In Our Time - Galen

Episode Date: October 10, 2013

Melvyn Bragg and his guests discuss the Roman physician and medical theorist Galen. The most celebrated doctor in the ancient world, Galen was Greek by birth but spent most of his career in Rome, where he was personal physician to three Emperors. He was one of the most prolific authors of his age, and a sixth of all surviving ancient literature in Greek was written by him. Celebrated in his own lifetime, he was regarded as the preeminent medical authority for centuries after his death, both in the Arab world and in medieval Europe. It was only the discoveries of Renaissance science which removed Galen from his dominant position in the pantheon of medicine.With:Vivian Nutton Emeritus Professor of the History of Medicine at University College LondonHelen King Professor of Classical Studies at the Open UniversityCaroline Petit Wellcome Trust Senior Research Fellow in Classics at the University of WarwickProducer: Thomas Morris.

This BBC podcast is supported by ads outside the UK. Thank you for downloading this episode of In Our Time. For more details about in our time, and for our terms of use, please go to BBC.co.com. I hope you enjoy the programme. Hello, in the middle years of the second century AD, a young Greek man called Galen began to practice medicine as chief physician to the local troop of gladiators. At the age of 30, he moved to Rome, where he became a personal doctor to the Emperor Marcus Aurelius, and the most celebrated doctor in the Roman Empire.

Galen was all of the most prolific authors of the ancient world, a polymath who wrote not just about medicine, but also about language and philosophy. More of his work survives than that of any other writer in ancient Greek. Galen was a pioneer of anatomy and the first person to identify many of the structures of the human body, and he wrote about drugs, physiology and therapeutic methods. His teaching dominated medical teaching,

both in the Arab world and later in Europe until the Renaissance. Women to discuss the life and influence of Galen are Vivian Notten, Emeritus Professor of the History of Medicine at University College London, Helen King, Professor of Classical Studies at the Open University, and Carolyn Petit, welcome Trust, senior research fellow in classics at the University of Warwick. Vivian Notten, would you tell us something about Galen's background in early life? Galen was born in the year 129 in the eastern half of the Roman Empire, the Greek-speaking half, which at that point was at its wealthiest and richest.

And he came from a city called Pergamum, which at that point was undergoing a huge makeover, new temples, new public buildings, and it was one of the intellectual centres of the ancient world. And his father was an architect, so he clearly benefited from all the building going on, and he intended Galen to be, I think, a public intellectual. He wanted to study, he studied classical literature, philosophy, and suddenly, when Gaelin was 17, his father had a dream, a clear dream sent by the God of Sleepyus, the God of healing, which said Gailen from now on must be a doctor.

And he then began what is the longest medical education on record, 10 years. First at home at Pergamum, then down the coast, at Smyrna, Modern Ismere, and then at Alexandria, which was the foundation of health for everybody, the great medical school. And his teachers had studied there, and Galen goes there and spends perhaps five years. What he learnt there is unclear. He doesn't like the Egyptians, he doesn't like the weather, he doesn't like the food, doesn't like his teachers, but he stays. And I think he learnt three things. One was pharmacology, the second was anatomy, and the third was surgery.

Can you just say a little more, that wonderful phrase, the intellectual centre? Now, what did that actually mean? The poem under town. What was intellectual centred about it? It was a place where poets, historians, philosophers came, debated in public. Pergamem itself had a huge library like that of Alexandria, and it was a vibrant community of intellectual people coming. There were contests, and Galen...

You mean intellectual contests? I can give you, debating contests. Debating contests. It was a wonderful place to grow up in, and Galen took full advantage. This dream that his father had, there was a belief then that gods spoke to human beings through their dreams.

That's why he took it so seriously. Much later on, Galen was going to have a dream which prevented him going to battle with Marcus Aurelius. So can you just tell us a little more about the seriousness with which people took such dreams? Galen and most people like him believe that the whole world was peopled by gods who could appear to you and give you instructions. And Pergamum, one of the local healing gods, is the great Asclepius.

So that adds to the weight of that dream. and Galen for the rest of his life believed that the God had accompanied him and instructed him even on how to cure people. I'm just to pause in a second. You've got this determined father, this great architect in this city which he's helping to build, which is one of the most glorious citizen.

