The eccentric engineer

E&T pays tribute to a Roman doctor who regarded human bodies as 'soft machines'.

It's very hard to understand - and still harder to repair - a machine that you not allowed to look at. Yet the workings of that most vital machine, our body, has for much of human history been deliberately hidden. In the ancient and medieval worlds, there was frequently a religious ban on human dissection which was considered to be interfering in the divine work of God. Thankfully, there was one Roman doctor who found unique ways around this ban and discovered that the body is simply a soft machine. 

Galen was born in Pergamum in what is today Turkey around 129AD. Galen's father, Nicon, had been a successful and affluent architect, and he had given his son a broad classical education in mathematics, logic, grammar and philosophy, but it was to medicine that young Galen turned when he was just 16. According to legend, his father had a dream revealing his son's destiny in the subject and, while this would probably be enough to make most independently-minded teenagers immediately enrol in the next travelling circus, Galen took his father's advice. The major problem Galen had was getting his hands on a body to experiment on. Infuriatingly, human dissection was banned in all but one place. So, in 152AD, he moved to Alexandria in Egypt where, thanks to the country's long history of embalming, human dissection was still permitted. His time in Alexandria gave Galen a passion for anatomy, which would be both the making of and, many centuries later, the breaking of his reputation. By opening human bodies, both living and dead, he was able to view them as machines and brilliantly deduce their functions. In his later career, he would repeat his investigations on animals in front of astounded crowds. One slightly gothic experiment involved cutting an incision down the back of a live pig and severing groups of spinal nerves to show their function. Of course, all the while the pig would squeal until he tied off the laryngeal nerve at which point the squealing suddenly stopped. And so he proceeded, removing or tying off various vital pathways and identifying their purpose from the effect. He tied off animals' ureters to demonstrate kidney and bladder function and closed off veins and arteries to prove that, contrary to the popular theory of the day, they carried blood and not air. After finishing his training, Galen returned to his native Pergamum where again he came up against the ban on dissection, but now he found a novel way around this, all thanks to one of the more gruesome entertainments of the Roman world.

Gladiators were the football superstars of their day, the subject of adulatory graffiti on public baths and the pin-ups of young girls everywhere. A good gladiator, although a slave, was worth a fortune to his owner and the very best doctors were hired to tend to them. For Galen this was the perfect opportunity. Gladiators often suffered horrific injuries - indeed they were almost 'self-dissecting' - and in repairing these Galen could not only make a good living but get a chance to explore inside the 'soft machine'. Provided it was a gladiator that made the incision in the arena (and not a doctor), no one complained if he then used these wounds - or 'windows onto anatomy' - to explore the inner workings of the body. At the same time, he pioneered the treatment of the more usual sports injuries: sprains, breaks, dislocations and concussions. From these he developed 130 of the 150 basic surgical techniques that are still in use today - everything from brain surgery to repairing compressed fractures and the use of traction beds to straighten broken limbs. Even at the end of a gladiator's career, there was one last Galen-developed procedure that would assist his patient in his new life - the removal of the tattoo that marked him as a slave.

Galen's fame spread, and soon the capital, Rome, beckoned. Here he took every opportunity to put his rivals in the shade. One such occasion was provided by the arrival of a Persian merchant complaining of a loss of feeling in the ring and little fingers and half the middle finger of one hand. For some time, Roman doctors had been applying unguents and creams to his fingers in the hope of stimulating them, but to no effect. Galen asked him an unusual question: had he hurt his arm recently? The question must have been quite surprising. The man's problem was clearly in his fingers. What had that got to do with his arm? But Galen was right. The man had taken a bad fall and hurt his back. Galen diagnosed a spinal lesion and recommended bed rest and soothing compresses for the injury site. It worked, and the man's fingers soon recovered. Rome was good to Galen, and he lived to be 87, but in the centuries that followed the city would also prove his undoing. Although here he could serve emperors and make a fortune, he was no longer working with gladiators and was forbidden human dissection. Instead, he relied on animal dissection apparently unaware of the huge differences between the anatomy of humans and other creatures. When, in 1543, the Flemish anatomist Andreas Vesalius, who by then had free access to human cadavers, compared what he saw in the anatomy theatre with what was written in Galen, he realised that much of it was simply wrong. The inside of a dog, or even the inside of Galen's preferred Barbary Apes, was not the same as the inside of a human. And so Galen's work, good and bad, was set aside and much of the knowledge gleaned by the first man to treat the body as a machine, was forgotten.

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