Claudius Galenus of Pergamum (Galen)

131-201 AD

Bust of GalenClaudius Galen a Greek physician practicing in Rome, was perhaps the most influential physician in ancient medicine. His works on anatomy served as a standard for 1400 years, from the 1st to the 16th centuries.

Galen drew from the work of Aristotle and Hippocrates and based his medicine on a theory of humors. He recommended specific diets to help in the "cleansing of the putrefied juices" and purging and bloodletting, in order to redress the imbalances in the humors.

Galen’s use of pneuma theory

Galen, like Plato, subscribed to a theory of pneuma. That is, he believed that blood contains "vital spirits" released into it by the brain. With the use of experiment Galen showed that the arteries carried blood and not air, as was commonly held. He also understood the value of the pulse in diagnosis. Galen incorrectly believed that blood was continuously being made and used up.

The fundamental principle of life, in Galenic physiology, was pneuma (air) or breath. Pneuma took three forms, with each being located in different parts of the body: (1) natural spirit resided in the liver, the center of nutrition and metabolism, (2) vital spirit was located in the heart, the center of blood flow regulation and body temperature, and (3) animal spirit was created in the brain, the center of sensory perceptions and movement.

Pneuma encountered the body through the windpipe (trachea) and so passed to the lung and thence, through the arteria venalis (our pulmonary vein) to the left ventricle, where it encountered the blood. A second source of pneuma was from food. Food-substances from the intestines were carried as chyle by the portal vein to the liver.

There they were converted into blood and endowed with a particular pneuma, the natural spirit, used to support growth and nutrition. This venous blood then entered the vena cava, from which it passed upwards and downwards to the tissues of the body. A portion of this venous blood entered the right ventricle of the heart, from which most of it passed by way of the vena arterialis (our pulmonary artery) and its valve to the lungs for their nutrition. The small remaining part of the blood in the right ventricle of the heart passed by way of invisible pores in the interventricular septum into the left ventricle of the heart. There it mixed with the air, drawn in through the pulmonary vein, to produce arterial blood, which was there charged with a vital spirit.

Blood containing vital spirit then passed into the arteries, endowing the various organs with activity. Such arterial blood as reached the brain became charged with the third and noblest pneuma, the animal spirit. The Animal spirit then passed through the hollow nerves to initiate motion and sensation in the organism. Movement occurred, according to Galen and followers, when the animal spirit was released and expanded the tissues of the muscles.

Galen performed vivisections of numerous animals. He studied the function of the kidneys and the spinal cord. He also investigated the anatomy of the respiratory system, and of the heart, arteries, and veins. In the course of his studies, he distinguished sensory from motor nerves in terms of the hardness of the nerves. Motor nerves were hard, whereas sensory nerves were soft.

Galen made his own medicines from animal and vegetables extracts, many of the plants being grown in his own garden. He detailed various remedies including how each was made and the recommended correct doses to be given.

Claudius Galen was born in Turkey, then part of Greece. He worked in the local temple for four years and then, following his father’s death, left his home to study in Alexandria, an important medical center. For 12 years he studied medicine. He then returned to his home town Pergamum, and began working as physician in a gladiator school.

After a few years at the school he moved to Rome. There he wrote and lectured on anatomy developing a medical reputation as a scholar and a practitioner. He became a court physician to Emperor Marcus Aurelius around 170 AD. He spent the rest of his life in the Imperial court, writing and carrying out medical experiments.

Galen’s ideas about speech, language and hearing, described below are drawn from translations found in Wollock (1997) von Leden (1998).

Galen on the voice and voice production

Galen compared the production of the voice to a musical wind instrument in which the glottis served as a reed and the pharynx and palate as a mechanism for voicing. He described the brain as the center of phonation and laid out the motor pathways via the laryngeal nerves to the larynx. He identified the larynx as the instrument of the voice and outlined the muscles of the vocal system. Finally, Galen differentiated physiologic from pathologic dysphonias, and ascribed different types of hoarseness to various diseases and disorders of the vocal system.

