by itself to cool the heart; hence air is also received through the skin. The diastole of the heart and arteries and inspiration also conduct pneuma to the blood, while the systole and expiration discharge the "soot" from the blood. Respiration has its origin in the vital, the pulse in the animal sphere. In this consists their essential difference, not in their function. Respiration is effected by means of the diaphragm and the intercostal muscles The physiological route of the pneuma (the respiratory process is one of combustion!) is developed within the body or the vessels as the circulation, which takes place as follows: from the stomach the food, which has undergone "coction", proceeds to the liver, where it is converted into blood. This blood is now carried to the heart, and the latter organ (whose various parts all contract simultaneously) drives into the lungs, through the pulmonary artery, so much of this blood as may be required for their nutrition. At the same time the remainder of the blood is driven through the veins into the body, and a minute portion passes through the pores of the septum into the left ventricle, where it is mixed with the pneuma drawn into the heart through the pulmonary veins in diastole. No blood returns from the lungs to the heart, for all of it is consumed in the nutrition of those organs. From the left heart the blood (mixed with the pneuma) proceeds through the aorta to be communicated to the veins finally by means of the pore-like anastomoses at the terminations of this vessel. To the veins all the nutrition of the body is due. The blood conveyed to the body by the veins is principally used up in nutrition; but what little remains, together with the new blood formed in the liver, returns to the right heart by a sort of ebb-tide in the venous circulation. Dilatation and diastole of the heart, as well as of the arteries, are the active factors in the motion of these parts, while systole is the passive element. The venous portion of the circulation is the seat, as we have seen, of nutrition; the arterial of the "vital spirits". Galen's explanation of the circulation is by no means clear. King Alfonso judged of the Ptolemaic system of the motion of the universe, that it was not sufficiently simple to be true. Singularly enough, however, no physician, down to the time of Harvey, formed a similar opinion of the theory of circulation of the Ancients! The blood is perfected in the heart and supplied with the calidum innatum, and then passes on into the body. The pulse arises from an active dilating force, pulse-force, communicated to the arteries from the heart. The heart has no nerves, but is the seat of passion and courage.' The brain is the seat of the rational soul, and an organ for the secretion of mucus and for

1. Gr. λιγνός or τὸ καπνώδες, Lat. fuligo: the excrementitious waste of the body. (H.)

2 It is interesting to observe how this idea has engrafted itself upon our very language, courage coming down to us from the Latin cor, heart, through the mediæval Latin coraticum and the old French corage. So Chaucer says:

"So priketh hem Nature in hir corages".

The venereal function of the liver is at least as old as Plato, and descends certainly as late as Shakespeare. To Ford's question "Love my wife?" Pistol replies "With liver burning hot!" (H.)