And he has this one dream and changes the course of direction of his son's entire life because of it. It's a fascinating story. There are other men from similar backgrounds who make the same... educational story who go to Alexandria. But nobody, as far as we know, has this amazing sort of personal relationship with the God

that Galen has throughout his life. Obviously this background, Helen King, the background is vital to him, and Lovynes talked about the long education. But can we dwell on this city a little more, city of Pervengan. Can you tell us more about it? Yes, Pergamum's a Greek foundation originally, and it became quite an important Greek city very early on,

one of the many cities founded in Asia Minor by Greek settlers. It then had a period where its kings, the Attalids, were a very important dynasty, who enriched the city, who became allies of Rome, which was a good thing for Rome, and Rome at that point liked to rule through what they called client kings. So kings who ran their own little domain, but basically conformed with Roman policy and sent soldiers and joined in battles. And then in the second century a shock moment occurred when the kingdom was left to, to Rome by its ruler.

Rome didn't quite know what to do with it because it wasn't doing direct rule at that point, but it took it over, imposed taxes generally put in Roman government. So it was Romanised as well as being Greek, the major cosmopolitan centre. Then there were some falling out moments where Pergamum allied with another king,

Mithridates, against Rome. And there was a moment there where they killed all the Romans in Pergamon, which is not a good move, really. So when the Romans took control again, they then put a very heavy tax burden on Pergamum. But by the time Galen's born, it's come out of that.

It's wealthy again. And instead of the wealth being used to fund wars, the wealth is all going into building the city. Where did the wealth come from? I mean, both you and Vivian have mentioned wealth several times. Where did it come from? What were they good at? Well, they were good at farming.

They were good at exploiting all the natural resources, the mines, the woods. And they were good at cosying up to the Romans and getting money. kickbacks of one sort of another and from slaves. Yes, they were very good at cozing up to the Romans and by the time that Galen was born

the city was extraordinarily rich, extraordinarily beautiful and it's not just that it had money, it's what it did with it. So like any... There's a great altar there built for instance. The great altar of Pergammon that's now in the museum in Berlin, which is

huge, enormous, it takes up a whole room. That was on the mountain side and the acropolis at the top was where the palace was They had agoras, big public spaces, they had gymnasia, they had temples, the big one of Asclepius that Vivian's already mentioned. They had everything a Greek city should have, but more. Can you tell us, is there any way of getting an assessment of the state of medical knowledge at that time, at the time when Galen was a young man?

The thing about medicine in Galen's period is that the main source is Galen. And actually that's the big problem with everything we're going to talk about today. What's your source for Galen? Gaelan. Tricky one. But what Gailen tells us is that medicine was very competitive in his time. That sort of fits with what we know from other sources.

Lots of different theories of the body and about knowledge and how you get knowledge of the body. So do you get it from experience by trying things out? Do you get it by logically thinking things through and then doing what your logical thought process tells you? There was also a group called the Methodists. There were the dogmatists and the Peresist. The group mentioned.

Yes. I'm trying not to give them those labels, because they probably didn't call themselves that. And you've called them that in your notes. I know. I know. Methodists, okay, Methodists, the method was that you basically have three types of illness, constriction, relaxation and mixed.

So if you've got a nasty case of constipation, it's constriction, it's gone the other way, it's relaxation, a bit of both mixed. And you can learn that instantly. I've just taught you it. So now you're a Methodist doctor. It doesn't cover a great range of things that have gone wrong with me. Oh, just try hard.

Just, you know, think constructively here. And Galen hated that. He said that was rubbish. People who did that didn't learn properly. And he talked about how some people know about mathematics purely to add up their accounts. That's what maths is about. There's a deeper maths.

Same with medicine. Some people learn it just to do a quick bit of healing. Medicine is actually a much more complex subject. One of his most famous lines is that the best doctor is also a philosopher. You need to understand what's happening in the body in a deep way and relate that to the rest of the universe. What was the status of medicine at that time, Helen? Well, again, Galen is not a good example because, as Vivian said, he had an extremely long medical education.

He was a very elite doctor intellectually. So doctors were at all levels of society. From young men starting out, maybe family medicine where their father taught them something, slave doctors in households of prominent Romans, doctors who were in the elite like Galen, it was a huge range of different types of people with different sorts of ideas. But can you just say a little more about the fact that for the rest of this program, most of the authority of what we're talking about, comes from Galen himself, a prolific polymath,

and also very self-assured about his own place in society and in the history of medicine? Oh, yes. Gaylan has a very strong sense of his own importance, which is one of the things people sometimes find a little bit difficult to get a grip on. But you can say, well, it's not just Galen. In the sort of culture he lived in, you have to promote. yourself if you're going to get anywhere, you have to show that you are the best. And quite honestly, Galen was incredibly good if we believe what he tells us. Well, other people believe what he tells.

