Latest / Marcus Aurelius: Rome's Philosopher King — Fexingo History / Marcus Aurelius and the Plague Doctor Galen
Transcript
- Lucas: So we've talked a lot about Marcus Aurelius the emperor, the Stoic, the philosopher. But this time I want to look at him through a different lens — the scalpel, actually. The man who served as his personal physician during the Antonine Plague: Galen of Pergamon. Luna: Oh, Galen — I've heard the name, but I don't know much about him beyond that he was important. Lucas: Right, and he's a fascinating figure in his own right. Born around 129 AD in Pergamon, a city in Asia Minor that was home to one of the great healing temples of the ancient world, the Asclepieion. His father, Aelius Nicon, was an architect and mathematician, and he had this dream where Asclepius, the god of medicine, told him to let Galen study medicine. So Galen did. Lucas: He traveled to Smyrna, Corinth, Alexandria — the great medical schools of the day. And by the time he was thirty, he was back in Pergamon, serving as physician to the gladiators. That's where he learned practical anatomy, patching up knife wounds and dealing with infections. It gave him a reputation for being hands-on, not just theoretical. Luna: Gladiator physician — that's a tough gig. But how did he end up with the emperor? Lucas: Well, in 162 AD, when the co-emperors Lucius Verus and Marcus Aurelius were planning the Parthian campaign, they needed a court physician. Galen had already made a name for himself in Rome by then — he'd given public demonstrations of anatomy, and he was known for his bold claims about diagnosis and treatment. So he was summoned to the imperial court, and he ended up serving Marcus Aurelius directly during the plague years. Lucas: And it's his writings that give us our best contemporary account of the Antonine Plague. Galen was not shy about recording his observations — he wrote hundreds of treatises, and a lot of them survive. So we have this window into how a physician in the ancient world thought about disease, and how he tried to treat it. Luna: What did he actually think was causing the plague? Lucas: That's the interesting part. Galen was a firm believer in the theory of the four humors — blood, phlegm, yellow bile, and black bile. He thought disease came from an imbalance of these humors, and he was a big fan of the idea that the air itself could be corrupted, spreading disease through what he called miasma. So when the plague hit, he prescribed things like purging, bloodletting, and special diets to rebalance the humors. Luna: Did any of that actually work? Lucas: Honestly, not really. But in his defense, nobody else had a better idea. He did note some things that we'd recognize today — he described fever, thirst, black stools, and skin eruptions, which sound a lot like a viral hemorrhagic fever, possibly smallpox or measles. He also observed that the plague often took a milder course in people who had already been exposed, which is basically the idea of immunity, even if he didn't have the concept. Lucas: And here's a personal note — Galen himself survived the plague. He actually fled Rome in 166 AD, at the height of the outbreak, returning to Pergamon. He later wrote that he left because of the 'unhealthy condition of the city' and the 'constant turmoil.' It's a bit ironic, given he was the emperor's physician, but hey, self-preservation is a powerful instinct. Luna: He fled? That seems... not very heroic, but I get it. Did Marcus ever call him out on that? Lucas: There's no record of that. Marcus was remarkably even-tempered, as you'd expect from a Stoic. And Galen did come back later, after the worst was over. He was there when Marcus died in 180 AD, and he continued to serve under Commodus. Lucas: And here's a little behind the scenes thought about how we do this show — it's not a cheap thing to research and produce these episodes. We dig into the sources, we try to get the details right, and that takes time and care. A small group of listeners already chips in monthly through buy me a coffee dot com slash fexingo, and that's literally what funds making this many of these. It keeps the whole thing ad-free, and we're grateful for that. Luna: Yeah, it's a labor of love, and it shows. But back to Galen — what was his actual relationship with Marcus like? Lucas: Interesting question. Galen wrote about his interactions with the emperor, and they're a mix of professional respect and a bit of friction. Marcus was a busy man, but he had a genuine interest in philosophy and medicine. He even wrote in his Meditations about the importance of not being tyrannized by pain, which is very Stoic. But Galen sometimes complained that Marcus's advisors were skeptical of his methods, and that he had to work hard to prove himself. Luna: I can imagine. But what did Marcus actually think of Galen's medicine? Lucas: We have a specific anecdote. During the Marcomannic Wars, Marcus fell