ne day when Galen was debating with his household slaves about what to do with a rancid cheese, a patient appeared at his door. It was an old man, arthritic with “chalkstones” (Galen’s word) in his joints. Unable to walk, he was being carried in a litter. Galen had what seemed to him the brilliant idea of mixing some of the cheese with cooked, pickled pig’s leg, blending it in a mortar and applying it to the affected joints. The plaster caused the patient’s skin to rupture (“spontaneously, without cutting”) and the chalkstones oozed away through the wound, over a period of several days. Both Galen and the patient found this outcome highly satisfactory; there was some difficulty when the supply of rancid cheese ran out, but the patient managed to procure another one and remained an enthusiastic user of, and evangelist for, the cure Galen had invented on the spur of the moment.
We can hazard a modern explanation of happened in the case of this patient. He probably suffered from gout; in advanced cases, uric acid crystals form deposits in the joints and over time can cause severe debility. Large accretions of crystals in the hands and feet are sometimes called “chalkstones” today. These can rupture spontaneously, and this is most likely what happened with Galen’s patient; there is no obvious reason why the rancid cheese plaster would have helped.1 It is inevitable that, reading Galen’s anecdotes from so long ago, we will refocus them through the lens of our own, very different ideas and experience, and in some places I have helped the reader to do this. But we should not lose sight of the fact that the story is a clue to Galen’s own perspective, in some ways so different from our own, in others startlingly familiar, and it is this—the experience of medicine in antiquity—that I hope most of all to convey to the reader.
I offer the story, then, not to suggest that Galen had some preternatural healing ability that transcended the limits of his understanding. There can be no comparison between the state of medical knowledge in antiquity and that following the “paradigm shifts” of the Renaissance and modern periods—for example, the discovery of the blood’s circulation, germ theory, or genetics. No paradigm shift occurred with Galen, who practiced what Thomas Kuhn, the inventor of that term, would describe as “normal science.”2 I have not belabored Galen’s errors about physiology, disease, the humors, and so forth, as our understanding of medicine has fundamentally changed in the last five centuries in ways that would make a catalog of his mistakes both overwhelming and unnecessary. I have pointed out intellectual contributions still relevant today—Galen’s anatomy, although based on that of animals, was the foundation of Renaissance anatomy, for example; and he was a keen observer of human nature with unnervingly accurate insights into psychological disorders. But this is not mainly a work of intellectual history.
Rather, the story of the elderly man with chalkstones, which appears in one of Galen’s works on pharmacology, his treatise On the Mixtures and Powers of Simple Drugs, illustrates the everyday practice of medicine by one of the most skilled experts of his time. This is what makes it historically significant: the patient arriving at Galen’s door even in the middle of a dispute with his domestic servants; Galen’s immediate, focused, apparently unmediated attention as he examines the patient, mixes the plaster, places it on the affected part; his characterization of the patient as old (this is one of very few patients so described); his lack of comment on the patient’s social status, which is probably, given the circumstances, humble. A richer patient would have sent for Galen, and Galen would have appeared at his house, even in the middle of the night, if it was urgent.
Galen practiced medicine in the Roman Empire for more than fifty years. In his own lifetime, as I shall describe, he achieved so much prestige through his reputation as a healer, his social standing, his prolific writing, and his ruthless demolition of his enemies in every debate and showdown, that he became virtually the last word on medicine. His works, for this reason preserved in scattered European locations and in Arabic translations, and collected in the massive editions of the Renaissance, represented the culmination of what was then known of medical science, the premodern “paradigm.” Until the twentieth century, he was the most influential figure in western medicine and perhaps in western culture generally. The most modern edition of his corpus runs to twenty-two volumes, including about 150 titles, and is one-eighth of all the classical Greek literature that survives.
Today, we are most accustomed to seeing Galen as an disembodied corpus of texts—a set of ideas about the body that became first canonical, then obsolete; a stultifying influence from which western medicine struggled, heroically and successfully, to escape. We fail to appreciate the extent to which Galen’s works are grounded in his life and in his practice, in what he observed, experienced, dared, performed, and accomplished. The Galen of this biography is a tireless interrogator of nature, an attentive inquisitor of patients and reader of diagnostic clues, a ruthless critic of ideas unsupported by experience, skeptical of nearly all received medical knowledge, and an aggressive and competitive public figure. When Vesalius used dissection to disprove many of Galen’s assertions about anatomy and then mercilessly skewered the followers of his remote predecessor for their mistakes, he was imitating the very methods that Galen had delighted in hundreds of years before.
One day, if humanity is lucky, our own state of medical knowledge will seem as quaint as that of Galen and his contemporaries. In modern medicine there is no shortage of mystery, of inefficacy, of ignorance. How then do we understand its place in our culture and in history? Galen’s life can offer us this perspective. This is the story of a brilliant and driven, privileged and highly educated, but otherwise normal person practicing normal science on normal people. My main emphasis is not on Galen’s ideas, but on his life.
I close this preface with a note on Galen’s personality; for ever since antiquity, one cannot write biography without consideration of the moral example set by one’s subject, nor disregard the historian’s traditional obligation of assigning praise and blame. Galen’s defects of character will be very obvious even to the casual reader of this book. In the modern, western world he might be diagnosed with a personality disorder, once megalomania, today narcissism. He also epitomizes the much-maligned “type A” personality. All of this, however, was typical of his time, place, and social stratum, and Galen was not more competitive, hostile, or self-aggrandizing than his peers. For these reasons I have chosen to call attention to qualities that the reader might more easily overlook, qualities that did distinguish him from his peers and contributed to his success and long-standing influence; among these are not only insatiable drive, intellectual curiosity, and self-discipline but also unusual powers of observation and a profound understanding of human nature.