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The life of Galen is a unique opportunity to look at Roman history from the perspective of a prestigious doctor who became the most influential voice in medicine for a millennium.

People fight for a variety of reasons. We’re intrigued by it when we’re on the receiving end of the news and not of a nearby fist. It fuels our desire for daily drama. In Dostoevsky’s masterpiece, The Brothers Karamazov, a beautiful tension blossoms within the family when the patriarch Fyodor and his son Dmitri fight over the affection of a lady named Grushenka. Conflict ensues. Sometimes people fight not to break hearts but inertia. When Melkor got bored of the song they were playing in the Silmarillion, he fought against the wishes of Elu Iluvatar and played a wicked out of key guitar solo that drastically altered the music of creation, paving the way for a bunch of small folk to save the world. We can survey the annals of literature all day to look for more examples, but we might never find samples as rich as those found in reality, and perhaps there’s no better place to look for conflicts than in one of the most martial cities in history, Rome.

Most interesting for a historian of ideas is when people fight over convictions, be it philosophical, economic, scientific, religious, political, and to the interest of this blog, medical. Rome had plenty of medical fights, some having great importance to the history of medicine. Reasons varied: people fought over correct interpretations of medical (usually Hippocratic) texts, the existence of a particular bone, the cleanest surgical stroke, the best possible cure for a certain disease, or whose teacher was the best. To drive home their points, the contestants used orations and blades, not swords, but their miniature cousins, scalpels. Soldiers and gladiators didn’t have a monopoly on combat in Rome, doctors had their fair share of battles as well.

No need to go to the battlefield for a bloodbath.

The medical culture of Rome was a microcosm of the empire: it was simultaneously brutal and beautiful, like Madame Guillotine dressed as Sailor Moon — beheading monarchs by moonlight, winning revolutions by daylight. Roman doctors lived in a highly-competitive society where success wasn’t simply the result of medical talent. Fixing Flavius’ fractured femur wasn’t gonna cut it: you had to tell others that you were the best at fixing broken thigh bones. An amazing ability to announce your achievements was a must. Mastery in the arts of oration, debate, and, sometimes, pugilism were important implements in a doctor’s medical kit. But aside from having the right tools, developing a committed character was also important. Arriviste physicians needed to be charismatic and convincing in speech, have sound philosophical minds, and possess tenacious spirits to survive and prosper. And in the pages of history, no other doctor in the Roman empire embodied all three than the Greek doctor from Pergamon, Galen.

For being so, Galen rightly deserves his own segment in this series. It is even important to do so. Partly because the life of Galen is very interesting as it is. But most important is its exemplary typification of Roman medical culture. Galen best exhibits the values of Greek intellect and Roman vitality, thus giving us the best possible example of what this partnership looked like when wed. That is to say, he was the living embodiment of the central idea developed in the previous essay, Roman Medicine Was Nurtured by Greek Doctors.

But we can get more from him than just the flavour of medicine in his time.

The life of Galen is an excellent study for the student of Roman history. It is an open window with a wide panoramic view of the empire, starting from the exotic luxuries of Asia minor, to the teeming markets of the Levant, to the busy ports of Egypt, and to the cobbled streets of Rome. To study the life of Galen is to illuminate Roman history from within and without, to make visible Rome’s complexities and confusions (why did the conspirators kill Julius Caesar in their bid to protect the republic when all it did was endanger it more?). Scenes, voices, faces, colours, scents, and diseases from the empire are again animated by the power of his words, for he was not only a tireless doctor, but he was also an incessant writer. Galen wielded a philosophical pen that was as sharp as his medical blade, able to cut through the thick epidermis of everyday Roman life. Every page of Galen’s texts is a dissection of the empire’s political underbelly; an investigation of the invisible social veins that channelled life and energy throughout the empire. Like a master surgeon to anxious juniors, Galen makes the initial incision to start the laparotomy, he then reaches out and hands us his tools: he tasks us to complete the investigation.

Before doctors make a diagnosis, they first need to analyse a patient’s case history. A case or medical history is basically a rundown of things that have happened to a patient that might have led to or caused the complaint. Last Tuesday’s accidental Lego up the rectum explains Friday’s severe gastrointestinal bleeding. So in order for us to really know what Galen was all about we first need to know his history, otherwise we might falsely identify our headaches as casual brain throbbing caused by intense knowledge acquisition.

