Galen of Pergamon (129 AD - 210 AD), recognized for a curiosity that evolved into valuable research, stands as the most prominent representative in the field of health in antiquity, succeeding Hippocrates of Cos (Sánchez, 2020). According to Sánchez (2020), in a historical period where diagnostic tools were notably scarce and knowledge in biology was limited, Galen emerged as a crucial figure by articulating ideas and principles that not only endured over time but also exerted significant influence on medical practice for several centuries.
In line with Romero et al. (2011), the Galenic encyclopedia is constructed upon four closely integrated elements, derived from the Hippocratic tradition. The physician from Cos constitutes the first and most powerful pillar of his doctrine, playing a hegemonic role. The second component that distinguishes his work is the influence of the ideas of Plato and Aristotle, whose theories and methodological concepts play a crucial role in Galen's scientific process. The third component is the creative systematization of the Greek medical tradition, and the fourth and final component emerges as the enduring and decisive foundation for the construction of Western medical thought up to the present day.
Biography
Claudius Galen was born in the summer of the year 130 A.D. in Pergamon (Sánchez, 2020). At that time, the city was located on the western edge of Asia Minor, a city that was then under Greek rule and is now part of Turkey (Villacís, 2020). This distinguished physician came from a wealthy and aristocratic family (Sánchez, 2020). Aelius Nicon, his father, was a renowned architect, landowner, and builder, also well-versed in mathematics, astronomy, and writing (Campohermoso et al., 2016). According to Sánchez (2020), little is known about his mother, except that she had a difficult temperament.
Galen's parents made efforts to ensure he received a solid education (Sánchez, 2020). Specifically, Galen's father had a significant influence on him; it is said that one night he dreamt of Asclepius, or Aesculapius, the god of medicine, who indicated that his son should study medicine (Campohermoso et al., 2016). For some reason, his father encouraged him to pursue this profession (Sánchez, 2020). In line with Campohermoso et al. (2016), Galen began his studies at the Aesculapion of Pergamon, a distinguished healing temple dedicated to both religious activity and the science of healing, where prominent individuals in various scientific disciplines gathered, and Galen acquired knowledge of anatomical and physiological concepts.
At the age of sixteen, Galen of Pergamon decided to focus his efforts on the study of medicine (Campohermoso et al., 2016). After three years of preparation in his hometown, he moved to Smyrna to study with Pelops in semiotics, delving into the investigation of Hippocratic texts. During this period, he wrote a three-book thesis titled "On the Movements of the Chest and Lungs," marking the beginning of a series of studies to describe the crossing of muscle fibers during respiratory movements (Romero et al., 2011). In accordance with Romero et al. (2011), his interest in understanding the mechanisms regulating biological phenomena and their interconnections would be the foundation for the gradual development of his teaching system.
In the year 152, he moved to Corinth and Alexandria, following Numitianus to continue his preparation, especially in anatomy, surgery, and therapeutics (Romero et al., 2011). Likewise, he gained knowledge of the techniques introduced by Herophilus and Erasistratus of dissection and vivisection in animals, allowing him to establish analogies with human morphology (Romero et al., 2011). Five years later, after the death of his father, he returned to his hometown (Sánchez, 2020). In that place, he served as a physician at the gladiator school for four years, excelling in his work with meticulousness and skill (Campohermoso et al., 2016). According to Campohermoso et al. (2016), this experience provided him with extensive knowledge in the art of healing, addressing both wound treatment and care for bones, joints, and muscles.
In the year 162, he moved to Rome with the purpose of disseminating the anatomical and physiological studies conducted up to that point (Romero et al., 2011). During this period, he wrote notable morphological works such as "On the Use of Parts" and "On Anatomical Procedures," which held a prominent place in medical thought and were fundamental in the anatomy and surgery lectures of medieval and Renaissance universities (Romero et al., 2011). In that place, his reputation grew to the point of becoming the personal physician of several emperors, including Marcus Aurelius, Commodus, and Septimius Severus (Sánchez, 2020). According to Sánchez (2020), during his stay, he played the role of a researcher, with an estimated 400 works written, of which only 150 have survived.
