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DOI: 10.14260/jemds/2015/651
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GALEN AND HIS CONTRIBUTION TO ANATOMY: A REVIEW
Rajkumari Ajita
1
HOW TO CITE THIS ARTICLE:
Rajkumari Ajita. “Galen and his Contribution to Anatomy: A Review”. Journal of Evolution of Medical and Dental
Sciences 2015; Vol. 4, Issue 26, March 30; Page: 4509-4516, DOI: 10.14260/jemds/2015/651
INTRODUCTION: Galen of Pergamum was the most famous Greek physician during the Roman
period (129-200 AD). He was a brilliant anatomist and pioneer of experimental physiology.
1,2
He was
both a universal genius and a prolific writer. He pioneered the concepts of anatomy, physiology and
therapeutics. He is credited as being the first to discover that arteries carry blood, not air, as was
previously believed. He developed medical tools for surgery and dissection and wrote many volumes
of his discoveries and observations.
2,3
He was one of the leading thinkers in medicine and one of the
best known physicians of all times.
4
He was not only a gifted practitioner but also a first class anatomist, physiologist, pathologist,
and pharmacologist of the ancient times. During fourteen centuries, Galen's works were undisputable
textbooks for students of medicine and most valuable manuals for practitioners besides the works of
Hippocrates. He established the fundamentals of the medical science which are still significant.
5
Galen
was the first to attempt to formulate a classification of diseases and symptoms with a strong basis in
anatomy.
6
In this review article, an exhaustive analysis and attempt has been made thereby depicting
the biography of Galen and reviewing his multiple contributions in the fields of medicine and
anatomy under various sub-headings and the same has been discussed with the available literatures.
GALEN'S EDUCATION, EARLY LIFE AND TRAINING: Galen was born in Pergamum on the Ionic coast
of Asia Minor in 129 AD under Roman jurisdiction. His father, Nikon, was a well-respected, wealthy
architect- engineer who took an active role in Galen's liberal early education concentrating on
mathematical and philosophical subjects, notably geometry and logic. This seems to have influenced
his methodological approach to medicine. His strong views on the importance of philosophy in
medical training reflected his eclectic, extensive, philosophical education.
7
His father was Galen's only
teacher up to the age of fourteen and a strong role model. In his book "On the Passions and Errors of
the Soul", Galen says he was "fortunate in having the most devoted of fathers". His first anatomy
teacher was Satyrus, a pupil of Quintus, who through his students played a major role in the increase
in activity in the field of anatomy that led to Galen's work.
8
ANATOMICAL AND MEDICAL STUDIES: Galen regarded anatomy as the foundation of medical
knowledge and he frequently dissected and experimented on such lower animals as the Barbary ape
(or African monkey), pigs, sheep, and goats. He distinguished seven pairs of cranial nerves, described
the valves of the heart and observed the structural differences between arteries and veins. He was
seriously hampered by the prevailing social taboo against dissecting human corpses. However, the
inferences he made about human anatomy based on his dissections of animals often led him into
errors. His anatomy of the uterus, for example, is largely that of the dog's. According to Galen, blood is
formed in the liver and is then carried by the veins to all parts of the body, where it is used up as
nutriment or is transformed into flesh and other substances. While human dissection was not
considered during his time, Galen performed dissections on animals assuming that human organs
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were identical.
9,10
Treating severe injuries of the gladiators, he enhanced his knowledge of anatomy,
physiology, trauma and sports medicine.
11
METHODS AND ACHIEVEMENTS: Anatomy was very important to Galen. He believed that "the
working body is not understandable without knowledge of its structure". Galen did not dissect
humans because of the negative social and religious stigmas associated with experimentation on the
human body, but he performed dissections and vivisection experiments on many animals including
apes, goats, dogs, and pigs. Because he could only study animals, some of Galen's anatomical
assertions were inaccurate with respect to the humans. Galen's reliance on anatomy and experiment
showed his belief in the value of observation in medicine. He argued that diseases were
manifestations of impaired anatomical functioning, so in order to diagnose and to treat disease, a
fundamental understanding of the human structure was critical.
