Galen on Food and Diet

Mark Grant

• Publisher: Routledge
• Year: 2002
• eBook ISBN: 9781134572700
• Topic: History
• Subtopic: Ancient History
• Index: History

Galen, the personal physician of the emperor Marcus Aurelius, wrote what was long regarded as the definitive guide to a healthy diet, and profoundly influenced medical thought for centuries. Based on his theory of the four humours, these works describe the effects on health of a vast range of foods including lettuce, lard, peaches and hyacinths. This book makes all his texts on food available in English for the first time, and provides many captivating insights into the ancient understanding of food and health.

1
INTRODUCTION

The life of Galen

Medicine occupies a central position in our lives today. We expect to be diagnosed correctly and to receive the latest treatment based on extensive scientific research. The media enthusiastically recount breakthroughs in our understanding of disease, or complex operations that can restore our quality of life. Alongside this progress psychologists have noted our increasing bewilderment and even anger in the face of death. Wonder at what medicine can achieve is disturbed by what it cannot. It is difficult then to envisage a world where medicine could offer only some comfort and where death, especially among the very young, was always lurking as a very real threat. Yet many historians concede that palliative care by Galen would have been far preferable to anything that was to be available until the closing years of the nineteenth century.

Galen was born in AD 129 at Pergamum, a large city on the Aegean seaboard of what is now Turkey.¹ As his father was an architect and interested in education, Galen was given lessons in mathematics and geometry. For a child from a wealthy background this was in some ways unusual, the emphasis in Roman schools being on the literature and rhetoric necessary for a career as a lawyer or a town councillor. On the other hand architecture, whilst an essential part of Roman civilisation, was not a profession that commanded a particularly high status. This liberal and in some ways radical background allowed Galen the scope to experiment: he was not bound by his family to enter into what was regarded as a traditionally safe career. Moreover, since Pergamum had long been an intellectual and cultural centre, Galen was able to attend the lectures of the Stoic and Platonist philosophers who were attracted to the city by its great library. It is an indication of his mental abilities that Galen was only fourteen when he began these studies.

In addition to its academic excellence, Pergamum was a religious centre with a large sanctuary dedicated to Asclepius. As the son of Apollo, Asclepius acted like a bridge between the divine and the human, for although he was a powerful deity, he was nevertheless concerned enough with mortals to try to combat death through his patronage of medicine. Healing by psychological means was conducted at temples around the Roman world, the sick sleeping in the precincts in the hope of dreaming about their own particular cures.² Even outside the temples, dreams were held to predict the future and advise on future courses of action. When Galen was seventeen his father received such a sign: he was to study medicine.

Hippocrates wrote in the fifth century BC that a good doctor should travel.³ On the death of his father in AD 148 (or perhaps AD 149), Galen spent a number of years training with medical experts in Smyrna, Corinth and Alexandria.⁴ There was no uniform medical curriculum or even a shared belief in how the body worked. Instead there were groups of adherents to several different theories, sometimes referred to as schools, based around opposing philosophical premises.⁵ Now fully trained, Galen returned to Pergamum in AD 157 and became the doctor to the gladiatorial school in the city. Again, this was an unusual step for an educated person. Gladiators may have fascinated the Romans by their oath of submission to death, but they were still considered socially to be very low or even outside the accepted laws of normal society.⁶

What Galen presumably gained from this appointment was a detailed knowledge of anatomy. Contrary to modern popular belief, gladiators did not usually fight deliberately to the death, especially in a provincial city like Pergamum. Whilst Rome could afford mass slaughter, the expense of training and maintaining gladiators meant that any other city had to harbour its resources. Gladiators were taught to draw blood for the entertainment of the spectators, but once outside the arena doctors were at hand to stitch and bandage ready for the next show. That is not to say that death was avoided, yet it was not a foregone conclusion.⁷ Working with gladiators also allowed Galen to experiment with regulating the diet for healing and building strength. In many instances diet was the only resource that could be applied, so its prominence in all ancient medical writings is understandable.