We can't be too, we can't go on. We can't be too sceptical. Everybody around me said he was the greatest doctor running. He lasted for about 1,500 years. Exactly. Give him a break. Exactly. I quite agree.

Let's give Galen a break. Caroline Petit, can you tell us, can you go into more detail about his early career as a doctor? Yes. Just like his education was exceptional, Galen's early career is quite remarkable because upon his return from Alexandria, where he spent quite a few years learning anatomy and a number of other things, as Vivienne already said, he was appointed by the high priest in Pergamum, as the physician to the gladiators. And he was only 28 at that time. It was his first job.

And that's an exceptional fact, because normally you would hire a much more experienced doctor for that sort of position, which is a tricky one, because your job is actually to keep gladiators alive. It's not always easy. And so, yes, so he was appointed physician to the gladiators there

where apparently he did a tremendously good job but again he says that he did a good job and his contract was renewed and because he had less casualties than his predecessors and he explains

this appointment with saying that he had come back from Alexandria with special skills he had already devised some new treatments at his young age. So he had already some innovative ideas to treat patients, especially wounds. And he already had a reputation for that in the city because some of his remedies were tried on friends and relatives. And so he already had a name, having

just finished his training in Alexandria. And of course, as well, as we Vivian and Helen pointed out, he had those very special family connections. So this probably helped in his nomination appointment as the physician of the gladiators. So in summary, by being a physician to the gladiators, he learned a lot about wounds, about anatomy, about the blood. He just learned a lot practically. Oh, yes. Yes, it tells us so. It was for him a couple of years, people say two years, three years, four years maybe, working with the gladiators. He was in charge not just of, you know, healing wounds, but also looking after them day by day, their training and diet.

Yes, developing his ideas of nutrition and so on. So he could observe the effects of nutrition on gladiators. He could observe, of course, a number of. of wounds and he devised some new treatments there, new ways to, for example, to secure muscles in a very deep cut that before him were not treated properly. So he is quite proud of his achievement in this respect. When he was about 30, he went to Rome and quite soon, spilling on a bit, but not all that much. He became well-known in Rome, very successfully very well thought of it and became one of the

a personal physician to Marcus Aurelius, the great emperor. Can you just elaborate that a bit more, please? Yes, well, the reasons for his move to Rome are not very clear. Was it just ambition or was it just trying to escape some problems in his native city? We don't know.

But he arrived in Rome and he had quite a good start there. thanks to his family connections. Partly he was able to reconnect there with friends of his family, like the philosopher, Eudemus, whom he cured from a bad disease. And this way he was introduced to the best people in Rome, to the elite, the high society. And case after case and demonstration after demonstration, he became one of the most prominent physicians there. But it wasn't a physician to the emperor straight away.

It took quite a long time. Yes, and even when he worked for all the emperors, he wasn't quite inside the palace. He was just called in for difficult cases. He did some spectacular things. He cured the emperor's son, Commodus, which must have been very significant for the emperor and for the high society in Rome.

Yes. he wrote a book telling his most remarkable achievements in this respect. It's called On Prognosis and Vivian, of course, knows best about this work, which he has translated, edited and commented upon. But yes, so he actually records a number of cases where he had an opportunity to shine in front of the high society. and he cured Commodus as a child from tonsillitis, I think. He also cured Marcus Aurelius himself,

who called him the first of physicians and the only philosopher or something like that. So again, we know this only through Galen, so it's only his side of the story, of course. But, yes, apparently he became closer and closer to the imperial cycle. circle and was able to shine really. We're all doubtful of the authority of Galen himself.

It's quite interesting. And yet we're talking about him and people have been talking about him for very nearly 2,000 years, often in the highest terms. But never mind, here we go, Vivian. He was particularly interested in anatomy. Where did he get his knowledge of the body from and how much knowledge could he at that time obtain?

