Doctor of Medical Science, Professor
Institute for the History of Medicine and Medical Ethics, University of Cologne (Germany)
By reviewing the original sources, this paper examines Galen’s contributions to the doctrine of stroke, or, in ancient terminology, “apoplexy”. Following a sketchy outline of methodical issues and pre-Galenic concepts of the disease, Galen’s definition and construction of the clinical symptoms are presented in detail. These include sudden onset, comatose state, serious impairment of movement, lack of sensation, shallow respiration, small pulse, damage of voice and usually fatal outcome. Galen distinguished “apoplexy” from other diseases such as “karos”, “lethargy” and “paralysis”. In retrospect, his definition includes modern disease categories such as myocardial infarction and pulmonary embolism with fatal outcome.
As to the origin of the attack, Galen used the Hippocratic concept of humoral imbalance as a fundamental explanation, but definitely rejected Aristotle’s teaching of the primacy of the heart. According to Galen’s teaching, stroke resulted either from an invasion of blood into the brain or from the accumulation of phlegm and black bile in the cerebral ventricles blocking the transmission of the animal spirit. Prophylaxis and treatment included dietetic, pharmacological, and surgical measures and corresponded to the supposed “hidden cause” as well as observable factors. Galen’s Greek texts on stroke remained an authoritative source until the early 19th century.
Keywords: Galen, history of cerebrovascular disorders, nervous system diseases, history of Ancient medicine, ancient brain research