Journal of the association of physicians of india • vol 63 • march, 2015 21

*Dept. of Medicine, TN Medical College & BYL Nair Ch. Hospital,

Mumbai 400 008

Galen is probably the most enduring physician of the medical history. He

brought science close to the medicine of ancient Greece, by introducing experimental physiology and anatomy.

Born in Pergamum, in Asia - minor (now Bergama, Turkey), he completed his education at Alexandria. His best work was in anatomy. As dissection of human body was forbidden, Galen’s work was confined to dissection of animals, mostly monkeys. Everything he observed was not applicable to human anatomy and hence it led to many erroneous conclusions. He developed an overall system of physiology, what was based to a great extent on the four basic humours. Then there was the theory of pneuma in vogue, which was a sort of spirit, inhaled into and flowed through the body mainly in arteries. Galen showed that arteries were filled with blood and not pneuma.

As an outstanding physician of Asia

Claudius Galen (130-201 A.D.)JV Pai-Dhungat*, Falguni Parikh*

Claudius Galen-Hungary, 1989 Claudius Galen-Greece, 1986 Galen along with new WHO Bldg. Yemen, 1966

Minor, he was attracted to Rome, the capital of the civilised world, at the height of its glory. His remarkable skill in the diagnosis and treatment, made him most sought after physician. His reputation soon reached the ears of the emperor, Marcus Aurelius, who commanded him to serve as his personal physician and to act as an official doctor for the gladiators. Romans loved the bloody exhibition of gladiatorial combat and Galen used this position to further his anatomical studies, treating cuts, broken limbs and torn vessels.

Galen was a prolific writer and was able to preserve his medical research in twenty-two volumes of printed text. He was a forceful, egoistic and dogmatic man.

For more than 14 centuries, Galen was quoted endlessly. It is surprising that no competitor threatened his reputation, nor were his scientific contributions put to test, expanded, revised or rejected. This was because

Aretaeus, a Greek was born in Cappadocia, a Roman province in Asia Minor. Records are unclear as to the

precise date of his birth. He was a contemporary of Galen in the 130-200 A.D. and studied in Alexandria. Although he was a prolific writer, only a few translations of his original communications remain, De causis et signis morborum being the only available treatise.

A sound clinician, he rejected the idle speculations and superstitions and added his personal experiences and observations to the Aphorisms of Hippocrates. His school of medicine was Eclectic, which combined the best of Empiricism and Methodism. The heart was regarded as the central organ of man, the site of soul. In this, he accepted the philosophy of pneuma.

Aretaeus identified a number of diseases. He was one of the pioneers to describe the cardiac murmurs and was probably the first to practice direct auscultation of the chest. Diabetes, a Greek term signifying a siphon, was described (note the stamp background) as : “melting down of flesh and limbs in urine”. Once the disease is fully established, death rapidly supervenes. Thirst is unquenchable. Restlessness and nausea

are terminal symptoms. It is more common among women. The development of dropsy and anasarca, is also identified in a diabetic (nephropathy).

His account of ominous nature of chronic cough with haemoptysis leaves little doubt that pulmonary tuberculosis (phthisis) was the morbid state.Trephine was used in the treatment of intractable epilepsy, if measures like application of heat and bleeding from forehead vein were ineffective. Mental aberrations were divided into mania, melancholia and stable insanity.

Diagnosis and treatment of Podagra (gout) was described, white hellebore, a powerful purge, was given empirically. The tale of an Olympic runner having gout, who was a victor in the game, between acute attacks, is given in this section. Endocrinology was not overlooked. A possible case of hypopituitarism was also described.

Aretaeus’ writings have meaning, in relation to practice of medicine today. A critical bedside observer, he reported morbid processes and refused useless speculations - a sound procedure from ancient Capadocia!

22 Journal of the association of physicians of india • vol 63 • march, 2015

he lived at a time, when Christianity was rising in power.Though he himself was not a Christian, he believed that one God made everything in the universe for a particular purpose. It made his work popular with ultimate medical authority for Europeans.

Even when Vesalius proved the errors, the authorities in the field would say that the human body must have changed since Galen’s time, but Galen could not have been wrong!!

*Professor of Medicine, T.N. Medical College (Retd.), Hon.

Physician, Bhatia Hospital, Mumbai; **Consultant Internal

Medicine, Kokilaben Dhirubhai Ambani Hospital, Mumbai

St. Vitus (285-304?), the only son of a senator, was born in Sicily, When he was seven,

he became a Christian under the influence of servants who tended him. When Valerian, the administrator of Sicily, knew his conversion and miracles, he had Vitus brought before him to shake his faith but was unsuccessful. Vitus then fled to Rome along with his tutors. In Rome, he exorcised Emperor Diocletian’s son of an evil spirit. The Emperor became afraid of St. Vitus mysterious powers and tortured him, but his faith remained strong and finally he died a martyr in Lucania. He prayed that all who commemorated his day should be protected from dancing mania. The great devotion to Vitus developed in Germany and France where his relics were translated in 836 AD. He is one of the fourteen holy Helpers and is patron of epilepsy, lightning, storm, St. Vitus’ dance, and actors. The miracles of healing have formed one of the fundamental qualifications for sainthood since Middle Ages through long pervasive culture of Christianity.

Dance of death was a phenomenon of the frenzied, mass hysterical behaviour during the plague pandemic of middle ages; i t reflected people’s wish to escape from their fear of death by visiting healing shrines of St. Vitus. In fact, the phenomena kept appearing wherever plague became epidemic, and was dubbed the “Chorea St. Vinti”, by Paracelsus (1416). Chorea Minor was named “St. Vitus dance”, by Thomas Sydenham (1675), who noted that it was occasionally associated with arthritis related to Rheumatic Fever. Thus,

Chorea-St. Vitus, Sydenham or Pandas?JV Pai-Dhungat*, Falguni Parikh**

St. Vitus Flume-1923 International Congress on Epilepsy, Rome showing EEG and St. Valentine, Italy-1988 Mental Health, Uganda-1988

it was different from the dancing mania of Middle Ages. The term Chorea originates from the Greek word ‘Khoreia’, which means act of dancing. In 1894, William Osler noted behavioural components in chorea that have features of Obsessive Compulsive Disorder (OCD). He observed that some patients with Chorea Minor had ‘perseverativeness of behaviour’.

Severa l in f lammatory d isorders are associated with preceding streptococcal infect ions , inc luding Acute Rheumatic Fever (ARF), Glomerulonephritis, Erythema Nodosum, and Cutaneous Polyarteritis. The spectrum has expanded with addition of Paediatric Autoimmune Neuropsychiatric Disorders associated with streptococcal infections (PANDAS). Criteria proposed for the diagnosis include presence of OCD or a tic disorder, abrupt onset of symptoms in childhood and associated neurological abnormalities. Thus, Chorea may be a part of the clinical spectrum of post-infectious streptococcal ilnesses. It is supported by the finding of antibodies against the neurons of caudate nucleus, probably result ing in imbalance between dopaminergic and cholinergic systems. OCD, Tourett’s Sydenham Chorea are neurobiological disorders possibly due to basal ganglia abnormality. The role of special imaging techniques (PET-MRI) a n d p o s s i b l e t r e a t m e n t a ve n u e s w i t h immunomodulatory therapies are complex and rapidly evolving areas of clinical research.