One of Galen's major advances was his work on the movement of blood in the body. While he
never explained how the blood circulated, he made many important discoveries regarding the
movement of blood in the body, including the differences between veins and arteries and the
anatomy of the heart and its associated vasculature. His precise descriptions and studies of
neurological functions and anatomy also led to major breakthroughs. He used dissection to explore
the anatomy of the brain and spinal cord, including the spinal nerves. Not only did he explore
anatomy, but he also demonstrated the functions of nerves. He also explored many other aspects of
the human body, including the eyes, tongue, larynx, fetal development and reproductive organs. In
addition, his experiments with the kidneys showed that they were functionally related to the bladder.
Galen viewed the body as consisting of three connected systems: the brain and nerves, which are
responsible for sensation and thought; the heart and arteries, responsible for life-giving energy; and
the liver and veins, responsible for nutrition and growth.
TREATMENT METHODS AND THEORIES: The foundation of all of Galen's treatment methods was
his belief that disease resulted from an internal imbalance of the four humours: air (blood), fire
(yellow bile), earth (black bile) and water (phlegm). Unlike Hippocrates, who believed that disease
resulted from a humoral imbalance throughout the body, Galen believed that a disease-causing
imbalance could be located within an organ. Drugs developed by Galen were made from herbs that he
collected from all over the world. The drugs were classified by their properties - heating, cooling,
drying, or moistening and were applied so as to counteract whatever humour disproportion existed.
Galen was the first physician to use the pulse as an indicator of illness when compared to the normal
pulse. Galen used pulse observations to diagnose diseases and symptoms such as fevers.
6
He created his own theories from those principle and much of Galen's work can be seen as
building on the Hippocratice theories of the body, rather than being purely innovative. He carried on
the work of Hippocrates by teaching that Doctors should study the symptoms of a disease before they
treated it. His medicine was based on the ideas of the Greeks and Romans. His ideas were widely
accepted because they fitted in with other Greek ideas about nature, which were believed in the
Middle Ages. A good example of this is the theory of the four humours.
THE THEORY OF THE FOUR HUMOURS: Greek thinkers emphasized the idea of balance in all things,
including medicine. They believed in the importance of a balanced lifestyle; to eat in moderation, take
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some exercise, sleep regularly and keep clean. In their search for the natural basis of all things, these
thinkers came up with the four elements: earth, air, fire and water. These elements were linked to the
four seasons and also to the four "humours" inside each human being: yellow bile, black bile, blood
and phlegm. Galen believed that imbalance in any of these caused illness. Doctors could restore the
balance by treating patients e.g. if a patient had a fever, his body needed cooling to restore the
balance of humours and therefore a cold drink might be prescribed.
4
GALEN'S CONCEPT OF DISEASE: Galen defined disease as impairment of bodily activities. Whatever
that impairs the bodily activities is the cause of disease. It is Galen’s great contribution to Western
medicine to have laid a foundation of pathology by combining physiological and anatomical point of
view.
12
He was the first to attempt to formulate a classification of diseases and symptoms with a
strong basis in anatomy.
6
GALEN'S VIEWS ON THE ANATOMY OF THE EYE: He believed that the eye was composed of
membranes and fluids. He distinguished the following membranes of the eye: the cornea, the sclera,
the choroid, the capsula of the lens and the retina, as well as the structure covering the muscles of the
eye and joining the individual elements of the eye with the orbital cavity and the skull. The following
were considered as fluid substances of the eye: egg-shaped fluid (i.e. albuminous fluid), crystal fluid
(i.e. the lens) and vitreous fluid. His theory of vision assumes the existence of a specific life force
called pneuma, which is under a considerable influence of the soul and which reaches the eye from
the brain through small channels in the optic nerve.
