Excerpt from The Great Influenza by John M. Barry, plus links to reviews, author biography & more

This hypothesis made sense, comported with observations, and could explain many symptoms. It explained, for example, that coughs were caused by the flow of phlegm to the chest. Observations of people coughing up phlegm certainly supported this conclusion.

In a far broader sense, the hypothesis also conformed to the ways in which the Greeks saw nature: they observed four seasons, four aspects of the environment (cold, hot, wet, and dry) and four elements (earth, air, fire, and water).

Medicine waited six hundred years for the next major advance, for Galen, but Galen did not break from these teachings; he systematized them, perfected them. Galen claimed, "I have done as much for medicine as Trajan did for the Roman Empire when he built the bridges and roads through Italy. It is I, and I alone, who have revealed the true path of medicine. It must be admitted that Hippocrates already staked out this path. . . . He prepared the way, but I have made it possible."

Galen did not simply observe passively. He dissected animals and, although he did not perform autopsies on humans, served as a physician to gladiators whose wounds allowed him to see deep beneath the skin. Thus his anatomic knowledge went far beyond that of any known predecessor. But he remained chiefly a theoretician, a logician; he imposed order on the Hippocratic body of work, reconciling conflicts, reasoning so clearly that, if one accepted his premises, his conclusions seemed inevitable. He made the humoral theory perfectly logical, and even elegant. As historian Vivian Nutton notes, he raised the theory to a truly conceptual level, separating the humours from direct correlation with bodily fluids and making them invisible entities "recognizable only by logic."

Galen's works were translated into Arabic and underlay both Western and Islamic medicine for nearly fifteen hundred years before facing any significant challenge. Like the Hippocratic writers, Galen believed that illness was essentially the result of an imbalance in the body. He also thought that balance could be restored by intervention; a physician thus could treat a disease successfully. If there was a poison in the body, then the poison could be removed by evacuation. Sweating, urinating, defecating, and vomiting were all ways that could restore balance. Such beliefs led physicians to recommend violent laxatives and other purgatives, as well as mustard plasters and other prescriptions that punished the body, that blistered it and theoretically restored balance. And of all the practices of medicine over the centuries, one of the the most enduring (yet least understandable to us today) was a perfectly logical extension of Hippocratic and Galenic thought, and recommended by both.

This practice was bleeding patients.

Copyright John M Barry 2004. All rights reserved