He studied anatomy at Pergammoner, at Smy, with teachers who had been formed at Alexandria. And Alexandria was the one place in the ancient world where you could study a human skeleton. Not a human body, but a human skeleton. And so he learnt about bones in Alexandria. And he claims to have learnt about the inside of the body from his own surgical experience

and from looking at whatever chance put in his way. We now know that there were other people at the time who were doing exactly that. He refers to somebody at the time of his grandfather who had, he said, restored anatomy. There was another man called Lycus who was carrying out public demonstrations on animals in Rome. And Galen continued that tradition, demonstrating the workings of the body on a skeleton, on pointing to features on the outside of the human body and experimenting, carrying out dissections on a variety of animals, big and small, to understand how a body works.

Sometimes in public. Sometimes in public. That was how he made his reputation in Rome. And he said crowds flock to them. And there were public debates there taking place. and he says he got this wonderful elite audience to come and he carried out experiments which are still valid today which were intended to give an impression

of just how good an anatomist he was. His most famous series was tying and then cutting the spine at various points to see what happened and he could tie the neck, the spinal cord of a pin. or goat, which made an awful lot of noise, and suddenly the nerve is tied or broken,

and the pig stops squealing. And everybody could then understand that something had happened. So it's this sort of experiment in public that gave him his reputation. Helen, can I talk about the four humours? Now, can you just tell us about the first humours? Now, can you just tell us about the four humours, where he got it from, how he developed it, and how it became so closely associated with him for so long? Yes, it's a really interesting thing that actually four humour theory is the big theory in Western medicine,

and it's Galen who puts it there. In the Hippocratic texts, there are lots of different models of the body. They're boast on the idea of fluids. Aproprides is about 500 years beforehand. The great doctor before Galen. Exactly. Fifth century, fourth century, BC texts associated with the name of Hippocrates. And what these are saying is that the bodies made up of various contributing parts. They might be hot and cold or wet and dry or fire and water, or they might be fluids.

And the fluids of the four humours, blood, phlegm, yellow bile, blackbile, turn up in a particular text associated with Hippocrates, nature of man. Now Galen, like everyone else in his era, was really interested in what were the genuine texts Hippocrates wrote, this great doctor their forefather. And Gaynan really liked the four-humour theory. So he elevated the Hippocratic nature of man to a genuine work of the real Hippocrates. This was the genuine Hippocratic stuff. And then that, which is a really nice model of the body, it's four things, it's quite easy to grasp.

And you can say that in spring, blood dominates because it's hot and it's wet and it's the sort of heat and wet coming through the system of the world, sort of affect what's happening in your body, microcosm, macrocosm. It's quite a powerful image. are the two bile? Oh, the two bile. Well, you seem to start off with one, so it's a three-biles,

street humour theory and one bile, then it gets split into yellow ones and black ones. And black bile is always the tricky one for modern medics looking back on it, because we know what blood and phlegm are. Yellow bile, well, it'll be something like stomach acid. Black bile, mm, not terribly clear. Black is generally not a good colour for fluids

when we look at the body. So Galen takes this as the theory of the real Hippocrates and then runs with it. But what's interesting to me is that in Galen's text, It's not like everything's about the four humours. It's actually much more complicated. He's much more interested in patients as individuals, in knowing their history. He doesn't just say, oh, this person is a sanguine person dominated by blood.

Therefore, we have to do this. He's much more interested in very, very individual material. So you're just putting it up into diet, drugs and surgery, doesn't it? First you get the diet right, then if you need drugs, you do it. And then if you absolutely, you do surgeries. Is he operating with that triad from the beginning? I think that's the triad he inherits. It's the triad that certainly goes back to the third century BC

to a guy called Herophilus, who incidentally is the only one who did dissect human beings, he and his colleague Erystitius in the third century BC, and whose books Galen had, all this stuff that's now lost, Galen had these materials, so he could read what Herophilus and Eresistratus said. But for Galen, it's interesting that he does do so. surgery, he doesn't see it as something that you leave two surgeons to do, something that is manual

and therefore beneath the dignity of a citizen such as himself. He sees it as perfectly acceptable. He'll do anything. So he has treatises where he's more interested in drugs, but he also will do surgery. He's holistic. He'll do anything, anything to help the patient. But these four humours are a four-wheel drive of hysteria, are they? They are, but they're really bigger in what comes after Galen, Galenism, where Galen gets simplified. Because he wrote an awful lot. It's very hard to make that into one theory, but we'll come to that later. Caroline Petit, he also took a close interest in drugs,

which may have begun with watching his father who was interested in plants and the effect that plants might have on people. Can you tell us about that interest in drugs and what he did with it? Well, Galen would treat primarily using regimen, dietetic measures, if possible. And then, if necessary, he would use drugs as well. But he was very cautious about them because he knew they were dangerous. But the first thing perhaps to stress about Galen's pharmacology, which is a very big topic for him.