13
OBESITY AND TREATMENT: Galen was among the first to establish scientific methods to describe
and treat morbid obesity. He stated that obesity results from the surplus of "bad humours" in the
body and specifically from a surplus of blood. Nevertheless, he proposed some treatments for obesity
such as diet, exercise, and medications that are still valuable and are nearly the same as what is
advocated today.
14
GALEN AS A PIONEER OF SPINE RESEARCH: Galen marked the history of medicine for more than 14
centuries. His doctrines, expressed in his voluminous work, combined the medical heritage of the
Hippocratic, the Alexandrian and some of the most important medical schools of antiquity. The strong
influence of the Hippocratic tradition can characteristically be traced in orthopaedics and particularly
in Galen's presentation of the spine. Based on his observations, derived from dissection and
vivisection of animals, Galen established a pioneer model for the study of human spine. His research
ended in an accurate description of the vertebral column and the spinal cord. He also described the
course and the distribution of the nerves emerging from the spine. Galen was the first physician to
demonstrate the neurological implications following transection of the spinal cord at several
levels.
3,11
GALEN'S MAJOR WORKS: His "On the Elements according to Hippocrates" describes the
philosopher's system of four bodily humours, blood, yellow bile, black bile and phlegm, which were
identified with the four classical elements and in turn with the seasons. Amongst Galen's own major
anatomical works are a seventeen-volume "On the Usefulness of the Parts of the Human Body" and
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"On Anatomical Procedure". He made extraordinary advances in anatomy which were not challenged
until the time of Andreas Vesalius. His dissections were of animals, which he then extrapolated to
human anatomy resulting in some unworthy errors.
6,15
Galen was the first to describe the ureters
with their functions, as well as organising the bones of the skeletons with their muscle
attachments.
16
On the basis of his own anatomical researches and logical conclusions, Galen
established connections between (i) the brain and the mind, (ii) the heart and the emotions and
feelings and (iii) the liver and certain appetitive sentiments like hunger or thirst.
17
GALEN'S PHYSIOLOGY: Galen’s genius was evident in physiological experiments conducted on
animals. The work "On the Usefulness of the Parts of the Human Body" comprised seventeen books
concerning with this topic. To study the function of the kidneys in producing urine, he tied the ureters
and observed the swelling of the kidneys. To study the function of the nerves, he cut them and
thereby showed paralysis of the shoulder muscles after division of nerves in the neck and loss of
voice after interruption of the recurrent laryngeal nerve. Descriptions in the Galenic "On the Anatomy
of Nerves" appear vague at first sight, but the described structures can be identified in most cases
without doubt on the basic of anatomical knowledge.
18
GALEN'S SUCCESS: His books were used to teach new Doctors and so his ideas remained important
for the next thousand years until the Middle Ages. This meant that his mistakes were also passed on,
which may have prevented the understanding and treatment of illnesses. Galen was not a Christian or
a Muslim, but he believed in one God and talked about 'the creator'. This made his work acceptable to
both Christian and Islamic cultures as it fitted in with their teachings. He is remembered among
pharmacists for his classification of animal and vegetable extracts which are still known as Galenicals.
As a practicing anatomist, Galen was possibly the first exponent of scientific method applied to the
vivisection and post-mortem dissection of animals, especially the Barbary ape. It is not thought that
he carried out any dissection of the human body. He concluded that the diaphragm and thoracic
muscles were responsible for expansion of the chest cavity in inspiration. He was one of the first to
describe correctly the function of kidneys and explain micturition. He proved that urine was formed
in the kidneys. Before, Doctors had thought it was formed in the bladder. Among his many
neologisms, he coined the term ureter and he was probably the first to recognize the value of a
competent ureterovesical valve. Galen advocated catheterization for urinary obstruction.
19
Galen, a prolific writer, produced hundreds of works, of which about 120 have survived. His
most important contributions were in anatomy. His descriptions of bones and muscle were notable.