The story starts in the city of Pergamon, in what was then a Roman colony found on the western lip of modern-day Turkey kissing the Aegean. Long before the Romans held the city’s reigns, Pergamon was home to its own homegrown kingdom. Its monarchs had the bright idea of turning the city into a centre of learning, so they built a large library. Indeed, it was large. It was also excellent. So large and excellent in fact that neighbouring kingdoms wanted one for themselves. In On Architecture, the Roman engineer Vitruvius says that the fifth instalment of the Ptolemaic dynasty, Ptolemy V Epiphanes, “actuated by zeal and great desire for the furtherance of learning” decided to make “a similar one for the same purpose at Alexandria, about the same period.” That later turned out to be the famous and much bigger Library of Alexandria, which was loved by both scholars and arsonists. Though Pergamon’s library was upstaged by its Egyptian counterpart, the city nonetheless maintained its prominence and prestige. Pergamon was “by far the most famous city in Asia” says Pliny the Elder in Natural History. This is the affluence and influence that Galen was born into.

The privilege of Pergamene upbringing didn’t stop there.

Subjugation under Roman command didn’t diminish the Hellenistic tastes of the Pergamene aristocracy and bureaucracy. They carefully cradled it like overprotective parents. Pergamenes were proud of their Greek lineage and tongue. Galen exclusively wrote in Greek despite making his fortune in the Roman empire. Not once did he quote any Latin passage or author. It’s tempting to accuse him of the good ole xenophobia, but proper historical context says that Galen was standing on reasonable ground because Greek was the intellectual language of the empire. In this regard, Pergamon wasn’t unique since widespread Hellenism was felt across the empire. But the privilege Pergamon bestowed upon young Galen wasn’t its uniqueness, but the collection of favourable circumstances that it had developed which altogether conspired to shape the destiny of Galen.

One favourite pastime of the Greeks was to glorify gods. And the Pergamenes, true to their Hellenistic heritage, loved worshipping. Among the gods that they chose to venerate was Asclepius, who, from earlier essays we’ve learned to be the Greek god of healing. They also built him a temple to house his attendants and the sick seeking to be cured by him. Though there is no direct evidence, leaving us to solely rely on speculation, we can suspect Asclepius as the divinity that designed Nicon’s dream.

And dreams were serious business in the ancient world.

Galen’s father, a Greek architect known to posterity by his Romanised name Aelius Nicon, supervised Galen’s education, starting when the boy was very young. When his son reached the age of 14, Nicon hired the best minds around to tutor young Galen in philosophy. His teachers came from various philosophical schools: of those present were a Stoic, a Platonist, a Peripatetic, and an Epicurean. This early introduction to the many branches of philosophy played a pivotal role in the formation of Galen’s unique mind. He would later write in On Anatomical Procedures that this exposure moulded in him an attitude of “never professing myself an adherent of any sect, making rigorous investigation of them with all diligence”.

One night, when Nicon was sleeping soundly, the god Asclepius paid him a visit. The sleep was deep, so there was no resistance on Nicon’s part. To thank him for the easy welcome, Asclepius made Nicon dream of his son: Galen will soon become a successful and popular doctor, if only you’d let him. Nicon woke up, flustered. In the ancient world, gods communicated with mortals through dreams. To discard dreams as rubbish was to deny the gods their will. Nicon wasted no time and told his son about it the following morning. Sweet dreams of expertise. Galen approved, himself now driven to become a medical expert. Who were they to disagree? Nicon was set to make his son a doctor, and he had all the finances to fund Galen’s education.

Galen didn’t choose the medical life, the medical life chose him.

His first foray into medicine happened under the tutelage of Satyrus, a student of the popular Roman doctor Quintus. It was also around this time when Galen first saw the devastating power of disease in wrecking human life, something that he would again, to an even greater extent, face when under the payroll of the Roman royalty. Between 146-148 CE, Galen beheld the spread of what he called “anthrax”. But instead of being deterred, Galen showed early signs of his rash and dauntless character: he faced the disease headlong and recorded everything that he observed. Risque, yes. But it was driven by a desire to know, risks notwithstanding. The outbreak was not a pretty sight, for “many patients were stripped of skin, and some also of the very flesh” (ibid). This was just the first of many unpleasant experiences Galen endured for the sake of knowledge.