I mean, he wrote throughout his life on drugs, He wrote something like, I don't know, over 3,000 pages in the current edition that we have. So it's a huge topic for him, but one thing to remember is that he really builds on a huge legacy here. The tradition was extremely strong and rich already before Galen. So he inherits all this material and he tries to. to be innovative, he believes that you can actually assess the properties of drugs. So he puts forward a new method to assess those properties and use drugs in a sort of scientific manner, really, not just reuse drugs used by others, but really try to identify their properties,

their strength, how to combine them in a scientific way. So that's his principles, really. But he wrote about, I think, over 700 simple drugs. So that's a huge amount of stuff, you know, of plants, of stones, etc. And his works became later the foundation of medieval pharmacology. And so it's a really important topic. You saw that drugs from India and people brought him gregers. gifts of drug, Vivian.

He also had the largest collection of drug recipes in the world. He said he got some of them from people who gave them to him. He swapped them with other doctors. And he said he had, A, the greatest collection of recipes. And, of course, as an imperial doctor in Rome, he had access to the imperial drug stores with drugs coming in from all over the Roman world and beyond. Are we always one by plant-based drugs?

Almost always a plant-based drugs, and he's very keen on getting the plants in the best condition. He does use some mineral drugs, and there's a lovely store of him going down a mine to get some form of copper sulphate. But he uses these almost entirely for external purposes, where they would work. Think of what happens when you use zinc ointment.

Galen uses that sort of ointment for skin condition. Use it every day. We have this man who, he was prolific. I'm going to ask you about that now, Vivian. But he still went down mine for copper sulfate. He did the operations. He did the demonstrations. He was right across the spectrum, wasn't he?

He's a remarkably practical man. One of the things that strikes me is that he is a wonderful observer. He sees everything, he notices, things. Sites, smells, sands. and he uses them as part of his... to add to his book learning, to add to all the things, and he then experiments. You talk about, in your notes,

one, is it to do with the brain of a pig where he opened up and something there that he saw, which was extraordinary, given he didn't have any technical instruments to get there? Two researchers in the last 15 years have carried reproduced his experiments on the brain. he used ox brains, big animals, to see how far you could trace the passage of the nerves and all the intricacies of the brain in that big animal.

And what they've shown is that he can see tiny things which most people would not be able to see with the naked eye and certainly not in the conditions of lighting that he would have then. Can you give us a swift but complete notion of the range of his writings, Vivian. I feel like saying your start of a 10. Well, this will be a starter for 100 because they range from logic

to a dictionary of ancient attic comedy, which he says is important if you want to understand what Hippocrates wrote because Hippocrates uses ordinary words and comedians need ordinary words for their audience to understand them.

We have those, we have anatomy, we have physics, We have books on huge books of commentary on Hippocrates. We've got pharmacology. We've got books on diet. We've got books on introductions to how to take the pulse. It's almost anything you can think of except really women's medicine. And he thought that the philosophy and language and medicine were deeply interconnected, didn't he?

He had the mind and body very interconnected. For him, mind and body are absolutely interconnected, and one of his great claims is that he can trace stress diseases. He can understand what happens to you when you begin to show signs of weakness when you're under tension, having to give a public performance or appear in court, or if your relative has died. This can say stress and it affects your body. equally, when you're standing on the top of a hill and looking over the edge, that is why your legs begin to tremble.

And there's this close connection between mind and body, which you can also show with anatomy. Helen, one of his better-known works is called On Prognosis, Helen King. Can you tell us about that? Certainly. I just want to add one thing to Vivian's comment there about his books, because on prognosis is actually a book about prognosis, as in what's going to happen next in a disease. And that's what the ancient medics found interesting,

not diagnosis, not giving it a name. It's what's going to happen next. And for Galen, what's going to happen next is very important because if he can say to someone, yes, I know at the moment you're feeling okay, but around about the fourth hour of the day tomorrow, you're going to have another moment of seizure, then this is because this is what's happening to you.