He was the first to observe that muscles work in contracting pairs and described the heart valves and
the structural differences between arteries and veins. He used experiments to demonstrate paralysis
resulting from spinal cord injuries and the passage of urine from kidneys to bladder. Galen pioneered
diagnostic use of the pulse rate. One of his most lasting technique that is still practiced by Doctors
today is taking the pulse of a patient. In his extensive travels, Galen also collected plants with healing
properties and explained their uses.
GALEN'S MISTAKES AND ERRORS: Unfortunately for medieval medicine, Galen made critical errors
about the heart and blood vessels that remained virtually unchallenged for 1,400 years. Because his
knowledge was derived for the most part from animals rather than human dissection, he made many
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mistakes, especially concerning the internal organs. One of Galen's most notable mistakes was to
think that the heart was divided in two parts. He maintained that blood permeated the septum
between left and right ventricle and persisted in the Hippocratic misconception that the body's fluids
were composed of an equilibrium of four humours (black bile, yellow bile, blood, and phlegm) and
the rationale of medicine was to restore any disease-causing imbalance. Galen accepted the common
view that disease was caused by an imbalance of these 'four humours' in the human body.
He also believed that blood formed in the liver and was circulated from there throughout the
body in the veins. He showed that arteries contain blood, but thought they also contained and
distributed pneuma, a vital spirit. His error, which will become the established medical orthodoxy for
centuries, is to assume that the blood goes back and forth from the heart in an ebb-and-flow motion.
His errors were not seriously challenged in medical thought and teaching until the anatomist Andreas
Vesalius in 1543 and the physiologist William Harvey in 1628 courageously questioned the
infallibility of Galenic authority and effectively substantiated their findings through demonstration.
Galen's teachings became the ultimate medical authority, approved by the Christian church because
of his belief in a divine purpose for all things.
His "On Anatomical Procedures" describes in minute detail how to perform a remarkable
series of experiments by which Galen demonstrated the anatomy and the functions of the respiratory
muscles, when work on human corpses was forbidden and it became a standard text on anatomy
when rediscovered in Western Europe in the 16
th
century.
20
GALEN AND ANATOMY: Galen was able to study skeletons, but not actual bodies. This was because
religious restrictions forbade the dissection of human remains. He also stressed the importance of
understanding the skeleton and the functions of parts of the body. He gained some knowledge of
anatomy and physiology from treating wounded gladiators. Although he realized the need to carry
out experiments, human dissection was not acceptable so he had to base his ideas on the anatomy of
animals, especially the ape, which he said was closest to the human skeleton. Galen made
extraordinary advance in anatomy which were not challenged until the time of Vesalius. His
dissections were of animals, which ultimately resulted in some noteworthy errors
6
. The Anatomical
Procedures is Galen's most complete treatise on anatomy, which the Western culture came to know
only in the Renaissance.
21
LATER YEARS: Galen's library and many of his own manuscripts were destroyed in a fire at Rome's
Temple of Peace in 192 AD.
20
Yet in spite of this loss, information about his writings remains because
he wrote two treatises “On My Own Books" and "On the order of My Own Books."
6
From 179 AD to
his death around 200 AD, Galen continued his medical research and writings producing such major
works as The Method of Cure. During his last years, however, he wrote more nonmedical works, such
as on the Equality of Sin and Punishment and The Slight Significance of Popular Honor and Glory.
BEYOND GALEN'S LIFETIME: His texts were kept alive primarily by the Arabs until they were
retranslated in Europe in the Middle Ages. One of the crucial causes of this endurance was that
Galen's concepts coincided, for the most part, with Christian beliefs. Of great importance was Galen's
assertion that human organs were suited for their function; this notion fit in with the Christians'
"belief in a system ordained by nature". In addition, although Galen was not Christian, his writings
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expressed his belief in one God and in the body as an instrument of the soul. He tried to differentiate
between blood spitting and blood vomiting, between colic from kidney stone and colic from the
intestines. He also understood well the psychosomatic element of illness. In the fields of therapy and
of pharmacy, Galen is remembered mainly for his schematism and extremely complex prescriptions,
sometimes containing dozens of ingredients.
