Galen's epic contribution to Western medicine came in the confident days of the mid-Empire. He was born in the reign of Hadrian in ad 129, lived his mature life under the great philosopher-emperor Marcus Aurelius (161-80), and died several emperors later in c.216. His professional influence from writing a corpus of over 350 titles cannot be underestimated—in total about as much as all other Greek medical writings put together. As he said, Hippocrates 'staked the way, but I made it passable'. He was an expert anatomist who left a continuing legacy of heroic bloodletting in Western medicine; but he was equally concerned to make his mark as a dietitian. Galen's long-lasting influence on hygiene came largely from his famous work De Sanitate Tuenda ('On the Healthy Life'); but also, from the way in which he extended and dominated the field of hygienic medical classification in general, as a teacher of 'the best of the young physicians'.34 It was Galen who absorbed Plato's dualist philosophy of psyche et soma (soul and body), and always took mens sana in corpore sano ('a healthy mind in a healthy body') fully into account. He extended the hygienic regimen of the psyche—passions of the mind—by joining the humours with the elements; this eventually resulted in the four famous mental and physical 'temperaments' (choleric, sanguine, phlegmatic, and melancholic).35 He also laid down a new set of medical 'means' (things to be administered, things toberemoved, thingsto be done, and things to be applied) and a much more comprehensive list of'neutrals' (food, drink, 'some kinds of drugs', air, massage, walking, exercise 'and all motor activity', baths, sleep, sexual activity, and the emotions). Thus, from being entirely unclassified, environmental hygienic interventions had been called Aids,
Means, Things—and were now Neutrals. Galen's 'Neutrals' were later turned into the famous 'Non-Naturals' owing to a translation error in the Isagoge, or Introduction, to medicine by Johannitius, which became the primary text for medical schools from the twelfth century onwards. For a fairly long period the actual number of non-naturals was not fixed, but in the end they stayed at six.36
De Sanitate Tuenda was ostensibly the main work through which classical hygiene was transferred to the later West. Unfortunately, it was only a fragment from a much larger œuvre:
And especially I wish him who would study these writings to read the book in which I consider of what art hygiene is (it is inscribed Thrasybulus), and likewise the one about the best condition of the body and the one about good health. Both are short books, and whoever reads them before coming to this discussion will easily follow what is now being said. And it has previously been said that my book about the elements according to Hippocrates is essential for the present discussion, and it is followed by the one about the optimum constitution and the one about good health.37
So really all we have in De Sanitate Tuenda is an introductory lecture course: most of the rest is missing. But those who preserved it obviously thought it sufficiently comprehensive. It contains many pithy definitions and generalizations on Graeco-Roman hygiene: health is 'a sort of harmony', 'a mean between extremes', a 'due proportion', a 'slight deviation from perfection'.
A good half of De Sanitate Tuenda was on the ideal methods of training the youth, 'placed under the art of hygiene' from birth, and raising him into a perfect constitution in peak condition, starting with the hygiene of the newborn and children up to 7 years. It then went on to a large section on 'training the lad', and for this Galen made extensive use of Theon's Gymnastics (another entirely lost work). He casually mentions the contemporary existence of 'so many varieties of rubbing, that you could not readily enumerate them', but at the same time warns students that it is difficult to learn such practices from 'the old books' alone.38 He also gives general advice on dealing with the typical patient—the busy middle-aged man. Roman businessmen apparently suffered from the perennial 'diseases of civilization'—a rich diet, lack of time, lack of exercise, headaches, piles, kidney stones, obesity, and stomach and bowel disorders.
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