A sudden segue to via tristitia happened in the life of Galen when his father died in 148 CE. Galen was just 19 years young and by all accounts had all the rights to sulk and abandon his father’s augury. But giving up was not his wont nor want. Throughout his life — if we’re to base his feelings on the mood of his texts — Galen rarely revealed his emotional state, consistently maintaining a calm and almost detached demeanour, even in the middle of severe situations (like when he first observed anthrax). This is not to say that he felt indifferent to his father’s death. On the contrary, he always held his father’s memory adoringly, peppering his texts here and there with praises for his father’s determined efforts to educate him (he only mentions his mother once in a scathing passage).

With his bag on one shoulder and his father’s dream on the other, Galen headed to Smyrna in 150 CE to start his education abroad. His first stop was the doorstep of the physician Pelops. From him Galen would learn a lot about making drugs (he would cite him as one of his primary sources). However, Galen felt Pelops was keeping away a lot from him, especially the notes and findings of Numisianus, Pelop’s teacher (who was also a student of Quintus, the mentor of Galen’s former teacher Satyrus). Pelops hid Numisianus’ documents from prying eyes, because, according to Galen (ibid), Pelops “preferred that certain theories, as yet unknown, should be attributed to him”. To put it simply, Galen accuses Pelops of plagiarising Numisianus’ works. Needless to say this relationship was in dire need of an immediate amputation.

So Galen removed himself from Smyrna to look for the lost master. He gives a detailed rundown of what happened thereafter (ibid): “Next, I was in Corinth on account of Numisianus, who was himself the most famous of the students of Quintus, and in Alexandria and some other places in which I learned that Numisianus . . . was living”. But despite the many steps taken, Galen never found Numisianus. Perhaps he had died without Galen knowing of it. A huge opportunity missed.

The loss of Numisianus presented chance gains for Galen as it allowed him to mingle with the other medical minds in Alexandria. In his time, Alexandria was the centre for anatomical studies, as it was one of the few (if not the only) cities in the ancient world where human dissection was not considered taboo, (sources say vivisection of criminals were also carried out). The Egyptian practice of mummification made the opening of cadavers a routine operation, devoid of the unnecessary spiritual baggage attached to it by other cultures. This openness to human anatomical explorations was probably what convinced the Greek anatomists Erasistratus and Herophilos to settle in the city and establish their famous anatomical school. So it is not surprising that it was in Alexandria where Galen learned to better his knowledge of anatomy and skills in surgery. “When I first returned from Alexandria”, writes Galen in Compounding Drugs by Kind, “I really and truly learned the treatment of those who were wounded in the tendons.”

When one door closes, don’t fret, look for open bodies instead.

Galen’s adamant search for the best medical education from the best teachers around, even at an early age, shows the strong and lasting influence Nicon had on him, and it is something that would guide Galen all throughout his life. This lifelong dedication to study has its roots planted in Greek intellectual culture, where men of learning devoted their whole lives to the study of philosophy and even natural history, as was the case with Aristotle. Through Nicon’s nurture, Galen was able to pick up the torch of Greek intellectual fire and lit the dark crevices of medical knowledge. What he revealed wasn’t always very nice though, and Galen was at times burned by his own fire as we shall see later.

The study of medicine necessitates actual practice to measure how well a student carries out the instructions and theories learned in the years of study. It was the same for Galen. After years of study in Alexandria, Galen went back home to Pergamon in 157 CE, probably in the hopes of practising there. Did he actively apply for medical positions or endorse himself to the public, there is no telling, for no evidence surfaces. But in 158 CE, Galen tells us of a remarkable development. He says (ibid) that the city’s archierus, or high priest, “decided to entrust to me alone the care of the gladiators, although I was still young as to stage of life.” What prompted the high priest to hire him, even Galen “does not know”. Perhaps he had already cultivated a reputation as a medical prodigy while he was still studying. Or maybe he had found success when he practised in Pergamon. Most likely both.

