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“He had also heard that when my father was introducing me to philosophy, he had been commanded by unambiguous dreams to educate me thoroughly in medicine, not just as a hobby.”

Galen, On Prognosis, trans. Vivian Nutton (Berlin: Akademie Verlag, 1979), 77–79 (XIV.608).

“Whenever a doctor who has been properly trained predicts the occurrence in a patient of delirium, rigor, depression, haemorrhages, abscessions to the ears or elsewhere, vomiting, sweating, a stomach upset, a fainting fit, or anything of the kind, he appears a strange monstrosity to the laity because of his rarity. The predicter is so far from gaining their respect that he would think himself lucky if he did not seem to be a sorcerer. There are, of course, a few who do not reject such a theory as impossible, yet they immediately ask the man who made the prognosis and his medical colleagues whether this sort of thing was also known to earlier authorities or whether it is the personal discovery of the forecaster. As a result, to conceal their sketchy learning, or possibly because some in fact know nothing, the doctors say that nothing like this was written earlier and that the man who has advanced such a prediction is a sorcerer. The forecaster himself dare not say that this subject was expounded by many of his predecessors and especially by Hippocrates, our guide to all that is good, both through respect for the other doctors present and from suspicion of their hatred. Nor dare he say that it is his own discovery: for then he would be lying—as well as incurring even greater enmity. Thus, as he is subjected to this difficult questioning on all sides, while, I suppose, he delays and debates with himself, he increases their suspicion of sorcery by his everlasting hesitation. Finally he stirs up such envy against himself that they conspire against him, first by plotting poisoning, secondly by the trap in which they caught Quintus, the best physician of his generation, who was expelled from Rome on a charge of murdering his patients. Thus, whoever wants to pursue the art of medicine in a philosophic manner worthy of the sons of Asclepius must suffer one of two things: either he can go into exile like Quintus and keep the rewards of his perception untarnished, or, leaving himself wide open to calumny, he can, if he lacks spirit, put forward a justification and then cower back, living like a hare, trembling in constant expectation of disaster—and still increase their suspicions of sorcery. If he has greater courage and joins battle, fighting alone against many wicked men well practiced in many ways of crime, himself relying upon his education and learning and innocent of such evils, he will be taken by force, and from then on he will be in their power, however they should wish to use him. Even if he holds out longer and continues the struggle by some remarkable luck, he cannot escape being caught up in that most dreaded of wars, internecine strife, both as attacker and attacked.”

Galen, On Prognosis, trans. Vivian Nutton (Berlin: Akademie Verlag, 1979), 71–73 (XIV.601–3).

“Just when I entered [the house] I encountered a person who carried from the bed chamber to the toilet a pan containing a thin bloody serum similar to the watery fluid of freshly slaughtered meat, which is a definite indication of a disease of the liver. I now went in together with Glaucon as if I had not seen anything at all. Approaching the physician I put my hand at his wrist in order to find out whether he had an inflammation or only a weakness of this organ [the liver]. As already mentioned, the patient, who was a physician, told me that he had just lain down, and because he had passed some stools he said: ‘Judge for yourself whether the frequency of my pulse has somewhat increased by my getting up to move the bowels.’ He spoke in this manner, but I found symptoms indicating that he suffered from an inflammatory disease. 

When I then noticed that a little cooking pot, standing at the window, contained a preparation of hyssop in water and honey, I came to the conclusion that this physician believed he suffered from pleurisy, because he had pain in the area of the false ribs as it sometimes occurs during inflammation of the liver. Because he had this [type of] sensation and his respiration was fast and shallow and he felt irritated by brief coughing spells from pleurisy, he had prepared hyssop in water and honey. 

When I realized that fortune had opened an opportunity for me to rise in the esteem of Glaucon, I guided the hand of the patient to the false ribs at his right side and indicating the spot I told him that he had pain there. When he confirmed this, Glaucon thought that I had made the diagnosis of the affected part only from the pulse and he appeared truly puzzled. To increase his astonishment I added these words: ‘Since you admitted pain at this spot, you can further tell me that you feel the urge to cough, that it is a brief dry cough at rather long intervals and that you do not raise anything.’

While I said this he just happened to cough in the manner I described. Thereupon Glaucon could not restrain his great admiration and raised his voice with loud approval. I replied: ‘This of course does not seem to me the only thing which an adequate [medical] art can foretell about the patient. There are other things besides these which I will now mention to you and the patient himself shall confirm it.’ Then I started again to tell him: 

‘When you take a deep breath, you will doubtless feel that the pain at the indicated spot will become more severe and you will feel a heavy weight in your right hypochondrium.’ At these words even the patient could not remain calm but voiced loudly his astonishment in unison with Glaucon.”