And then you get to that hour and you have the seizure. Wow, Galen's the doctor. And he talks about how people in Rome called him Wonder Worker or Miracle Worker. And people were even suggesting that perhaps he got some sort of weird magical powers because his ability to prognose was so great. And that's how he makes his reputation. So in prognosis, he tells you the stories, the best stories, as Caroline's already said, about the elite patients he treats.

what you get a clear sense of there is Galen as moving socially through using his connections. So he starts off with people who come from Pergamum to Rome, and so they're fellow Pergamine citizens in Rome like him. And then because when he treats one of them, Udemos, a guy from Syria called Flavius Boethus, an ex-consul, so a high-ranking Roman citizen, happens to come and visit, and witnesses Galen saying what's going to happen next and then witnesses that it does happen.

Berethus then thinks this is a great guy and has Galen in to treat his wife and his son. So you can see the way that the social connections are happening. So really, in On Prognosis, there's only one case where he talks about the cure, the actual things Galen did. Mostly it's about how he said what was going to happen next. Caroline Piddee, can you describe his approach to treating an individual patient? We've had a bit already from Helen, but there's anything more to say about that?

that. Yes. What's remarkable about Gaylen's approach is his deep awareness of how each patient is different. So Galen is sometimes described as a dogmatic physician, but that's a sort of retrospective illusion due to the way he was interpreted in later centuries. In fact, Galen is very keen on observation, as Vivian said, and he will observe, every possible sign on the patient, but also in his environment. He will make the patient talk, which is extremely important in his approach, the dialogue with the patient. And he will this way reconstruct in the closest possible way what happened to the patient. Now, we've got to turn to his massive influence and legacy.

We're talking about someone who is still... some of his medicine being taken today. He was massively important in the Roman world, in the Arab world, in the medieval world, right into the Renaissance, even people who were refuting him, took on board his style, took on board a lot of what he did. So we've got to get some sort of grip on that. Helen, so he died around 2,000, sorry,

he died around 215 AD. What was his status then before we move on? It was already high. He talks about moving down to the bookseller's quarter in Rome and seeing someone selling a book called The Doctor by Galen. And he thinks that's a bit strange. And another potential book purchaser goes up and has a look at it, reads the first two lines out loud and says,

hmm, that's not Galen. And Galen's delighted by that. So people are already passing things off as by Galen because his name's got the power, but people can spot the real Galen. He likes that. Within a few years after his death, we get papy from Egypt,

copying out pieces of his texts. So it's spreading. And the way that Galen's work spread, is that he has things written maybe for a friend or a patron, or someone will take shorthand notes at one of his demonstrations and then write them up. He'll give these to people, they'll then have them copied to give to their friends, they'll leave them to their heirs in their wills.

So stuff is already happening in his lifetime. It's spreading. So we're talking about, let's go through a third, fourth, fifth, sixth century ago. Is his reputation growing down? He's steady. He's still, as it were, the man of medicine to turn to and to learn from. Yes, he becomes the man very quickly. And he then moves into being on the syllabus of medical schools in Alexandria.

By the time you get to the Middle Ages, medical education in the... You're ahead of me. I'm ahead of you. Okay, I'll come back to that later. But in the ancient world, it's a steady buildup. It's a steady buildup, yes. Are there any sort of Galen satellite persons who... Not really. That's what's interesting, I think.

There are no Galen pupils. We hear about him talking about teaching, and he writes simplified versions of some of his books, like Bones for Beginners, implying that there are people who are beginners. We hear vaguely about the people with him. We assume that they're pupils, but we don't really know. There's no Galen Disciple who goes out and spreads the word. That's odd, isn't it?

Because when you look at the people he and mine, Plato, Aristotle, they all had academies. Absolutely. Their pupils went forward, but not his. Can you think of a particular reason for that? Not at all. I'm utterly bafford. I'm interested to know if anyone else in the room has got a theory on that. Maybe you want to answer that

but I'd like, do you want us that before going to the Arab world? Why do you think it didn't have people? Well, the problem with Galen is he wrote too much. Yes. And the first problem is how to deal with 350 books, which cost a lot of money, and the answer is you forget most of them. And gradually his reputation grew

and he subsumed other names, other writers under his works, and by the time we get to 500 AD, we have a short syllabus of theoretical texts telling you the theory of medicine. And they are studied in Alexandria. These are Galen's texts. And they're studied in Alexandria. They're taken over into Syriac.