In the city of Rome, dissections on human beings were prohibited, leading Galen to conduct his research on animals, whether alive or dead (Sánchez, 2020). Despite these limitations, he managed to understand the basic function of the kidneys and spinal cord. Unfortunately, much of his work was lost in a fire in the year 171. Before his death, the eminent physician returned to his hometown, Pergamon, where he passed away around the year 216. According to Sánchez (2020), without Galen's contribution, neither medicine nor pharmaceutical chemistry would have advanced so rapidly in knowledge.
Exploring the Psyche in the Tripartition of the Soul
He adopts a Platonic perspective in central areas of his thinking; this influence is especially evident in his moral psychology, where he assumes the Platonic division of the soul into rational and non-rational parts, with the latter further divided into the spirited and the desiderative (Singer, 2016). The fundamental distinction between the rational and non-rational soul is crucial for an adequate conceptualization of the soul and its internal functioning, particularly for a correct approach to ethics. However, the Platonic tripartition is also fundamental to Galen's body physiology. The three parts correspond and are located in the brain, heart, and liver, respectively. According to Singer (2016), these organs play proportional roles in Galen's physiology, being responsible for rational thought, perception, and voluntary and involuntary movements necessary for the maintenance of life, blood production, and nutrition.
According to this scheme, the psychic is properly attributed to a single part of the tripartite soul, specifically the one residing in the brain; and indeed, Galen uses "psyche" and its cognates in a narrower sense to refer to the brain and its functions (Singer, 2016). However, it is important to note that the Greek term "psyche" encompasses more than simply the mind or soul; it is the vital principle that explains life in the body, as well as the locus of thought and moral activity. For this reason, according to Singer (2016), all vital activities, in this sense, can be defined as psychic, as the "psyche" is responsible for both mental and physical function.
The Intricate Link between Body and Mind
Galen held the belief that bodily states had the ability to induce mental states, and, conversely, mental disorders could impact the health of the body (Pearson, 2016). His strongest argument regarding a theory of the body-mind identity is found in his analysis of the relationship between the rational soul and the physical characteristics of the brain (Singer, 2016). While he does not establish as close, at least proven, a connection between the heart and liver and their psychological functions as he does with the brain, the fact that the thumoeides, which encompasses emotional reactions, is located in the heart, illustrates examples from both everyday experience and traditional thinking. Thus, according to Singer (2016), Galen makes efforts to identify physical correlates for various psychological or emotional states, linking them to specific actions and states of the heart or blood; however, the relevant texts do not clarify the precise nature of the causal relationship.
The Four Temperaments
Galen embraced the Hippocratic theory of the four humors, which states that the balance of humors represents eucrasia (Campohermoso et al., 2016). For Galen, humors are fluid bodies that flow and interact in an orderly manner, maintaining the balance of vital functions (Villacís, 2018). Thus, illness was considered an imbalance between these fluids, diagnosed through pulse, urine, and organ inflammations, requiring prior knowledge of anatomy (Campohermoso et al., 2016). According to this theory, blood is formed in the liver; yellow bile in the gallbladder; black bile in the spleen; and phlegm in the pituitary gland. According to Campohermoso et al. (2016), these humors correspond to the elements and seasons of the year: blood to air, prevailing in spring; yellow bile to fire, prevailing in summer; black bile or melancholy to earth, prevailing in autumn; and phlegm to water, prevailing in winter.
Based on this, he proposed the existence of four temperaments based on the humor theory (Sánchez, 2020). The melancholic temperament characterizes those with a predominance of black bile. These individuals have a melancholic temperament, being sad, anxious, restless, reflective, and artistically sensitive (Sánchez, 2020). Similarly, they enjoy silence and solitude, often forgetting their surroundings and easily becoming distracted (Amezcua, 2016). The choleric temperament represents those with a large amount of yellow bile, leading to a passionate, perseverant, and highly vital temperament (Sánchez, 2020). They are ambitious, individualistic, and demanding of themselves (Amezcua, 2016). Additionally, according to Cajal (2019), individuals with these traits tend to be impulsive and react according to the environment: when convenient, they are communicative and good-natured; on the other hand, in an unfavorable environment, they become irritable and angry.
