Galen on Apodictics. Dmitry A. Balalykin

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Galen on Apodictics - Dmitry A. Balalykin

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to its description in today’s medical vocabulary is “paralysis”. On the other hand, Galen’s understanding of the term “apoplexia” (“fit of apoplexy”) was broader than today’s. The modern-day doctor may associate a case of sudden, simultaneous, complete loss of mobility and sensation, including with impairment of consciousness and breathlessness with the manifestation of several diseases, starting with brain trauma, heart attack or pulmonary embolism with loss of consciousness and ending with acute toxic response. The equation of the meaning of a fit of apoplexy in Galen’s work with the modern-day concept of stroke, which, at first sight, seems obvious, may lead the medical historian to the wrong interpretation of the text of the source.

      For ancient doctors, the correct prediction of the course and outcome of a disease was more important than terminological nuances of diagnosis. Hence, depending on the severity of the disease, Galen drew a distinction between two forms of apoplexy, which are judged based on the familiar symptoms of irregular breathing and pulse. Critical deviations from the natural respiratory rhythm and the corresponding changes in pulse pointed to an incurable form of apoplexy with high likelihood of a fatal outcome. Minor violations of vital functions enabled to make an optimistic prognosis of the course of the disease. However, already at the stage of this distinction, the difference between the views of Galen and the views of the modern doctor with pathogenetic thinking is noticeable. Galen considered breathlessness as only the result of the patient’s failure to move chest muscles. In other words, his ideas are also associated with anatomical-physiological factors, but exist in a different “explanatory model” from today’s—investigative capabilities determine the type of rationality of the scientist.

      Galen’s theory was also based on the Hippocratic theory of the four liquids—blood, phlegm, black bile and yellow bile,—and their associated qualities—hot, cold, moist and dry. Overabundance of one of the humors could be the reason for the violation of their good mixture (or “dyscrasia”), leading to the dysfunction of the body in the form of any given disease. Galen considered two scenarios of the development of apoplexy. In one case, he suggested the possible development of apoplexy in the form of local “dyscrasia”; the accumulation of a dense, viscous and sticky fluid in brain ventricles blocked the movement of the “animal spirit”, which in turn made difficult or stopped the transmission of sensory and motor pulses between the brain and other parts of the body. In the other case, which best matched the modern concept of hemorrhagic stroke, apoplexy developed as a result of local plethora. Brain tissue is overfilled with excess blood, which squeezes it. The result of this excess pressure is the impairment of the functions of the brain as the centre of control of body parts. In this case, Galen does not explicitly claim that the plethora of the brain is the result of haemorrhage. Ultimately, at the last stage, both scenarios of the development of the disease lead to a critical change in the temperature of the brain and subsequent cessation of the circulation of the “animal spirit”.

      Galen’s interpretation of the causes of brain injury as the pathological change in the movement of the “animal spirit” enabled to consider disease as a result of anatomical and functional violation of the unity of the spiritual and the corporeal. Furthermore, such a view took into consideration the possible pathogenetic effect of body ageing processes and external factors on the likelihood of the development of apoplexy. During clinical observations, Galen paid attention to the fact that the average body temperature in the elderly was usually lower than in younger people. It followed that their bodies were more susceptible to the so-called cold diseases, for example, caused by excess yellow bile. Also of great significance were climatic and seasonal factors, which influenced the “good mixture” of liquids (for example, sparking an increase in the accumulation of yellow and/or black bile in the body). Overcooling of the brain with subsequent development of bouts of disease could be a result of an unhealthy lifestyle. Any excessive eating was considered harmful: in particular, excessive consumption of wine, according to Galen, reduced natural body heat and was undesirable. The plurality of external factors, such as climate and season, and internal predispositions (age, bad habits, etc) led to the cooling of the body and was the cause of “cold” diseases.

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