THERAPEUTICS

Treatment Options


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Galen viewed the physician’s role as both preserving and restoring health. He discussed the importance of preventative care and also wrote extensively on different healing treatments.

A painting with a group of figures draped in olive green, purple, and pale blue clothes. In the center, a kneeling man attends to another man’s bare leg.

Surgeon treating a thigh wound (the physician Japyx healing Aeneas). Roman, 45–79 CE. Fresco. Triclinium, House of the Surgeon, Pompeii. H. 51 cm; W. 44 cm; D. 6 cm. Museo Archeologico Nazionale di Napoli: 9009. Photo: Ministero per i Beni e le Attività Culturali e per il Turismo / Museo Archeologico Nazionale di Napoli.

The types of interventions that an ancient physician was able to provide were far more limited than in our current world, yet the three main therapeutic categories within which Galen worked are recognizable to us today: dietetics, pharmacology, and surgery. He was following an established tradition described by earlier thinkers; the Roman encyclopedist and medical writer Celsus (ca. 25 BCE–ca. 50 CE), for instance, wrote that the

“art of Medicine was divided into three parts: one being that which cures through diet, another through medicaments, and third by hand.”

In practice, there was not always a sharp divide between these approaches: dietetics and pharmacology, especially, were part of a continuum since all food affects the body; but depending on use, dose, and preparation, they could be applied in various ways to different ends. Venesections (bloodlettings) and cupping were common treatment options while surgery was generally regarded as a last resort.

A hollow, bullet shaped vessel in a silvery brown color, lying diagonally on its side.

Cupping vessel. Roman, 1–79 CE. Bronze. Pompeii. Science Museum, London: A608651. Photo: © The Board of Trustees of the Science Museum. CC BY-SA 4.0.

Galen advocates beginning with the mildest, most minimally invasive treatment and gradually escalating interventions depending on the situation.

But how does a doctor know what treatment to provide to a sick patient? This question was posed by Galen’s friend Glaucon—more specifically, he requested “an outline of a general method of treatments”—and Galen’s texts Therapeutics to Glaucon together with On Therapeutic Method provide a systematic overview of his approach. By no means are these two books on the subject the only place one may find such explanations, and Galen’s prescriptions are also found throughout his case studies and anecdotes, as well as in books concerned specifically with each branch of treatment. And in many ways, his theoretical, research-oriented writings cannot be separated from the practice of patient-centered treatment. In fact, a tension between general medical knowledge and the specifics of particular cases is at the center of Galen’s answer to Glaucon: treatments should be based on universal medical facts (rooted in truths about anatomy, physiology, pathology, dietetics, pharmacology, etc.) and obey unchanging logical principles; yet at the same time, the physician must attend to the particulars of each patient, since no two people are alike. The value of general medical theories for the practicing physician, then, is to provide a framework for guiding individual treatments. 

A colorful illustration with an arch, under which are two bearded figures, one kneeling in pink and blue clothing, the other standing behind a green chair. The kneeling man grasps the standing man’s arm as they look at each other.

Reduction of the shoulder over a wooden pulpit. From Apollonius of Citium (fl. ca. 60 BCE), Treatise on Joint Dislocations (10th century CE), fol. 190r. Biblioteca Medicea Laurenziana: Plut. 74.7 (Codex Niketas). Photo: De Agostini Picture Library / Pinaider / Bridgeman Images.

Individualized care was an important principle for Galen, and he attended to the particulars of each patient’s story, symptoms, and prognosis. He was meticulous in his descriptions of how to think through patients’ illnesses, yet we do not know for certain if he had a routine examination protocol. From his various writings, we learn that he took careful patient histories, even speaking with patients’ friends and members of the household, and he frequently used pulse readings as part of his physical exams. The pulse was used to evaluate far more than heart rate and rhythm. For Galen pulse reading was a subtle art that took a much greater range of pulse qualities into account. In Roman medicine, subtleties of the pulse provided an assessment of changes in internal organs, mental or emotional states, fevers, the presence of tumors, and more (an elevated pulse rate does indeed indicate a fever). Galen also had a keen eye for visual diagnostic clues and noted changes in pallor, flushing, or wasting, and also scrutinized the color of urine samples.

Two facing pages. The left shows an elaborate circular diagram divided into twenty subsections, each with a flask-like symbol containing a differently colored liquid. In the center of the circle is an illustration of a seated man holding a flask before a youth. The right-hand page arranges the same flasks in two columns with accompanying text.

Urine color chart. From Ulrich Pinder, Epiphanie medicorum (Nuremberg, 1506), fol. A1v–A2r. Folger Shakespeare Library: R128.6.P6 1506 Cage. Photo: Folger Shakespeare Library. CC BY-SA 4.0.

He was not squeamish: he examined, feces, sweat, sputum, vomit, pus, blood, and anything else excreted from the body. In some accounts, Galen diagnoses a patient at a glance, much to everyone’s astonishment, while in other instances he recounts examinations that are extremely thorough. 

When writing on how to approach a method for treatment more specifically, Galen’s requirements of the ancient physician are familiar to us today. A doctor must have a firm grasp on different remedy options, the knowledge of how to apply them, and judgment of when to administer the selection. Galen describes his multipart assessment procedure in detail—how to analyze, categorize, and classify the specifics of a patient’s case—and describes ways to avoid confusing the cause of a disease with its symptoms. Identifying and understanding the cause of an illness is key for Galen: to a qualified doctor, correctly understanding a cause will indicate the appropriate treatment.