Unlike some of his predecessors, Galen concluded that the brain controlled cognition and
willed action. The initial evidence for this doctrine was that the brain was the site of termination of all
of the five senses: touch, taste, smell, sight, and hearing. He presumed that the information from these
five senses was organized by a part of the brain that generated a concept of an object common to all
senses; this part of the brain he considered to be the area of common sense. He thought that he could
differentiate sensory from motor nerves (not nerve fibers) by palpation. Galen considered that
common sense, cognition and memory were functions of the brain. His studies of respiration and of
the recurrent laryngeal nerve solidified the knowledge that the brain, not the chest, was the site of
the rational power that guides human behavior.
2
Apart from being an outstanding physician, he had a
great knowledge of medicines and ways of their production. Galen developed his general theory of
body functioning. It was only after his death that his works attracted more general attention. Both
theoretical developments and his works on various ailments were first recognised in the Arabic
world. It was only this fact that resulted in his works being gradually translated from Arabic into
Latin and published in Europe where they grew important among European university circles.
22
CONCLUSION: Galen's influence on medical theory, terminology and practice remained unquestioned
in Europe and the Middle East throughout the Middle Ages and Renaissance. His work was so
influential there that he has been described as the Medical Pope of the Middle Ages.
19
He was one of
the originators of the science of anatomy and was probably the most important physician of all time.
His surviving writings make up about half of all ancient writings on medicine. The importance he
placed on anatomy and verification of science led his followers to create a surge in inquiries about
bodily structure and function. His influence on medicine was still crucial to modern medical science.
The progress he made in his lifetime was astonishing, especially because he managed to influence
medicine and philosophy simultaneously in dramatic ways.
5
His description of experiments on the exposed animals and animal brain is remarkable and
depicts the origins of experimental neurosurgery
6
. His achievements in anatomical science in
antiquity are unequalled.
23
Galen brought neuroanatomical knowledge and physiology together in his
study of the brain and nerves using experimental methodology which arguably represent the zenith
of neurological investigation in the ancient world.
6
Although it has been almost 2,000 years since
Galen walked the streets of the Roman Empire, his legacy continues via multiple eponyms that bear
his name. He became one of the most celebrated figures in the history of Science.
11
Urology occupies a considerable place in Galen's work. He was the first to describe the ureters
with their function, as well as organising the bones of the skeleton with their muscle attachments.
16,24
He remained the highest medical authority until Andreas Vesalius and William Harvey exposed the
fundamental errors of his system. Nevertheless, his significant contribution in the fields of medicine
and anatomy deserves to be appreciated by the medical professionals more particularly the
anatomists. It is recommended that every medical professionals and anatomists study the biography
of Galen and his multifarious contributions made in the fields of medicine and anatomy.
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DOI: 10.14260/jemds/2015/651
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AUTHORS:
1. Rajkumari Ajita
PARTICULARS OF CONTRIBUTORS:
1. Associate Professor, Department of
Anatomy, Regional Institute of Medical
Sciences, Imphal, Manipur, India.
FINANCIAL OR OTHER
COMPETING INTERESTS: None
NAME ADDRESS EMAIL ID OF THE
CORRESPONDING AUTHOR:
Dr. Rajkumari Ajita,
Pishumthong Oinam Leikai,
Imphal West District, Imphal-795001,
Manipur, India.
E-mail: rajkumariajita13@yahoo.com
Date of Submission: 08/03/2015.
Date of Peer Review: 09/03/2015.
Date of Acceptance: 18/03/2015.
Date of Publishing: 28/03/2015.
