PROGNOSIS

What Galen Saw

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In the winter of 162 CE, the philosopher Eudemus, then sixty-three-years-old, fell ill. He and Galen were acquaintances in Rome, although they knew each other from years earlier in Pergamon. They moved in the same circles of educated people from influential families, but the philosopher—a generation older than Galen—was already socially established in the capital when the thirty-three-year-old doctor first arrived that same year. The two men were on their way to the baths with a few other friends when Eudemus wondered aloud if he should be bathing given his recent symptoms.

Baths of Caracalla. Roman, ca. 211–ca. 216 CE. Rome. Photo: Ethan Doyle White / Wikimedia.

He’d been feeling feverish and suffering from fits of chills. The others shrugged it off, except Galen, who remained silent. Eudemus pressed Galen and asked him to examine his pulse, but the doctor advised that he could not offer a sound evaluation since he was not familiar with Eudemus’s baseline pulse reading. However, Galen knew that something was off, and, later that night, Eudemus suffered an attack of feverish heat. 

Eudemus “gathered the best doctors in the city,” and Galen, still relatively new in town, stayed out of the fray as the competitive medical world of the Roman bedside swung into action. The physicians prescribed a specific medication to be administered in the morning, when the next attack was expected. But after the doctors left the sickroom, Galen told Eudemus privately that the drug would not work and might even worsen his condition. Avoiding an awkward situation, Eudemus followed his doctors’ orders: he took the prescription, and another feverish attack soon followed. Galen suspected that the medication had caused this subsequent attack—on top of Eudemus’s original symptoms—and, to confirm, he asked the philosopher to save his urine overnight. When Galen examined Eudemus’ excretions the next morning, the physician predicted yet another attack, which soon came to pass. The situation was now dire, and the other doctors had lost confidence that Eudemus could be helped. But Galen continued to attend to his friend, despite the ridicule he endured. He accurately predicted Eudemus’ three attacks—their timing as well as well as their remission—and issued a positive prognosis: Eudemus would recover. And indeed, contrary to the other doctors’ expectations, he did. The case established Galen’s fame in Rome and raised his profile within this elite community.

Eudemus, detail from the title page of Galeni Opera Omnia (Venice, 1550). Photo: Reynolds-Finley Historical Library, the University of Alabama at Birmingham.

As word spread of Galen’s outstanding care for Eudemus, witness accounts highlighted the doctor’s amazing ability to anticipate the disease’s progress. “Astonished” is a word that appears frequently in Galen’s semi-autobiographical On Prognosis; even more than the treatment, it was the prognosis that made an impression. In the ancient world, diagnosis and prognosis were essentially the same art: the name of a disease was less important than being able to predict its course and the outcome. Prognosis is essentially a forecast—knowledge of the future—and for physicians like Galen, these predictions were rooted in scientific truths and close observation of a patient. But medical prognostication was also cause for anxiety: there was tension between the rational, evidence-based prognoses of academic doctors (those who studied science) and the sorcery of magic-based healers. Both doctors and magicians were predictors of the future, although their methods radically differed. Galen dismissed divination, astrology, omens, oracles, incantation, and amulets—he associated such practices with disreputable charlatans—but was himself accused of magic by colleagues on several occasions. According to Galen, his prognoses were so accurate, and his rivals were so unable to parse the subtle details that he noticed in his patients, that his medical talent looked to some like sorcery. In fact, a prominent doctor accused Galen of using magic to predict the outcome in Eudemus’s case, an attack on the newcomer’s reputation. Galen vigorously denied accusations that he used magic, but the potential ramifications of this kind of slander were serious enough that he skipped town to avoid it. He confides that his temporary but hasty departure from Rome soon after his first arrival was motivated in part by a desire to avoid jealous, cutthroat colleagues, having taken to heart tales of earlier doctors who had been run out of town—or even poisoned!—by malevolent rivals. The line between medicine and magic was high-stakes business, and it was critical that one’s reputation stay on the right side.