The Life and Times of Ancient Rome’s Most Prominent Physician

The best physician is also a philosopher.

--Galen

Galen of Pergamum (129-ca. 216 CE) is often described as the most significant physician of antiquity, and his contributions, particularly in anatomy and patient care, were influential until the Renaissance in both Western and Arabic medical traditions. He was also an esteemed philosopher, and his written works represent more than one-eighth of the existing corpus of literature in classical Greek.

Beyond his obvious intellectual gifts, Galen was a fascinating personality: an arrogant showman, a tireless self-promoter, and a relentless seeker of the truth.

Galen did not shrink from challenges. He performed risky medical procedures and exposed himself to contagious diseases to treat and comfort patients, and to learn. And he could be a brutal competitor humiliating opponents with his lacerating wit and brilliance. In one public demonstration, he disemboweled a living monkey and challenged the flustered physician witnesses to replace the organs.

But the complicated Galen also devoted his entire focus to the patients he treated, offering compassion and every tool at his disposal to promote healing.

Galen’s career began as the treating doctor for gladiators in Pergamum [modern Bergama, Turkey]. His reputation as an effective healer grew, and he eventually served as a physician in the court of Marcus Aurelius and other Roman emperors.

Historian Dr. Susan P. Mattern explores Galen’s life in her new book The Prince of Medicine: Galen in the Roman Empire (Oxford University Press), a work that has been acclaimed as the first authoritative biography of the remarkable physician in English. The book is based on Dr. Mattern’s extensive research on Galen and his extensive body of writing and on the world of Rome during his lifetime.

Readers have been especially enthusiastic about Dr. Mattern’s ability to capture the humanity of this most prominent physician and thinker and the people of his time almost two thousand years ago. Sherwin B. Nuland, physician and winner of the National Book Award commented: “After centuries of traditional academic studies of the works of this most influential physician of all time, we are here gifted with this full-blooded and much-needed biography of Galen the man. In every way as scholarly as previous attempts to bring his paradoxical genius to life, Prof. Mattern's enormous contribution is set within her meticulous understanding of second-century Rome, its medical sects, and its socio-political atmosphere. All hail to her!"

And historian J. E. Lendon wrote of The Prince of Medicine: "A pathologically quarrelsome physician, Galen was, in a sense, the Dr. House of Antiquity, and through his eyes Susan Mattern gives us the whole Roman world, from hovel to palace, as he treats ruptured rustics, gutted gladiators, and neurasthenic noblemen. Galen's tale is told with style and panache and due help to the reader unfamiliar with Rome -- and even better than that, with plenty of enjoyably disgusting medical details."

Dr. Mattern is a professor of history at the University of Georgia. Her other books include Galen and the Rhetoric of Healing, an analysis of Galen's stories about his patients and a study of his medical practice; and Rome and the Enemy: Imperial Strategy in the Principate; and she co-wrote a textbook, The Ancient Mediterranean World from the Stone Age to A.D. 600. After a year of professional development studying social and abnormal psychology, she is now beginning research for a new book on mental illness in antiquity.

Dr. Mattern recently discussed her work on Galen by telephone from her office in Georgia.

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Robin Lindley: What inspired your new biography of renowned physician Galen? Was it an interest in the history of medicine?

Dr. Susan Mattern: No. I’m a historian and I got interested in Galen through the people he treated. There are a large number of anecdotes in his work and, from the historical perspective, it is very unusual for us to have that very direct light on everyday life in the empire. And some are funny and he had quite a personality. That’s how I got started.

Galen’s story is fascinating, but my sense is that most people today don’t know about Galen. How would you introduce him to someone who asks who was he and why is he important?

People ask me that all the time. I tell them that he was a Greek doctor in the Roman Empire and he wrote a lot. Doctors usually do know who he is, so I can tell if someone has a medical background or medical training.

How do you go about researching a person who wrote prolifically but lived almost two thousand years ago? I was wondering about your process as a historian and if you found information that hasn’t been available -- or at least not available in English before.

It’s not a mystery. It’s the old school way. You have to read the material. It’s in Greek but more and more is available in English, and some major work has come out in English since I did the research for the book so it’s not as hard today as it was previously, but that’s why not a lot has been written about Galen until recent years because it’s very hard to read the corpus.

So that’s the method. There’s nothing mysterious. Of course, now the Greek text is digitized and searchable that way, and that has added a lot to research capabilities in recent years. We can now search words and phrases and find more accurately where Galen talks about things and [we can] look for patterns in how he talks about certain kinds of things.