In the absence of a police force, except in Rome itself, ancient cities were prone to social unrest. The autumn of AD 161 saw Galen leaving Pergamum to avoid being caught up in such an event, perhaps provoked by the sort of food shortages that he mentions throughout his dietetic writings. He travelled around the eastern Mediterranean, researching the properties of various plants and minerals used medicinally in Lemnos, Cyprus and Palestinian Syria (modern Israel), before reaching Rome in the summer of the following year.⁸

Marcus Aurelius had just become emperor. Rome was at the height of its power and prosperity. Galen began to build up his reputation in the capital, giving public lectures and anatomical demonstrations and writing about anatomy. These endeavours came to a close in the summer of AD 166. A Roman army returning from a campaign in the Middle East brought with it the plague and Galen seems to have thought it wiser to return to Pergamum than to try to practise his medicine on those afflicted. In addition, his growing influence had made him numerous enemies among the medical profession and in the face of this violent jealousy he began to harbour doubts about his own physical safety. His efforts, however, had made him famous enough for Marcus Aurelius to invite in AD 168 him to join his military headquarters at Aquileia in northern Italy. Moving to Rome the next year with the imperial family because of another outbreak of the plague, Galen spent the rest of his life in the capital. He became so successful that he was appointed as personal physician to Marcus Aurelius himself. His voluminous writings he authenticated in his treatise On My Own Books.⁹ It is now thought that he died in about AD 210, although earlier estimates put his death at about AD 200.

Galen the doctor

The name of Archagathus has been passed down as the first Greek doctor to have practised at Rome. According to Pliny (Nat.29.6.12–13) he set up his surgery in the capital in 219 BC.¹⁰ Both he and his successors were very much engaged with the upper echelons of society that had developed a keen taste for all things Greek, following the wars of conquest that ended with the complete subjugation of that country by Aemilius Paullus in 168 BC. At the same time the lower classes were deeply suspicious of doctors, preferring home cures passed down through the family, magic and astrology, and the assistance of herbalists. Yet from the diverse evidence of writers such as Cicero, Seneca and Plutarch, a general picture can be constructed of what a Roman aristocrat demanded of a doctor, in particular the sort of friendship that could offer comfort throughout the duration of an illness.¹¹

Educated Romans were for the most part conversant with current medical theories. For example Cicero (Cic.ND 2.137–8) describes in precise detail how the body was believed to process food, the disquisition only ending to avoid any possible offence over the nature of defaecation. Celsus, writing in the time of the emperor Tiberius (AD 14–37), wrote an encyclopaedia whose extant part discusses medicine in a tone that seems to reflect an educated person’s view of the discipline.¹² Later in the first century AD Seneca makes frequent remarks in his letters about his illnesses and alludes to the sort of help that might be expected in such cases, whilst Pliny pays great attention in his Natural History to the broad scope of medicine as it stood in his day.¹³ Petronius (Petr.42.5–6) even satirises medicine, focusing on the notion that an illness could be restrained by a starvation diet (Hp.Nat.Hom.9=6.54–6L). Not only that, but medical books were available from shops in the Argiletum, open lectures were presented by practising doctors, and surgeons would demonstrate their prowess with the knife in front of audiences.¹⁴

But how Galen fits into this picture is still open to debate. Modern consensus seems to suggest that the status of doctors in the eastern part of the empire was greater than that of their counterparts in the western part, although paucity of evidence must be held up as a strong caveat in this discussion.¹⁵ Patronage is, however, almost certainly the answer to Galen’s rapid rise to fame. His family was connected with the leading citizens of Pergamum, and these in turn had connections with the influential and powerful in Rome; so when he arrived in the capital in AD 161, he could quickly become friends with senators and others in the imperial court. Right from the start he was in a far higher position socially than most other doctors who similarly came from the eastern Mediterranean.¹⁶ His private means are further demonstrated when he left Rome the following year, for he had to employ an auctioneer to sell off his house in Rome (Prog.9.2=14.648K) – he was no struggling tiro waiting on the largesse of others.

It has been pointed out that Galen was not the only doctor to have a strong showing in both medicine as well as other intellectual pursuits. Thrassippus of Corinth, for instance, was deemed pre-eminent in medicine and poetry.¹⁷ Where Galen was different was in his combative style of rhetoric, his overwhelming sense of self worth and importance, his literary productivity that was enormous by any standard, and his blind assumption that he alone was graced with the ability to bring Hippocrates’ work to completion. That he was able to write so much was, of course, due to his use of other medical works as a core outline.¹⁸ Even if he did add further comments as he thought appropriate, his overall knowledge of medicine was by no means dissimilar from that of his contemporaries. He may have served as physician to the Roman elite, but his writings on food and diet can be used as a legitimate source of what generally counted for medicine in his time.

The Hippocratic background

Throughout Galen’s writings the name of Hippocrates is invoked, either in support of a particular idea or to ridicule the views of an opponent. Sometimes Galen goes as far as to idealise Hippocrates almost as if he were a god (e.g. Gal.Us.Part.1.9=1.16K). There were several factors which seem to have contributed to this point of view. To begin with, writers of the second century AD were particularly fascinated with the classical past, whether its literary style or philosophical ideas. The former tendency is derided by Galen throughout his dietetic works, for he believed that current nomenclature and phraseology were far to be preferred over archaising sentences (e.g. Gal.Alim.fac.2.44.5=6.633K); the latter Galen believed in very strongly, because for him Hippocrates had discovered all that there was to know about medicine, and all that needed to be done was to interpret and explain his theories in more detail.

