Today’s scholars will find it incredible that only sixty years ago no serious historical work on Galen (b. 129 CE) was being done: like the weather, everyone talked about him but nobody did anything about him. As a budding medievalist at Harvard then, anxious to explore Galen’s medical ideas, I discovered that the only advice my mentors could give me was to look through the mouldering pages of Kühn’s edition from the 1820s (there was of course no reprint yet), Greek text and Latin translation, as guided by its index in vol. 20. Historians may have been deterred by the language problem, the sheer volume of Galen’s work, his reputation for self-aggrandisement, but for whatever reason they shied away from him. Today the situation has been reversed—there is a frightening quantity of work being published on Galen, new works are being discovered and familiar works being translated into modern languages—and probably the most influential figure in this long rediscovery is the author of the present study, Vivian Nutton. I count about 750 items in its enormously useful bibliography: 670 of them were published after 1960, 50 of those by Nutton himself. Given this situation, it is only someone like Nutton who could be expected to be well enough acquainted with this volume of scholarship to give us an up-to-date assessment of Galen’s life and thought.
But how could Nutton or anyone hope to bring all this material under control? All we know of Galen is what he lets slip in his own (numerous) writings, none of which includes an autobiography that could provide a narrative story. The tack that Nutton has taken instead is to approach Galen as a coherent but multi-faceted individual, devoting individual chapters to aspects of a personality evolving over time. He introduces his subject with two chapters that examine his cultural identity. In the first, “Galen the Greek,” he builds on Galen’s various mentions of his teachers to construct an episodic picture of Galen’s formation in the eastern part of the empire: his wealthy father’s supervision of his upbringing and education in Pergamum (Nutton’s evocative account of the second-century city makes clear why it meant so much to Galen), and his early formation in language and Greek literature, philosophy and medicine; then after his father’s death his travels and further study in other great eastern cities, ending in Alexandria, famous for Hippocratic commentaries and anatomy and surgery, where his lifelong conviction of Hippocrates’ infallibility was confirmed. He returned to Pergamum about 157 and was appointed physician to the gladiators there, a position of great municipal importance.
Yet in 161 Galen moved to Rome, which would center the remainder of his life. In Nutton’s second chapter, “Galen the Roman,” he evokes the Hellenisation of the Roman elite of the day, which immediately brought Galen prestigious patients as well as audiences for his public anatomical demonstrations, but his abrasiveness and unflagging self-promotion aroused hostility, too, which led him to abandon the city in 166. But in 168 the emperor Marcus Aurelius called him back, and for the rest of his life—Nutton makes the case for his death about 216—he was physician to a succession of emperors as well as other clients, writing the bulk of his most important works, and promoting himself energetically in the competitive atmosphere of Roman medicine. The disastrous fire of 192 destroyed many of his writings, but he determinedly rewrote many before he died. “Galen the Roman” presents him as a Greek who appreciated the city for what it could do for him, but who could also complain to his Greek readers about the love of luxury and the stubborn hostility he regularly encountered there.
The three chapters that follow constitute the bulk of the book and draw on Galen’s writings in order to examine his intellectual and scientific activity as, successively, “the observer,” “the thinker,” and “the doctor.” Together, they give the reader a thorough appreciation of Galen’s wide interests and achievements, as well as of his limitations. “The observer” moves from the discrete observations of nature that crop up in his works to the planned observations of anatomy that he pursued all his life, and from that to the physiological systems he believed his discoveries entailed, many of which he tested experimentally. Here his most serious misunderstanding concerned the action of the heart, which led him to place great weight upon qualitative differences in pulse as a guide to prognosis; yet that reflects his conviction that close observation of all characteristics of an illness was essential to understanding and responding to that illness, which sets him apart from many of his contemporaries. “The thinker” brings out his close understanding of Plato and Aristotle, on whom he founded his medical teleology, incorporating the relation between body and soul on the one hand, and the body and the natural world on the other: the latter grounds his system of physiology at the micro level (elements, temperaments, faculties). It is a real achievement for Nutton to have surveyed so much material in such short compass. The last chapter of the three, “the doctor,” reconstructs Galen’s understanding of how the ideal physician should act—not merely a deontology, but a picture of his actions at the bedside, in diagnosis, in his exchanges with the patient, and in his choices among the therapies a classical physician had to draw on: surgery (Galen was a firm believer in blood-letting if the patient were strong enough to sustain it), drugs, or diet. How effective a practitioner he himself was is not easy to assess, Nutton acknowledges. Galen’s relentless self-promotion arouses a modern reader’s mistrust—and yet we must recognise that he enjoyed a Mediterranean-wide reputation throughout his long life.
I should stress two things that stood out to me in all these chapters. One is Galen’s habit, not only of close observation, but of casually passing these details on to his readers so as to illustrate or merely enliven what he has to say. The other is Vivian Nutton’s own astonishing command of this Galenic detail, as recorded in Greek or Arabic or even Syriac sources, and his ability to deploy it in truly Galenic fashion to illuminate or intrigue his present-day readers; it is a tour de force. I wish there were scope in this review to furnish examples of both.
Nutton ends with a chapter on “Galen the Ghost,” which he introduces with the tale of an Italian physician c. 1501 to whom Galen appeared in a dream asking him to prepare a new edition of one of his works in Latin translation, specifying corrections that would have to be made. Nutton uses this vision to epitomise the power and appeal enjoyed by Galen’s work for a millennium and more after his death, in a tradition that he traces in detail: condensed variously in the later Empire; spreading throughout the Islamic world in Arabic translations of the ninth century; translated further into Latin in the twelfth century and dominating the new European universities of the later Middle Ages; printed in Greek by humanists of the sixteenth century, then gradually discarded by anatomists and physiologists after Harvey but retaining influence in therapeutics until the nineteenth century; and finally attracting the attention of twentieth-century philologists. Nutton is right that this is a process that deserves to be appreciated and understood.
Yet I wonder whether “ghost” really conveys all that Galen meant to his readers for so many centuries after his death. In the 1290s Montpellier’s medical masters were vigorously debating whether something could be set on fire by something colder than it was itself, and an event that they seized upon and made central to their debate was the course of the Pergamum house fire that Galen had happened to describe in typically close detail in one of his works (mentioned in Galen, p. 53). All the masters agreed that Galen was a keen observer whose exact words had weight—he was scarcely a ghost, he was virtually present with them in the hall to give them access to the truth. Galen, I suspect, was always a vivid presence of this sort to his admirers, not a momentary phantasm, and it is one of the many merits of this book that, whatever his faults, it allows us to understand why.