Galen, On the Affected Parts, trans. Rudolph E. Siegel (Basel: S. Karger, 1976), 161–63 (VIII.362–65). 

“You well remember the great interest in art and learning of Flavius Boethus, the ex-consul: he also had as his tutor in Peripatetic doctrine Alexander of Damascus, an expert also in the teaching of Plato but who inclined more to those of Aristotle. When he invited me to show him by dissections how breath and speech are produced, he got several kids and pigs ready. I had said that there was no need to dissect apes since not only these but almost all other land animals are similar in structure: those with loud voices are much better at providing a convincing demonstration to prove the point at issue than those with soft. The prospect of the demonstration attracted some others, including especially Adrian the orator—he was not yet a sophist but still attached to Boethus—and Demetrius of Alexandria, a follower of Favorinus, who used to lecture daily on the suggested themes in the style of Favorinus’s discourse. Before dissecting, I said that I would demonstrate what was revealed by dissection and that I rather hoped that Alexander could be my guide, indeed the guide of all of us, in drawing the logical conclusions from what was thereby achieved. Everybody else accepted this suggestion as reasonable, for they respected Alexander and were eager that the whole meeting should pass off without acrimonious disputation. As you recall, Alexander was renowned among all for this failing, as he then clearly revealed. I promised a demonstration of the minutest nerves, and to show how there is a hairlike pair implanted in the muscles of the larynx, on both left and right, which if ligated or cut render the animal speechless without damaging either its life or its functional activity. Alexander intervened before I could show this and said, ‘Should we agree with you on this primary point, that we should all believe in the evidence of the senses?’ When I heard this, I left them and went off, saying only that I was mistaken in thinking that I was not coming to meet boorish sceptics; otherwise I would not have come.

On my departure, the others condemned Alexander; and Adrian and Demetrius, who were always ill-disposed to his contentiousness, had a plausible occasion to censure him severely. When this was made known to all the intellectuals living in Rome and to Severus, Paulus and Barbarus, they all roundly reproached him and demanded that the dissections be performed in their presence when they had assembled together all others distinguished in medicine and philosophy. The meeting lasted several days, in which I showed that an intake of breath is produced by the dilation of the thorax, an exhalation by its contraction, and displayed the muscles by which it is dilated and contracted, and also the nerves branching to them which have their origin in the spinal cord. I also demonstrated how an unforced release of breath produces a soundless exhalation and the alternative, forced release is accompanied by sound and we call it efflatus. I also revealed how this efflatus by itself, when, in its passage along the larynx, it strikes against the cartilages there, produces voice: these cartilages are activated by muscles and damage to the nerves that activate the latter results in loss of voice. My detractors were all put to confusion when I showed this, and Boethus begged me to give him my lecture notes on it.”

Galen, On Prognosis, trans. Vivian Nutton (Berlin: Akademie Verlag, 1979), 97–99 (XIV.627–30). 

“The young man was in the fifth day of his illness: the help of venesection seemed to have been omitted, although, from the outset, his condition demanded it on the second, third, or, at the latest, the fourth day. But since neither the season of the year nor the age of the patient nor any lack of vital power nor the previous regimen in his illness offered any indication to the contrary, but all agreed together in pointing to venesection, the doctors reached a fair decision and determine to cut the vein. But I carefully observed all the obvious signs that were said by Hippocrates to portend a haemorrhage, and then said that, although they had rightly decided to extract some blood, the patient’s own nature also was fast coming to this by itself as it strove to expel what was oppressing it: this would occur soon, even if we did nothing. When the doctors heard this, they were indeed surprised, but then the patient stood up in bed, as if he wanted to jump out. When asked why he had jumped up when there was nothing to fear, he said that he saw a red snake crawling from the roof and was scared that it might lose its hold and fall on him: he was therefore avoiding the place where he had been lying. They still thought that this had nothing to do with the impending haemorrhage, but I examined everything closely, including the right side of his nose, extending to the cheek bone, where I saw a redness, hitherto faint, had now begun to be much more prominent. It then became clearer than ever that the haemorrhage would come from his right nostril. So I spoke quietly to one of the invalid’s slaves there, and told him to have ready under his cloak a bowl suitable for receiving blood, and then I announced in the hearing of all the doctors that, if they would only wait a moment, they would see the man bleeding from the right nostril. They laughed at me for proposing to include the right nostril in my prognosis. ‘Well then,’ I said, ‘either both must happen or I must be wrong on both counts: for both derive their prognosis from the same theory. The patient will suffer a haemorrhage and this will come from the right nostril, which [I have asked] you to observe.’