Did you find material that’s not known by many historians?

Yes, there are a lot of things that people didn’t know about. More things have appeared in modern language translations and some works are more accessible now. There were German scholars in the early twentieth century and a few other scholars who knew what was in Galen and cited him. This material was not unknown and was available, but it’s pretty obscure.

More and more has come out recently, especially in French editions of some of Galen’s more autobiographical work. There is some new work that has been published by Véronique Boudon-Millotand and she has also written a biography of Galen, so a lot has become more available than it was.

You mention that Galen was quite a character and now might be diagnosed with a personality disorder with megalomaniacal and narcissistic traits. He seemed a brilliant, driven, eccentric person. How did this obscure Greek doctor, though from a privileged background, become the treating physician for Roman emperors?

I don’t know how eccentric he was in context, but he was in a very competitive world.

He became successful in the Greek world by beating up [intellectually] on everybody else. He was very good at that and good at showmanship and debating. He was also very smart and good with language and rhetoric and he was able to defeat his enemies with words. He displayed and perfected those skills. Those skills were continually tested and challenged in the competitive and public world he lived in. At least that’s what he wants us to believe about how he became successful. We don’t know because we only have his story. We don’t know if patronage or family connections played more of a role than he said.

You breathe life into this remarkable man and I came away with the image of a showman in a bloody toga humiliating doctors and others in arguments as he cut up animals in public. What inspired Galen to choose a career in medicine?

He wrote that his father had a dream from the god Asclepius who told him that Galen should be a doctor. That probably happened and I’d say that’s what inspired him. And it turned out he was very good at it and, at the time, it could be a high-prestige profession that hooked up with the elite culture of the second century. He was successful socially as a physician.

Galen studied the iconic Greek physician Hippocrates and became determined to write down everything known about medicine up to his time. Did he use Hippocrates as a foundation for his work?

He commented on most of the works that he believed were written by the genuine Hippocrates, but not all of them. He intended to get to all of them, but he died before he could do that.

He commented on almost every medical writer and his strategy was that Hippocrates, the founder of medicine, was always right. We don’t have this in medicine anymore -- things aren’t right because an ancient authority said them. In Galen’s world, that was more the epistemological strategy. Hippocrates was viewed as this oracular, binding authority.

But Galen would not consider himself a Hippocratic and, whatever he was doing, he was not a strict follower of Hippocrates, but he thought some others were, so he qualifies his reliance on Hippocrates in that way. And also, by the time Galen is done with his interpretation and commentary on Hippocrates, it’s very different. The original Hippocratic texts are quite spare and cryptic and nowhere as voluminous as Galen’s writing.

Galen is debating people not only about medicine but also about philosophy and he’s a student of philosophy. How would you describe his personal philosophy and how it may have influenced his practice of medicine?

That’s a very big question and it depends on the part of Hellenic philosophy you’re asking about.

He had a lot to say about epistemology and about the nature of the creator, and ethics. He didn’t claim to be the follower of any particular sect and he was adamant that he wasn’t the follower of any particular authority either in philosophy or in medicine. He also claimed a very eclectic education in philosophy and in medicine.

It’s hard to say in a few words what philosophy he espoused. He admired Plato yet a number of his most important ideas are fundamentally Aristotelian, especially about epistemology and science -- on how we know things.

I think that captures the complexity of Galen’s thought. You call Galen a “normal scientist” and part of his skill was to observe and to learn from observation and questioning, especially in treating patients.

Yes, he believed in the value of observation and the phenomena, which are very Aristotelian ideas. That’s behind his whole theory of vivisection, which he did constantly.

When I said he was a “normal scientist,” I meant that in the sense that Thomas Kuhn uses it as opposed to paradigm shifting science or revolutionary science. Galen didn’t invent a new paradigm but expanded and explored the edges of the old paradigm that had been in place forever. He didn’t change science fundamentally but was doing “normal science” in the Thomas Kuhnian sense.

You indicate that Galen was “pious.” It seems he was spiritual but not religious.

I disagree that he was not religious. He was pious in many ways. He was a devotee of Asclepius and believed in the god and what he said to him in dreams. He believed that Asclepius saved him from fatal illness. And he believed in a creator and very eloquently wrote about the creator and the how creation happened and by what mechanisms.