The high priest made the right choice. Almost immediately, Galen reversed the rather terrible outcomes of his predecessors. The doctors before Galen recorded an impressive sixty gladiator deaths under their care. In Galen’s five year tenure as doctor to the gladiators, he only had an underwhelming two deaths to his name. All the more impressive was the fact that Galen worked alone at a relatively young age for a doctor. “Although, at that time, I had not yet completed thirty years of my age”, recounts Galen in On the Examinations by which the Best Physicians are Recognised, he was already handed the responsibility of treating “all the wounded men who had fought duels in combat.” This was in stark contrast with the medical organisation before his arrival. He continues: “Before my time, two or three of the Elders were in charge.” The confidence and trust bestowed upon him by the authorities is highly indicative of how his skills were appreciated and admired by the Pergamene elite.

Gladiatorial games were mainly conducted to entertain. Fights were carefully choreographed to ensure that no real harm was done to the gladiators. They were what athletes are now, expensive to keep and beloved by the public. Accidents, however, were inevitable. So was grudge and the avante-garde attitude of not sticking to the script. With the arrival of Galen, the realm of entertainment was further stretched to include the operating table. He used his privileged position as a platform to publicly demonstrate surgical techniques learned and innovated by himself. One such demonstration was the case of a wounded “horseman” with a very long laceration “going very deep into the frontal and lower sections of the thigh” and a wide gape “one edge torn upward, the other pulled downwards toward the kneecap”. Galen “attempted to proceed from the so-called lateral joint, and bring together little by little the sundered parts of the muscle with stitches” (Compounding Drugs by Kind). The wound was closed without any complications and infections. Another successful operation added to his fast growing résumé. But like his combative patients, he also dealt with non-human subjects.

Public demonstrations of surgical and medical skills on animals were a common spectacle in the empire. Physicians readily carried out these performances to showcase their skills, dazzling the crowd with precision cuts, popped veins spraying blood in every direction, eviscerated innards, and erudite speech, just like a regular TED Talk but with an extra element of gore. A sanguine theatre where doctors enjoyed prominent roles and elaborate lines while colouring the town red. Who needs gladiators when you have doctors to satisfy your blood lust? It was admittedly lopsided against the animals, as they couldn’t fight back, but the crowd was still captivated. They either cheered or jeered. Despite the obvious disregard for the ethical promise of primum non nocere, Roman physicians were eager to conduct these exhibitions for these had the positive effect of hauling in curious students to study under their influence, thus increasing their sphere of influence and popularity. It also served as a powerful stage to silence your critics in public. This was the case when Galen, on his free time as a doctor to the gladiators, vivisected a monkey. Galen started by disembowelling the monkey, then challenged “the other physicians who were present” to safely return its viscera inside its body before the poor screaming creature lost its life. When none would dare take up the task, Galen, ever the showman, showed them how and easily succeeded in doing so, “making it clear to the intellectuals who were present that” whosoever had abilities like his “should be in charge of the wounded” (On the Examinations by which the Best Physicians are Recognised).

This was Galen’s favoured tactic in proving that he was right: aggressively prove that others were mistaken. Galen garnered a reputation for being stringent and arrogant, always believing himself to be the paramount authority in medicine, second only to Hippocrates. But who could blame him? He had a great education and was able to prove himself correct time and time again without anybody able to prove otherwise. With today’s sensibilities, this may display a lack of class, but Galen’s attitude was perfectly in sync with the class he belonged to. Arrogance, vigour, and a relentless drive for argumentation were currencies flaunted by the intellectual elites of his time. And he was unabashedly one of them.

Having spent the better of five years as the premiere physician in Pergamon, Galen then moved to the biggest ward of them all, the eternal city of Rome. There is no telling what prompted him to do so, and he also doesn’t tell us whether the high priests terminated his contract. Perhaps it was his lust for challenges that drove him to Rome. After all, it was in the notorious streets of Rome where Quintus, the teacher of his own mentor, Satyrus, plied his trade. He may have wanted to get a feel of what it was like to be a doctor in the most famous city in the ancient world. There were also no reasons to stay in Pergamon. All the signs pointed to Rome. His years of education and training had prepared him for the spotlight, and he had everything going well in his favour: he was wealthy, popular, intelligent, and so far, had been mostly lucky.

Galen made many brief stopovers along the way to stock his supplies of drug ingredients. Some of the materials he gathered have been clinically found to immediately raise modern eyebrows, like “black crustaceous rocks and rocks which, when exposed to fire, emit a meagre flame,” (On the Mixtures and Powers of Simple Drugs) which he collected in what is now Palestine. His search for medicament also exposed him to the working and living conditions of rural peasants, an experience that he was proud to recall in his books. Whether he was inside ore mines, sharing tables with farmers, having fortunate encounters — since it was an invitation to study human anatomy — with unfortunate carcasses on the road, or enduring long sea travels, Galen always recorded every bit of information that he accrued, increasing the riches of his mental medical treasury.