In his own words (as translated by Wollock, 1997)

…as we have already demonstrated that increased velocity of the air is an indispensible condition for the formation of voice, and as we are showing here that this velocity increases with the narrowness of the passage, nature, not without reason, has constructed at the interior of the larynx an organ (ie., glottis), exactly resembling the reeds which are found in auloi (a musical instrument like the modern oboe). Indeed the lower end of this organ is quite slender, whereas above the glottis is the extremity of the larynx, then comes the pharynx, and after this like a sounding-board, the vault of the palate. What chiefly prevents the glottis from closing during strong emissions of the voice are the oblique muscles placed at the interior of the air passages, muscles which pull back the glottis, and which are the most important of all the laryngeal muscles. (This continues on for two more paragraphs in Wollock).

Galen On spasmodic dysphonia or “checked voice” (pp. 168, 174-179)

There was a certain man who had difficulty in emitting the voice when he was speaking. But when he had spoken one word, the tongue was thenceforth wonderfully untied; this man’s affliction occurred also from the bad form subsisting in his epiglottis; wherefore the physicians then burdened him with many medicines. Hence I advised him that before hand he should contract his chest in a small way in the beginning of his collowuium; then if he should wish to contract it all at once in the end he might do so. And he said in reply: that your advice is good; and he wondered at himself, how he had not realized what was happening to him; saying that his voice was broken off for him when he was sepaking his speech vehemently; but when he spoke beginning his speech in relaxation, he suffered no tightness in it. (From Wollock, 1997, 0. 170).

Galen on the difference between voice and speech

…the tongue is an organ not of the voice, but of speech; and therefore, when it is injured, speech defects occur (Wollock, 1997, p. 11).

Galen’s views of stuttering, stroke, and misarticulation.

Galen, in keeping with humor theory, asserted that stuttering is due to excessive moisture, or in some cases dryness of the tongue. His treatment involved heating the tongue (including cauterization), or wrapping it in cloth soaked with lettuce juice.

Generally, Galen also used humor theory to understand stroke and its symptoms. He saw strokes as being caused by an accumulation of a think, stick humor—Black bile or phlegm. The viscous liquid, he felt, blocked the flow of animal spirit, and interrupted the transmission of movement and sensation to the body. Elsewhere in his theorizing about strokes, Galen came from an excess of blood near the brain that cooled the brain and blocked the flow of pneuma (Karenberg & Hort, 1998, p. 167).

With regard to articulation, Galen had the following ideas:

He identified a type of misarticulation as traulotes in which the person cannot produce apical trill (tr) (Wollock, 1997, p. 191) and another, psellismos as an s problem (Wollock, 1997, p. 194). He also talked about degrees of severity: ranging from complete disability, to diminished ability to corruption (Wollodk, 1997, p. 365).

Relevant writings by Galen

Galen (1976). Galen on the affected parts. Translated by Rudolph E. Siegel. London: Karger.

Writings about Galen

Karenberg, A. and Hort I. (1998). Medieval descriptions and doctrines of stroke: Preliminary analysis of select sources. Part I: The Struggle for terms and theories – Late antiquity and early middle ages (300-800). Journal of the History of the Neurosciences, 7, 3, 162–173.

May, M. T. (Ed.). (1968). Galen: On the usefulness of the parts of the body. Ithaca, NY: Cornell University Press.

Nutton, Vivian, (2000) Galen of Pergamum and the medical renaissance. University College London.

Nutton, Vivian (2005) The fatal embrace: Galen and the history of ancient medicine. Science in Context 18(1), 111–121 (2005).

Singer, C. (1956). Galen on anatomical procedures. NY: Oxford University Press.

Smith, E. (1971) Galen’s account of the cranial nerves and the autonomic nerous system. Clio Medica, 6, 77-98.

Temkin, O. (1947). Galenism: Rise and decline of a medical philosophy. Ithaca, NY: Cornell University Press.

Von Leden, H. (1998) A cultural history of the human voice. Chapter 2 in R. Sataloff (Ed.) Voice perspectives. San Diego: Singular Publishing Group.

Wollock, J. (1997). The noblest animate motion: Speech, physiology and medicine in Pre-Cartesian linguistic thought. Philadelphia: John Benjamins Publishing Co.