And he believed in dreams. He reflects a culture where medical advice was often hidden in dreams, and he took that very seriously and didn’t question that dreams could be inspirational and probably have some divine input. He talks about his Diamon, his personal divinity that talks to him, one of the more interesting features of Galen’s spirituality.

At the beginning of his medical career, he was attending to gladiators and treating their wounds and illnesses. How did this training influence his practice?

He mentions that a few times, usually in the context of drugs he invented when treating gladiators, and suturing techniques. He performs a lot of suturing and surgery on them. They are a sort of laboratory for different drugs and [medical] techniques.

You write that Galen tapped into “the voice of the healer.” What’s your sense of his bedside manner and patient care?

He talks to his patients and focuses his attention on them. He’s observing everything about the patient and interrogating the patient, trying to do everything he can to find out what’s going on. Sometimes he’s trying to show off and that he knows things without asking, but most of the time he is very dependent on what the patient and the people around [the patient] were telling him.

He focuses on the problem and nothing else matters. From what he writes, he tends to treat the patients all the same. He’s trying to find out the symptoms and what he needs to observe. I would say that’s his bedside manner.

How do you see Galen’s contributions as a physician? Didn’t physicians for centuries follow his approach to diagnosing illness?

That’s a complicated question. We didn’t have a full corpus of Galen until the sixteenth century. Before that, the legacy is much more patchy in different locations. The place where we see the biggest continuous legacy is probably in the Arabic translations, and his corpus is much more fully preserved in the Arabic tradition whereas it’s patchy in Greek tradition until the Renaissance.

When we speak of diagnosis, we don’t know if people are doing this because of what their teachers did or because they were reading Galenic texts. We don’t know how much was tradition and practice and how much was reading the Galenic texts.

It seems Galen had mixed feelings about working for Marcus Aurelius and other emperors, even though his position at court was seen as a great honor.

I think he thought it was limiting. It limited where he could go and what he could do, and once the emperor decided that he needed him, Galen was obliged. He tried to return to [his home city of] Pergamum, and did live there for a couple of years before the emperor recalled him.

He wanted freedom and worried about getting sucked into the emperor’s [orbit] and being told what to do and not being able to say no. That’s what he wrote and it’s plausible that he [really] was worried about that.

Then there’s a cultural issue. He was proud of his Greek ethnicity and culture, and Greek culture had an ambivalent relationship with Roman leadership and the Roman ruling class, even though there wasn’t much of a distinction and there were plenty of Greek intellectuals in the Roman ruling class. But there was an ambivalence and tension between the two groups. That was part of it for Galen. It wasn’t cool to be the emperor’s lackey [because] you’re a Greek aristocrat and you’re supposed to be superior in many ways.

Much of your book is based on Galen’s writings. Was there much commentary on Galen from other writers such as observers in the court of the emperor?

No, there was not.

How do modern physicians see Galen and his contributions? It seems some of his practices are still followed today.

Not really. I wouldn’t go very far with that. For example, Galen was an enthusiast of bloodletting, something we don’t think is a good idea. His ideas and times were so different, there’s very little overlap between Galenic medicine and modern medicine.

However, what Galen does do is talk to his patients. He was focused on his patients and observing them and getting their background and history. That is probably the thing that he did that is or should be more practiced today.

Didn’t Galen’s work provide a foundation for physicians such as the sixteenth century such as renowned anatomist Andreas Vesalius.

Yes. Galen’s anatomical research was very important. He was a very good student of the anatomical tradition. He wrote very extensive anatomical works and that was the state of anatomical knowledge when the Renaissance physicians picked up from there. It was mostly animal research, but he didn’t claim to dissect people. He was very frank about that. So yes, I think Galen’s research did provide the foundation for later anatomical research, but as far as practices, it was different.

Do you have any further thoughts about what you hope readers take from your book or about lessons for today from the life of Galen?

Of all the things that Galen says to us, his interaction with patients and his clinical practice are most relevant to us today. I also think that he’s a very good window into what it was like to live in the Roman Empire or practice medicine in the Roman Empire or live in a world that was that different, especially with this factor of disease that was so different. Looking at a biography of Galen is a good way to get into that. We can learn about the Roman world and the larger pre-modern world before the epidemiological shift when disease and infection were the big factors in life.

Your biography is a fascinating social history. And Galen lived a very long life for the time despite his exposure to disease.

He lived to be 87, and that was quite an achievement in itself.