Finally, in his 32nd year of his life, Galen arrived on Rome in the spring of 162 CE.

Roman interest in the medical arts slowly snowballed after Julius Caesar set the motions for the republic’s collapse. Greek doctors, who were mostly slaves, comprised the majority of healthcare providers in Rome. Caesar, before being murdered and subsequently turned into a vegetarian option, was the first to inject some sense of healthcare professionalism in Rome with an important edict: Caesar granted Greek doctors Roman citizenship in 46 BCE. Not to be outdone by his adoptive father, Augustus, Rome’s first emperor, blessed doctors with certain tax exemptions and gave them special privileges. Vespasian further enhanced their station by allocating state money for the salary of doctors who were in the business of teaching future physicians. The state and public support enjoyed by doctors in Rome made the city an enticing venue for medical practice. By the time he arrived in Rome, Galen was just another name in the long list of doctors testing the limits of their luck. All roads lead to Rome, indeed.

However, while recent developments improved life prospects for doctors, the local populace lived in constant peril from diseases, infectious or otherwise, thanks to imperial priorities. Augustus and Agrippa may have turned brick to marble, but later emperors spent much of the empire’s energy and fortunes on wars abroad, largely neglecting the marble-lous grandeur of Augustan Rome. As the military was expensive to keep, funding for better public housing and sanitation measures were kept to a low. So people had to make do with what little the state provided them with. They were cramped in very tight horizontal and vertical spaces. Dense was the city, which made pathogens and vectors very happy. There were so many people and so little space that even proximal contact with neighbours was blurred. “One peculiarity of Rome, which is not shared by other cities”, writes Galen in On the Examinations by which the Best Physicians are Recognised, “is that not even neighbours, let alone other inhabitants, know how a patient has died, or by whom he has been treated. This is because the city is great and populous.” It was so crowded that deaths hardly mattered. Dead tenants were easily replaced by other warm bodies looking for homes.

This was the Rome Galen found himself in. It was definitely wealthy but hardly healthy.

To be new in this highly competitive medical environment was difficult. Lonely neophytes were set up against a drove of desperate elder doctors. Luckily for Galen, some Pergamenes preceded him in Rome, so he was not without welcome and support. A compatriot named Teuthras helped butter the way for Galen’s smooth entry into Rome’s medical throng. He was Galen’s first level of support that allowed Galen to build an initial following. Teuthras also served as a wellspring of good advice, which came in handy almost immediately.

Galen was aching to get his career up in running in Rome, so shortly after arriving, he found himself in the middle of a medical snafu. Treatments in Rome were usually a public event, as it was an outgrowth of the Greek practice of conducting lectures out in the open. One day when he was roaming the streets, Galen saw a gathering of people and heard that they were discussing phlebotomy (drawing blood). It was one of his favoured treatments so he joined the fray eager to know what others had to say about it. Conducting the discussion was a sect called (by Galen) the Erasistrateans, who boasted a record of avoiding phlebotomy in their repertoire. Upon hearing the offending group express their reluctance to bleed their patients, Galen immediately engaged them with his preferred mode of dissent: direct confrontation. With obvious disdain and intensity in volume, Galen politely reminded them that they were wrong for omitting phlebotomy from their services. But his was an unfamiliar voice in an unwelcoming environment, and he failed to convince the participants of his gospel. Unable to sway attending opinion to his side, Galen quickly got riled up. But Teuthras was with him and pulled him away from the crowd. Now in safe distance from the more established and well connected rogues, Teuthras offered Galen a sound advice: “You will never influence these men; they are too stupid to remember the patients who were killed by Erasistratus. For what other reason did the patients they are citing now come to die, if not that the remedy of phlebotomy was omitted” (On Venesection against the Erasistrateans at Rome).

Teuthras’ words had an immediate and profound effect, for Galen changed his rather tactless urgency into a well structured (and probably choreographed) demolition. When the second occasion for a showdown occurred, Galen produced a very articulate refutation of the Erasistratean method which won him the reinforced ire of his newfound enemies as well as some fresh followers.