In the case of the sanguine temperament, the humor of blood predominates (Sánchez, 2020). Characteristics of the sanguine temperament include self-confidence, joy, optimism, expressiveness, and sociability (Sánchez, 2020). They are good-humored, enthusiastic individuals who exude confidence (Amezcua, 2016). Their traits are highly sociable, which could make this person somewhat despotic in some of their actions (Cajal, 2019). Lastly, the phlegmatic temperament characterizes those with a predominance of phlegm in their body (Sánchez, 2020). Phlegmatic individuals are reflective, fair, incorruptible, calm, not very committed, and somewhat lazy (Sánchez, 2020). Similarly, in correspondence with Amezcua (2016), they love the good life and dislike work.
Parkinson´s Disease
The last great classical master, Galen of Pergamon, clearly mentioned the postural changes and tremor associated with Parkinson's Disease (García, 2004). This philosopher described this disease as a type of paralysis that hinders walking straight (Campohermoso et al., 2016). He further adds that the tremor is an unfortunate condition, as movement becomes unstable and uncontrolled (Campohermoso et al., 2016). Galen goes even further by distinguishing between voluntary action tremor and resting tremor (García, 2004). Finally, in accordance with García (2004), after Galen, there are no known references to Parkinson's Disease for almost 15 centuries.
References
Amezcua, M. (2016). Teoría Hipocrática de los Humores. Fundacionindex.com. Recuperado 8 April 2021, a partir de https://www.fundacionindex.com/gomeres/?p=1990
Cajal, A. (2019). Hipócrates: Biografía, Obras y Aportes. Lifeder. Recuperado 8 April 2021, a partir de https://www.lifeder.com/aportaciones-de-hipocrates/
Campohermoso, O. et al. (2016). Galeno de pérgamo "príncipe de los médicos. Scielo.org.bo. Recuperado 18 July 2021, a partir de http://www.scielo.org.bo/scielo.php?pid=S1652-67762016000200014&script=sci_arttext
García, P. (2004). Prehistoria de la enfermedad de Parkinson. Sid.usal.es. Recuperado 21 July 2021, a partir de https://sid.usal.es/idocs/F8/ART13699/prehistoria_enfermedad_parkinson.pdf
Pearson, A. (2016). Galen: An Ancient Roman Forefather of Modern Psychology. Words from the Wind. Recuperado 19 July 2021, a partir de https://philosophadam.wordpress.com/2016/10/10/galen-an-ancient-roman-forefather-of-modern-psychology/
Romero, A. et al. (2011). Galeno de Pérgamo: Pionero en la historia de la ciencia que introduce los fundamentos científicos de la medicina. Medigraphic.com. Recuperado 18 July 2021, a partir de https://www.medigraphic.com/pdfs/abc/bc-2011/bc114g.pdf
Sánchez, E. (2020). Hipócrates y la teoría de los humores esenciales en el ser humano. La Mente es Maravillosa. Recuperado 8 April 2021, a partir de https://lamenteesmaravillosa.com/hipocrates-y-la-teoria-de-los-humores-esenciales-en-el-ser-humano/
Sánchez, E. (2020). Galeno, biografía de un médico brillante. La Mente es Maravillosa. Recuperado 18 July 2021, a partir de https://lamenteesmaravillosa.com/galeno-biografia-de-un-medico-brillante/
Singer, P. (2016). Galen. Plato.stanford.edu. Recuperado 19 July 2021, a partir de https://plato.stanford.edu/entries/galen/
Villacís, C. (2018). Galeno de Pérgamo: una de las cumbres del pensamiento griego. academiaplay. Recuperado 18 July 2021, a partir de https://academiaplay.es/historia-medicina-galeno/
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