Well-Being: Galen’s Legacy

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Well-Being: Galen’s Legacy


Ancient Roots. As in the rest of science, the medieval world inherited its theories of health from the ancients and based its attempts at remedies on a simplistic and idealized understanding of how the human body works. The most important source of medical knowledge came from a Greek doctor named Galen, who was the personal physician to Emperor Marcus Aurelius in the first century C.E. Galen wrote hundreds of works, and at least 120 of his works on medicine survived to the Middle Ages. Some of his works were available in Latin as early as the fifth century and continued to be translated from the Greek or from Arabic translations from the tenth to the fifteenth centuries. Galen’s most important contributions to medieval medicine were the theories of the humors and pneuma (spirit). The idea of humors apparently originated in the fifth century B.C.E. with Hippocrates (whose name lives on in the Hippocratic oath that all doctors still take), and the idea of pneuma was also ancient, but Galen’s name is attached to both concepts because he was the best-known writer on the topic.

The Four Humors. In the Galenic system the body is composed of four substances: blood, phlegm, black bile (also known as “choler”) and yellow bile (or “melancholer”). Each humor is produced in a different organ of the body, blood in the heart, phlegm in the brain, black bile in the spleen, and yellow bile in the liver. Each humor holds a position analogous to one of the Aristotelian elements and is in fact associated with its corresponding element although they are not one and the same. And, like elements and qualities, the four humors act in opposition to each other according to simple principles. When a person became unhealthy, ancient and medieval people believed that the humors were “out of balance” and designed treatments to restore the natural balance of those humors. The English language still includes phrases that derive from this belief, such as saying that someone is melancholic (too much yellow bile) if sad or phlegmatic (too much phlegm) if listless. A lethargic person was believed to have too much blood, and the doctors called for bloodletting. In mild cases leaches were attached to the patient’s arms or abdomen to draw off blood, but in cases a doctor considered acute, the patient might actually be cut and allowed to bleed freely until “sufficient” blood had been drained. Modern medicine does recognize that blood loss stimulates new blood production,


H ildegard of Bingen, well known for her knowledge of medicinal plants, related her views on diet to the theory of humors:

If a person eats cold dishes in the summer when he is very hot inside, he easily develops gout [and] builds up phlegm in himself. For that reason, a person should eat moderately hot and cold dishes in the summer, and these will give him good blood and healthy flesh. If a person eats a lot in the summer, when he is very hot within, his blood will become excessively warm because of the great quantity of food; his humours will degenerate, and the flesh of his body will swell up and become unnaturally distended because the air is warm… . [When] he is overjoyed, he should eat only moderately, for then his blood is scattered by widening of the blood path. Otherwise the humours release strong fever attacks into his blood if he eats a lot at that time.

Source: Hildegard of Bingen. Holistic Healing, A Translation of Liber compositae medicinal, translated by Manfred Pawlik, Patrick Madigan, and John Kulas; edited by Kulas and Mary Palmquist (Collegeville, Minn.: Liturgical Press, 1994), pp. 104–105.

which can help some illnesses, but medieval doctors seem to have believed in the adage “that which does not kill you, makes you stronger.”

Pneuma. Galen’s theory of pneuma, or spirit, explains how it is that living creatures differ from inanimate lumps of matter, even though they are made of the same four elements. Pneuma is the vital spirit and life force of living creatures, and Galen employed this concept to describe how people breathe in air and eat food. From his work on dissection, he correctly differentiated the cardiovascular system (blood), the respiratory system (air), and the nervous system (brain and spinal cord), and assigned a pneuma to each. While this theoretical understanding permeated the universities, another tradition, deriving from the late Roman tradition, provided the foundation of practical health in the Middle Ages.


Donald Edward Henry Campbell, Arabian Medicine and Its Influence on the Middle Ages (London: Kegan Paul, Trench, Trubner, 1926).

Benjamin Lee Gordon, Medieval and Renaissance Medicine (New York: Philosophical Press, 1959).

Robert Steven Gottfried, Doctors and Medicine in Medieval England, 1340–1530 (Princeton: Princeton University Press, 1986).

Monica Helen Green, Women’s Healthcare in the Medieval West: Texts and Contexts (Burlington, Vt.: Ashgate/Variorum, 2000).

Stanley Rubin, Medieval English Medicine (Newton Abbot, U.K.: David & Charles, 1974).

Nancy G. Siraisi, Medieval & Early Renaissance Medicine: An Introduction to Knowledge and Practice (Chicago: University of Chicago Press, 1990).