That's the language of the Christians of the Near East. And from then into the Arab world, with the Arab conquests. and in the 9th century, the caliph and his court seemed to have developed a passion for Galen and translate as much of Galen as they can find. Now, that is a key point, because these great Arab scholars, philosophers and people interested in medicine, a great intellectual elite,

really took him to their hearts and minds, and why were they so entranced by him? I think because he gave them a new model. He gave them a model that fitted a new type of education. He emphasized the need for the doctor to be a thinking, philosopher, a logician. And it's no coincidence that many of the great Arab names are also famous as logicians, philosophers. Razzis, Averroes, Maimonides are all famous as philosophers and doctor. So he gave them a model, and he also did seem to have far more to say than any existing Arabic author.

And so they go back to these huge books, which they want to translate as containing the medical wisdom of the past. They have the short syllabus, which becomes the basis for teaching, 16 or 20 books, depending on how you term them. And these books are then translated quite early in the 11th, 12th century into Latin. And they come into the universities, in the new universities in Western Europe, which are in a sense founded as theoretical institutions. So you have Greek, Syriac, Arabic, Latin. Caroline Petit, do you want to talk about the medieval world, Galen in the medieval world? Well, in the medieval world, you would have to distinguish between places.

There is the Islamic tradition, there is the Byzantine tradition, and the Latin one in the West. And at no moment in the medieval period can you find all of Galen's works, or even half of them or 10% of them, in the same place, except maybe in Baghdad in the 10th century or something. So Galen's works have become very difficult to get hold of. And very few people... What date you were taught them in the 12th to 13th century? Well, you can say that already in the 13th century in Byzantium, it's really difficult to find works by Galen in Greek. Very few manuscripts are around.

In the West, it's even worse because you rely on Latin translations from the Arabic or from the Greek, and very few of them are actually. actually around. So Galen is read by only a small minority of people and that's something that's going to change in the Renaissance. Oh dear. We're at the Renaissance and we haven't got really enough time to do it justice. Oh dear.

Helen, can you just let's put it bluntly. In the Renaissance Galen ran up against two people who didn't attack but undermined its authority. It was Vasilius and there was Harvey. It was the anatomy of Veselius and the circulation of a blood by Harvey.

Is that right? Can you just develop that? Well, Vesalius is interesting because he translated Galen. He knew Galen really well. But from his own hands-on dissections of the body, because dissections back in the Western medical curriculum by the 15th century, from his own hands-on dissection, Vesalius keeps finding bits that don't seem to work. So hang on a minute, this must come from animals,

this is only found in this type of beast. This is what happens in the kidneys of an ape, not in the kidneys of a human. He starts to realise that. So he says, famously, he's found over 200 errors in Gailenus. and that Galen was, quote, deceived by his monkeys, which is a wonderful quote, because Galen did a lot on monkeys. Now, of course, Galen would love to do a human dissection, I'm sure.

He always took advantage when he got a nasty wound in a gladiator, but he couldn't. But then there's the circulation of the blood. Yes. The four humours, depending on the blood being static almost, in different places in the body. And Harvey said it circles or wherever you got the same sort of blood. And that kiboshed the four humors.

Well, yes, it does, except that it's such a wonderful image that it doesn't go away. Nothing goes away. And of course Harvey thought his circulation of the blood proved the truth of Galenic therapy because it explained better than Galen's theory how drugs

work. And in terms of therapy, Galenic therapy with vegetable drugs lasted well into the 19th century because there was very little to put in its place. and the idea of examining the patient in the way that Galen insists on

became the foundation for 17th, 18th, indeed early 19th century doctors. So his therapeutic methods survive the anatomy, survive his physiology, and his model is still there in parts of the Islamic world as the theoretical, philosophical doctor who looks at you as an individual. And it has to be said that Faselius as one of them, one of those who, as you were, undermined him, which played him the greatest respect,

adopted his style, adopted his methods. And he was held in awe until beyond the renaissance. Oh dear, we have to go now. Thank you very much. Thank you, Carolyn Petit, Helen King, and Vivian Notten. And next week, we're going to talk about the Book of Common Prayer and its magnificent language.

1549. Thanks for listening. There are many more Radio 4 arts and discussion programmes to download for free. Find these on the website at BBC.co.com.uk slash Radio 4.