They broke into laughter, as you recall; but as soon as I saw the invalid scratching his nostril as if it was itching, I told the servant hiding the bowl to pay attention to what was happening and, when he saw blood pouring from the nostril, to run and put the vessel under it. Just as I was saying this, the patient drew out his bloodstained finger, at which the servant rushed forward and held the bowl underneath. As you know, there was a great shout and all the doctors fled. In response to your query, I showed that I had learned the whole theory from the pronouncements of Hippocrates, adding that we should expect the haemorrhage to be severe; for the impulse of his nature was strong and the disease unconcocted, which together usually produce excessive evacuations. So, thinking it best to stay a little while with the invalid, I sent my accompanying slave to fetch a large cupping glass without attracting most people’s attention. Quickly collecting a large amount of blood in the bowl, I asked for another, and on receiving the blood I calculated the weight of the evacuated blood at four and a half pounds.”

Galen, On Prognosis, trans. Vivian Nutton (Berlin: Akademie Verlag, 1979), 135–37 (XIV.666–69). 

“I was called in to see a woman who was said to lie awake at night, constantly tossing from one position to another. When I found that she was not suffering from fever, I asked about each of the details that had happened to her from which we know the presence of insomnia. She replied hesitantly or not at all, as if to show the folly of such questions, and finally turned over, buried herself completely deep in the blankets, covered her head with a small wrap and lay there as if wanting to sleep. On my departure I decided she was suffering from one of two things: from a depression caused by black bile or from some worry she was unwilling to confess. I thus postponed a further investigation until the next day and, on my arrival, I was first told by the maid in attendance that it was impossible to see her just then. I was told the same thing on my second visit, but I came yet a third time. Then the maid ordered me to go away, for her mistress did not wish to be disturbed. Knowing full well that she had bathed and eaten a normal meal after I had left, I returned the next day and in a private conversation with the maid on one subject and another I discovered beyond doubt that she was racked with grief. Exactly what this was I found out only by chance, as I believe Erasistratus did. After I had diagnosed that there was no bodily illness and that the woman was troubled by some psychological disturbance, I happened to receive some information at the time of my visit which confirmed my suspicions. A man coming from the theatre remarked that he had seen Pylades dancing. Her expression and facial colour changed, and observing this and putting my hand to her wrist, I found that her pulse had suddenly become irregular in several ways, which indicates that the mind is disturbed: the same happens to those who are entering any sort of contest. The next day I told one of my followers to arrive just after I had come and seen the woman and to announce that Morphus is dancing today. When he did so, I found that her pulse was unaffected. Similarly also on the following day, when I had an announcement made about the third member of the dancing troupe, her pulse stayed steady. On the fourth evening I kept a very careful watch when it was announced that Pylades was dancing and I saw that her pulse became immediately wildly disturbed. Thus I discovered that the woman was in love with Pylades, and by careful watch on subsequent days my discovery was confirmed. I made a similar diagnosis in the case of a rich man’s slave steward who suffered a similar indisposition.”

Galen, On Prognosis, trans. Vivian Nutton (Berlin: Akademie Verlag, 1979), 101–3 (XIV.631–33). 

“Accordingly, in the case of the athletic young man who started to be feverish during the first hour of the night, I saw him about the third hour on the following day. I found the fever to be excessively hot, but also that the pulse was regular, very large, rapid, frequent and strong, and that the quality of the heat was not corrosive to the touch, and further, that the urine was not far removed from normal in both consistency and color. I learned that the man had neglected his customary exercises for about thirty days but had exercised quite vigorously only the day before, although still not to excess, and had taken his customary foods and digested these, albeit slowly and with difficulty. [I also learned that] when the fever came on in the evening, the man appeared red and full, and further, he said there was a certain sensation of fullness in him. When one of those present spoke about phlebotomy, I decided to put off consideration of this remedy to another time, partly so that we might make a more accurate diagnosis of the class of fever, and partly of necessity, because of the [slow digestion] that had previously occurred. However, since the fever seemed to reach a peak similarly during the evening with no perceptible relief, there was already a suspicion that this was a continuous fever due to a blockage and excess of blood due to a stoppage of the pores resulting from the amount of flesh. When the fever maintained an equal magnitude throughout the whole night, it seemed to all the doctors observing him on the following day that phlebotomy was required. 

