Five Quarts_ A Personal and Natural History of Blood - Bill Hayes [6]
When Galen put a phlebotom to a vein, he was continuing a medical tradition that had existed since at least 2500 B.C., the approximate date of an Egyptian tomb painting showing a noble being bled at the foot and neck, the earliest-known depiction of phlebotomy. Of course, this is not meant to suggest that there hadn’t been two and a half millennia of naysayers, just that scant records survive. What is known is that, from Hippocrates’s day forward, the critics of bloodletting were as passionate as the advocates. Galen discovered this firsthand when he moved to Rome, the big city, in the year 162. A local celebrity in Pergamum, the thirty-three-year-old found that his specialty made him an outsider here, and he immediately butted heads with the Roman medical establishment. His biggest opponent, strangely enough, was a man five hundred years dead, the Greek physician Erasistratus (300–260 B.C.), who’d taught at the celebrated medical center in Alexandria and had been vehement in condemning venesection. He had a legion of vocal followers, known as Erasistrateans.
In a colonnaded hall opposite the Forum, Galen joined others in giving public lectures during his first year in Rome. In the spirit of self-promotion, he held forth on a range of topics, including, notoriously, his enthusiasm for bloodletting and his disdain for the teachings of Erasistratus. The Erasistrateans in attendance were not pleased, although their heckling probably just drew larger crowds. Galen relished stirring up controversy. He was also eager to drum up business. Unlike the majority of Roman physicians, he proclaimed himself to be above all sects, the leader of his own school of thought. He ingratiated himself to the audience, which swelled over time as word spread of the brash, charismatic healer. Bored with chariot races at the nearby Circus Maximus, dignitaries dropped by to see the theatrical young man who, for example, demonstrated vivisection with a squealing pig. Shorthand writers transcribed his speeches and, within months of his arrival, Galen’s views on bloodletting were published in the book Against Erasistratus, the title alone like a gauntlet thrown down.
A modern reader of the book and its sequel, Against the Erasistrateans Dwelling in Rome, gets a vivid sense of this renegade doctor, a man whom one nineteenth-century historian described as a “quarrelsome, self-willed spiteful brawler, who goes for his adversary foaming at the mouth.” Nonetheless, Galen’s words lift from the page and, like a gentlemanly participant in a cross-time debate, he reiterates his opponent’s positions before dissecting them, even quoting the dead Erasistratus verbatim. This is fortunate since Erasistratus’s words survive only within the works of others.
Galen starts off on a conciliatory note: The two physicians would not have disagreed, he admits, about what causes illness—humoral imbalance—or about the final goal of treatment, the “evacuation” of the plethos. They parted ways when it came to the means. “The easiest and promptest course of action is to open a vein,” Galen states. “In this way, we evacuate the actual inflammatory materials themselves. And nothing else.” It’s a remedy that was “esteemed by the ancients.” By contrast, the main Erasistratean solution, starvation, “apart from the long time it requires, evacuates the whole system indiscriminately.” Even now, I can almost hear Galen’s tsk-tsk, as well as the grumbling of the Erasistrateans gathering at the back of the crowd.
In addition, starvation, Galen warns, is accompanied by a host of evils: severe