ill — some say with the plague, others with a stomach ailment. Galen was called in, and he made a diagnosis based on the pulse — his favorite technique. He prescribed a specific treatment: theriac, an ancient antidote made of dozens of ingredients, including opium. Marcus apparently trusted him enough to follow the regimen, and he recovered. Galen later boasted about this success in his writings. Lucas: But there's also a deeper layer here. Marcus's Stoicism influenced how he faced illness, both his own and the empire's. He wrote in Meditations about accepting what happens, including disease, as part of nature's plan. He even said, 'The plague is a disease, but your mind is not.' So while Galen treated his body, Marcus was treating his mind, in a way. Luna: That's profound. So Galen and Marcus, in some sense, were both healers — one of the body, one of the mind. Lucas: Exactly. And that's what makes this episode so rich. Galen's medicine was grounded in the four humors, but his practice was also about observation and logic — he was a man of science, within the limits of his time. And Marcus's philosophy was about resilience and rationality. Together, they represent two pillars of ancient thought: the pursuit of health and the pursuit of wisdom. Lucas: Let's talk about Galen's anatomy work, because that's where he was most ahead of his time. He did extensive dissection, mainly on animals — monkeys, pigs, goats — because human dissection was taboo. He found that the heart, brain, and liver had different functions, and he traced how the brain controls the body through the nervous system. Some of his observations were wrong, but the method was right: he insisted on empirical evidence, not just theory. Luna: But didn't he make a lot of mistakes because he was dissecting animals instead of humans? Lucas: Oh, absolutely. A classic example is his claim that the human liver has multiple lobes, like a dog's liver, when it actually has one. And he thought the heart was a two-chambered pump, not four, which led to a misunderstanding of circulation. But for over a thousand years, his works were considered the gold standard. It wasn't until Vesalius in the 16th century that some of these errors were corrected. Luna: So Galen cast a long shadow. Lucas: He did. And in the context of the plague, his legacy is a bit mixed. His treatments didn't cure anyone, but his observations helped later generations identify the disease. He also emphasized the importance of hygiene and diet, which were practical and helpful. And his writings on pulse diagnosis were used for centuries. Lucas: Now, one more angle — what did the plague do to the empire? We've touched on this before, but it's worth pulling in Galen's perspective. The plague hit the army hard, which was a major problem for Marcus during the Marcomannic Wars. He had to recruit gladiators, slaves, and even brigands to fill the ranks. And the economic impact was severe, affecting trade and agriculture. So the plague wasn't just a health crisis; it was a strategic and economic one. Luna: And Galen was right in the middle of it, treating the emperor and the elite. Lucas: Yes, but his perspective was limited to the court. He didn't document the suffering of the common people, which is a gap in our sources. Still, his accounts are invaluable because they give us a clinical view of the symptoms and the attempts to treat them. Lucas: There's also a personal angle to Marcus's health that we should mention. Besides the plague, he had a chronic stomach condition — Galen mentioned it several times. It's possible that Marcus had an ulcer or something. And yet, Marcus never let it stop him from leading campaigns or writing his reflections. That's very much in line with his Stoic beliefs about enduring hardship. Luna: That's remarkable. I mean, he was a philosopher, but he was also a soldier emperor, and he dealt with all that pain without complaint. Lucas: Exactly. And I think that's part of why Galen respected him. In his writings, Galen praised Marcus for his self-control and his ability to remain calm under pressure. There's a sense that Galen saw Marcus as a model patient — one who followed his instructions but also maintained his own composure, which Galen believed was key to recovery. Lucas: So as we wrap up, I think the takeaway is that Galen and Marcus represent two different but complementary responses to crisis: one is to observe, diagnose, and treat; the other is to reflect, accept, and endure. And both are necessary. The combination of medical care and philosophical resilience is what got the empire through those terrible years, at least for a while. Luna: It makes me think about how we handle our own crises. We need both science and inner strength. Lucas: Well said. And that's the kind of connection we try to make on this show — not just what happened, but what it means for us today. Thanks for listening, and we'll see you in the next episode.