When discord arose about the timing [of the phlebotomy], and the view of those who recommended deferring it to the following day prevailed, the fever clearly showed an increase in strength through the whole day. And when, during the following, third night, another paroxysm in proportion to the first did not occur, the burning was intolerable to the patient, there was a tension of the whole body as if it had been filled, and a pulse in the head. Because of these things, the insomnia was terrible and the young man was throwing his body from one side to the other. Therefore, as he could no longer bear it, somewhere around the eighth hour of the night, he sent out a household slave to me with a request to come to him as quickly as possible. I listened of course and set out, finding on arrival that the fever was very hot and the pulse was of the kind I previously stated. Since neither in the pulse, nor in the urine, nor in the actual quality of the heat, was there any apparent sign of putrefaction of the humors, it seemed to be better to cut the vein before putrefaction began. 

Accordingly, I deliberately took from him an amount sufficient to bring about fainting, since I had been taught that both on theoretical grounds and from experience this is a most important remedy for continuous fevers in someone of strong capacity. For first, a body being cooled in the fainting very quickly comes to the opposite state. Nobody would be able to discover anything more pleasant or useful than this, either for patients or for the actual nature governing animals. Since, of necessity, in such bodies gastric excretion follows, while there is sometimes also vomiting of bile, the result is that moisture is immediately removed from the whole body, or there are sweats. Therefore, when these things all happened in sequence in that man, I quenched the fever right away so that some of those present said, ‘You, sir, have slain the fever!’ upon which we all laughed.”

Galen, Method of Medicine, trans. Ian Johnston and G. H. R. Horsley (Cambridge, MA: Harvard University Press, 2011), 465–71 (X.610–12). 

“Now the cure that I performed on the emperor himself was really remarkable. He and the medical advisers who had accompanied him on campaign believed a paroxysm of fever had begun, but they were all proved wrong on the second and third day, both in the morning and at about the eighth hour. On the previous day he had taken a draught of bitter aloes at the first hour and then some theriac at about the sixth, as was his daily custom. He had a bath at sunset and a light meal. All night long there followed colicky pains and evacuations through the lower belly, which made him feverish, and when his court doctors saw him in the morning, they advised him to rest and fed him some thick gruel at the ninth hour. Although I was then called in to sleep at the Palace, it was just when the lamps had been lit that an emissary from the emperor came to summon me. Three doctors had already examined him at dawn and at the eighth hour; they had taken his pulse; and they agreed that this was apparently the opening of an attack of an illness. When I stood by in silence, the emperor looked at me and asked why, when the others had taken his pulse, I alone had not done so. I replied that since they had already done so twice and the peculiarities of his pulse were probably known to them through their experiences on their travels abroad with him, I expected that they could obtain a better diagnosis of his present condition than I. On hearing this, he commanded me to take his pulse. It seemed to me that his pulse, compared with the general norm for each age and constitution, was far from showing the onset of an attack of an illness, and so I said that there was no attack of fever, but his stomach was overloaded with the food he had taken, which had turned to phlegm before excretion, and that this was now quite clear. After praising my diagnosis three time in these words: ‘That’s it, what you have said is just it: I feel that some rather cold food is upsetting me,’ he asked what was to be done. I told him what I knew and said that, had it been anybody else in that condition, I should have prescribed my usual dose of wine with pepper on top: but in the case of kings like him, when doctors should employ the safest remedies, it was enough to place over the mouth of the stomach a pad of wool impregnated with warm nard ointment. He replied that in any case, when he had a stomach complaint, he used to apply warm nard ointment smeared on scarlet wool, and he ordered Peitholaus to do that and then dismiss me. After the ointment had been applied and his feet warmed by the warm hands of masseurs, he called for Sabine wine, sprinkled pepper on it, and drank it. After he had drunk it, he remarked to Peitholaus, ‘We have one doctor, and he is a very enlightened gentleman.’ As you well know, he was continually speaking of me as the first among physicians and unique among philosophers: for he had already met many who were avaricious, quarrelsome, proud, jealous and spiteful.”

Galen, On Prognosis, trans. Vivian Nutton (Berlin: Akademie Verlag, 1979), 127–29 (XIV.658–60).