Even from the time of Hesiod (Hes.Op.109 ff) the ancient world had looked back to a mythological golden age when life was good, simple and healthy. Galen had no single philosophical basis for his science because there were so many competing theories about how the body functioned; his teachers had revered Hippocrates and had taught him to commit certain apothegms to memory. This procedure accorded well with rhetorical practice and its need for pithy statements by which arguments could be supported. Otherwise known as ‘the pointed style’, it was preferred by writers such as Seneca and Tacitus. It is easy to view Galen’s adherence to this method with some cynicism, because he often could not remember where some Hippocratic quotes derived, and yet he was always certain that he knew exactly what an ambiguous statement in Hippocrates actually meant.¹⁹ None the less the method behind this reasoning served as a sound support for his practice of medicine and for his place in Roman society.

Galen’s teachers were certainly not unique in their reverence for Hippocrates. Even in the fourth century BC the legend of Hippocrates as the perfect doctor existed, saving patients from the plague, resisting the financial inducements of the Persian king, above all working strenuously as a Greek among fellow Greeks.²⁰ When the emperor Marcus Aurelius called Galen the finest doctor and a unique philosopher (Gal.Praen.11=14.660K), this was as a compliment to the image Galen had constructed of himself, an expert in classical ideas despite the decadence of the contemporary world.²¹ To carve a niche in Roman society meant fighting fierce competition. But claiming that all he was doing was to elucidate Hippocrates’ ideas gave Galen the wherewithal to win this fight. If an opponent attacked him, then that opponent was attacking Hippocrates, and who could have prevailed against such a potent and hallowed legend?

Diet within medicine

Scribonius Largus, writing at the time of the emperor Claudius (AD 41–54), summed up the stages of medical care (Scrib.Larg.intr.6): first came diet, then drugs, and finally either cautery or surgery. Omitted from this list is venesection because not all the schools of medicine advocated this procedure. Diet was therefore not the only way by which disease could be treated, although it was perhaps the most important. As Scribonius Largus states elsewhere (Scrib.Larg.intr.2), most people were terrified of the knife or hot iron, but there were factors other than fear behind this emphasis on diet.²² Plutarch (Plu.Mor.73D) held that a good doctor was someone who used sleep and diet rather than violent drugs to effect a cure.

Manual work denoted a low social status in the Roman world, yet surgery obviously depended wholly on the knowledge gained from actual experience. This awkwardness can perhaps be seen in the arguments promulgated by some doctors in support of this learning by trial and error.²³ To achieve greater prestige, a doctor had to avoid dirty hands. As Galen was only too well aware, philosophy was the key to this respectability. On the one hand a training in philosophy may have allowed a doctor to communicate more effectively with patients, whilst on the other hand it created the feeling of trust and friendship that Seneca stressed was so important for medical practice and technique.²⁴ Even so, medicine was considered, by the upper end of Roman society, a craft to be shared with slaves and freedmen, a prejudice that did not begin to dissipate until the later empire.²⁵

It has been estimated that some 80 per cent of the patients Galen recorded in his works belonged to the elite, whereas only 46 per cent were sophists and 21 per cent were of the lower classes.²⁶ He himself said that he wrote for Greeks and for anyone who, whilst not actually Greek, at least made efforts to attain the qualities of the Greeks (Gal.San.Tuend.1.10=6.51K). If this statement referred to those educated in Greek literature and philosophy, then his focus was very much on the rich and powerful. Moreover, the intimacy demanded by dietetic medicine of the patient’s way of life made for a pronounced concentration on the upper strata of society, for only they could afford the time and the expense such details naturally required.²⁷ Prescribing a diet backed by humoral science to these patients kept a doctor’s hands clean and gave a definite intellectual cachet to the interaction.

That a good diet ensured health was a fundamental concept of ancient medicine, since food could cause disease or restore health through its effect on the balance of the humours. Thus prevention was in every way better than a cure. By contrast drugs, venesection, cautery and surgery were ...

Table of contents

• Cover Page
• Title Page
• Copyright Page
• Acknowledgements
• 1 Introduction
• 2 On the Humours
• 3 On Black Bile
• 4 On Uneven Bad Temperament
• 5 On The Causes of Disease
• 6 On Barley Soup
• 7 On the Powers of Foods
• 8 On the Powers of Foods
• 9 On the Powers of Foods
• Glossary of Plant Names
• Notes
• Editions and Translations of Ancient Authors
• Bibliography