But it would be a mistake to think of Galen as someone like today’s internet trolls. Galen didn’t poke his head around every discussion ready with ornate obloquy and belligerent burns. Despite his rashness, Galen only reserved his contempt for corrections. To right wrongs – the very essence of medicine. Being doctors meant being intellectually responsible for pointing out the medical errors of others, which also required a willingness to wear a bulls eye for the scorn of wrongdoers — Galen wore that to the best of his abilities, for he was duly recognised as the best. He expressed unwavering allegiance to accuracy, but hated the consequences that came with it. In fact, he disdained the benefits of having enemies as it gave him unwanted press and attention. Gossip and defamatory hearsay against him spread like pestilence, forcing his early exit from Rome: “I wanted to escape the slanderous tongues,” Galen writes in On My Own Books, adding that he also planned to refrain from “[saying] anything beyond what was necessary among the patients” and “teaching in public, as before, nor performing demonstrations.” Rome had a sickness unto itself that sucked the life out of its doctors, and not even the great medical mind of Galen could deal with it.

But perhaps it wasn’t a social ill that he ran away from. There is reason to believe that he was only trying to escape the wrath of a virulent disease that had set afoot in the far reaches of the empire. Galen recounts in On My Own Books, “When the great plague began, I immediately left the city and travelled to my homeland.”

Wait a minute, if he was such a good doctor then why did he run away from duty? That’s something salacious journalists might munch for dinner — saucy and trite yet containing no gram of truth. Historian Susan Mattern argues that Galen had no intention to distance himself from the plague, but his motivation to leave Rome was driven by a desire to confront it as per his responsibility as a doctor. She writes in The Prince of Medicine (an excellent biography of Galen from where many of the quotes here are taken from), “Galen fled not from the plague, but toward it —motivated, perhaps, by worry about his hometown and a desire to be there for his people.”

There is no telling what Galen’s true intentions were but he did leave Rome in 166 CE and went back to Pergamon. Retreat from Rome didn’t mean resignation from medicine. It was business as usual in Pergamon: Galen admitted patients, argued here and there, conducted anatomical experiments, and edited some of his books. Life was going well, so Galen thought, until a letter arrived in 168 CE. It was an imperial summon. Apparently, it wasn’t just slander and malice around his name that circulated in Rome, but news of his talents also went viral. The message was simple: the royal household wants you back in the capital. To this there was only one possible reply: compliance. Galen soon found himself taking the trip back to the place he dreaded.

All roads led to Rome, yet again.

In the second season of The Life of Galen in Rome, the drama continues and heats up as even more poisonous tongues lash their malice at Galen’s enviable position. Galen achieved what only a few doctors have and would ever reach: the coveted title of archiatros, physician to the emperor. Along with the honour came financial security as well as the insecurity of others. It was a trade off that was unavoidable, but was Galen now more capable and mature to deal with it.

His appointment came in a unique time in the empire when the first co-emperors sat on the throne of power. However, Lucius Verus died of the plague in 169 CE on his way back to Rome. At that time, Galen was still in Aquileia, tending the sick and infected Roman soldiers, which meant two things: first, Galen couldn’t supervise the treatment of Lucius Verus which could’ve saved the co-emperor’s life; and second, he only served the other co-emperor Marcus Aurelius.

Galen’s sophomore spell turned out to be a period of prolific productivity and mastery. Marcus Aurelius was often abroad fighting on the German front, leaving Galen with enough time to write more books and seek more enemies. His one great task as archiatros was the care of the sickly Commodus, son and heir of Marcus Aurelius. This proved to be a wise decision on the emperor’s part, but a generally frowned upon move by the Romans and later historians: Wise because when young Commodus suffered an intense fever, the best doctor Galen was there to the rescue; damned because Galen cured him and put him back to good health. A positive medical outcome seen by many as a net negative for the empire because Commodus turned out to be a fine emperor of bad taste and abandon.

When Marcus Aurelius did return to Rome in 176 CE, Galen was there to meet him. Included in the arriving imperial entourage were three other doctors who were presumably military medics or personal physicians. Galen met them too. And they were immediately set against each other in a battle of medical alacrity and wisdom.

The emperor brought back with him a medical complaint as a souvenir for all his troubles. He felt ill and convulsive, so he summoned the three doctors and Galen to check up on him. The first to do their examinations were the three, leaving Galen the unenviable task of being last. When it was Galen’s turn to inspect the pained emperor, he didn’t. In On Prognosis, Galen describes the event in full:

“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.”

At this point, it’s safe to say that we’ve already established Galen’s superior dexterity and guile over his competitors, so it’s predictable what happened: he was right once again. The emperor ecstatically received his diagnosis, remembering that, indeed, his stomach was a bit upset from all the meals that he had taken. Galen’s accurate medical judgement instantly set him apart from the three doctors, leading the emperor to claim “we have one physician only”, which of course meant Galen.

From this story, two major medical themes arise to serve as important reminders to posterity on how to properly conduct medicine and science.

Opinions always vary: some are patently false without any hope of redemption, while others are true yet incomplete. The task of science is to collect the bits of scattered truth and use it to build structures of knowledge supported by verifiable reality. But to know which fragments are genuine, a rigorous process of sieving the grains of truth is and should always be observed. Nowadays we call this peer review. In medical consultation, this can also mean seeking second opinions. Aurelius asking Galen his opinion on the matter is evocative of this ideal design. To ask for a consensus regardless if ideas and opinions clash with each other, for what matters is that the best ideas from the best minds are canvassed. But what truly stands out in this story is something of the heroic: this episode would have waned in poignancy had Galen been unwilling to challenge his seniors. Reviewing and revising means to test ideas and concepts against extremely high standards — this requires a disposition of strength and fortitude able to withstand the might of authority. Did not Galen exhibit this early on when he challenged the Erasistrateans? And this aforementioned episode is just one of the many fracas where Galen stood up against authority to wave the banner of truth. Galen’s argumentative flair wasn’t indicative of a rebellious tendency nor vagrancy, it was all part of the Hippocratic spirit that Galen passionately embodied in his public and academic life. Thus, while it wasn’t unusual for Galen, his boldness to declare the truth against the more established elders in front of the emperor, in the biggest stage at that time, serves as an example of correct scientific virtue and consequently a crucial lesson to today’s doctors and medical students.

The second and most important tenor in Galen’s diagnosis of Marcus Aurelius was his high valuation of case histories. Galen’s reluctance to examine the emperor after the three doctors have done so exemplifies the Hippocratic demand to view health as the total outcome of a person’s unique history. That is to say, health concerns vary from one person to another as per their life experiences. Galen knew well that he was unfamiliar with the emperor’s day to day life as he was practising in Rome while the emperor was off fighting on foreign soil. He had no insight to the daily regimen of the emperor, leaving him with little to no information about the factors that led to Marcus Aurelius’ complaint. Now, this leaves us with the question: if Galen didn’t have the emperor’s case history as a reference to base his judgement, then how was he able to diagnose Marcus Aurelius correctly and save the emperor’s life? The brilliance of Galen shines through when he read the emperor’s pulse, only after being urged, and matched it with what he had observed from other people of the same age (the case histories of others), which led him to conclude correctly that there was nothing inherently wrong with the emperor. By comparing Marcus Aurelius’ pulse with that of others, Galen ensured that his judgement was informed by research – research that could only have been possible with the study of case histories. This strategy allowed him to prove that the methods of the three doctors were wrong, leading him to devise another stratagem: to look at the events that transpired before the complaint, that is to say, analysing Marcus Aurelius’ case history. The emperor had a lot to eat. His stomach was complaining. Galen said that was causing the pain. Marcus Aurelius agreed. Job done.

It may be tempting to abuse the character and name of Galen for intellectual anarchy. True, there is an element of romance in Galen’s struggles against the doctors of his time that is tempting to emulate, a delectable tale of the underdog succeeding against the odds by virtue of wit, wisdom, and intelligence. But to believe this genre is to remove Galen from the reality of Roman life. The whole truth is hard to know, since we can only dissect the texts left by Galen himself. But it is thanks to his extensive corpus that we are provided with an opportunity to travel back in time and have a closer look at the dynamics of Roman medical life, an institution that Galen dominated and developed so effectively that his importance and impact lasted for a millennium. The life of Galen is a genre of its own – a medical and philosophical odyssey along the august steps of Roman history. But in whatever mode you might read it in, what stands out are his fights, for Galen fought them to bring medicine to the forefront of intellectual life. And, despite all the drama that comes with it, that was and is a fight worth fighting for.

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