Written by Yiting Liu

Part one: The body of infants and children before adolescent

1§1 In Hygiene, Galen defined medicine and health, explaining that the medicine can be divided into two parts: hygiene and therapeutics. Health is the balanced state of organic parts: cold, hot, dry and wet, determined by their number, magnitude and conformation. As in his assertion, human bodies are born hot and wet, and become cold and dry with age. He used the analogy of a drying plant to compare it to the process of a person’s aging. Infant bones are too moist but become the strongest at youth, as the person continues to age, their strength declines and their bones become too dry and cold[1]. Furthermore, Galen showed a very specific division of patients by their ages in Hygiene. He divided the young patients by 7 years a stage: the first seven years, the second seven years, and the third seven years, where the first two stages were considered as children by Galen (pais, paidon, paidiske, or paidarion). Between these two stages, he addresses the focus in health differently. For the first seven years, Galen mainly talked about care of newborns with their bodies[2], while for the second seven years, he changed his primary focus to the care of children’s soul[3].

1§2 From Galen’s description of children’s physiology and his division of children’s age groups, it can be inferred that he already had an overall knowledge on the characteristics of the bodies of infants and children in his understanding system of health. He also clearly has his opinion on how they differ from adults.

Part two: Treatments and maintaining health in children

2§1 According to Galen, children are born to be hot and moist, which are the better humours compared to cold and dry. However, when infants were born, it is inevitable for them to be in contact with both cold and hot in their environments. Therefore, he suggested that following birth, a healthy newborn should be sprinkled with a moderate amount of salt in order to make its skin firmer and thicker, and then it should be wrapped in swaddling clothes. This intended to keep the outside of the child firm, assuming the inside was wet and hot, simulating the experience within the uterus[4]. Galen also recommend that children should practice his exercises with a small ball, which he claims to be most suitable for someone who has a weak capacity and needs to rest to restore to health, and most able to be effective for an old person and a child. Despite his efforts on preventive medicine, deaths in infants and children are inevitable, and especially prevalent during his time.

2§2 The mortality rate among infants was extremely high: 30.56% at age 0 and 21.58% at age 1[5]. The condition remained critical as infancy turned into childhood. As written in Pliny the Elder’s Natural History (23/24 -79 AD) Agrippina and Germanius had nine children but only six survived into adulthood. As a physician, Galen tried to heal the children. with the understandings available at the time.  Except for figuring out the mechanism in infants and children as well as prescribing medication, Galen even suggested using amulets for the sick children. For example, Galen cured a child who had epilepsy by putting an amulet around his neck[6]. Thus, it can be seen that as a physician, Galen was truly devoted to the health of the young patients.

2§3 For common treatment principle, Galen agreed with [Hippocrates]: opposites are the cures of opposites. He then raised the example of fever, on which Galen had extensive analysis in his books. Fever is a dry and hot disease, so moist regimen was needed. Although he supported the opinion that the opposite regimen should be used for the body, he pointed out that moistness in children is natural, therefore, they should be fed a moist diet and bathed with potable water instead of using drying regimen on them.

2§4 The reasons for his such measures was also included in his work. Galen once explained in Method of medicine to Glaucon, that when the disease is hard in nature, the strongest medications are needed. However, for women and children, who are soft-fleshed and weak, physicians should use soft medications[7]. Galen considered the lack of strength may cause the medicine he prescribed to result badly with their physiologies. For example, in a case where a fever is caused by the blockage of the blood, assumed cure is to remove the blood from blocked vessels, thus, Galen would usually conduct a phlebotomy. However, for children, a phlebotomy is not conducted[8]. In later volumes, the reason is further explained. Because children are hot and moist, a great part of the substance of the body flows away and is dispersed every day[9]. As a result, what they want to achieve by conducting phlebotomy can be achieved spontaneously by nature. Furthermore, child bodies cannot sustain the stress of phlebotomy[10].

2§5 In Method of medicine to Glaucon, he states that he had never seen a youth who was bilious and dry in krasis seized by quotidian fever. On the other hand, smaller children and those who are phlegmatic are thick in bodily state and are easily seized by quotidian fevers[11]. . For quotidian fever, Galen noted which populations were more susceptible, and found that phlegmatic adults and some children were more at risk. the susceptible population including both groups, some of the children and some of the adults.

2§6 For bone fractures, as discussed in the previous part of this paper, it is acknowledged that children have relatively soft bones. Galen built on this theory and asserted the fractured bones of small children can grow together. However, for adults, after fracture, it is not possible for bones to grow back. It is only possible to build a callus around the fractured area.

2§7 Aside from the discussion of bones and fevers, he once raised an example of an infection in In Method of medicine to Glaucon. There was a young boy from Cercyllius who had erysipelas. Due to strong astringents and cooling agents, he had a swelling around his whole thigh. To treat him, Galen used medication ground into fine-particles, and rubbed the swollen thigh with oil, and let it sit in deep bowl with Sabine oil. He also applied a mixture made of various herbs and acrid vinegar on the whole thigh. As a result, the swelling was reduced.

2§8 The physiological difference and the resulted difference in diseases and injuries are prerequisite conditions for separating the treatment of children from that of adults. Also, in his treatises on health, Galen divided patients into three categories: women, men, and children, which can also be seen as a way to see the possibility of forming separate sects of medicine.

Part 3: Comparison of Hippocratic Corpus and Galenic Corpus

3§1 There were attempts to help child patients by acknowledging the difference between children and adults and adopting different approaches to treating children than adults from Hippocratic Corpus to Galenic Corpus. Both of them understand that adults’ bodies and children’s body are different from each other.

3§2 Both Hippocratic Corpus and Galenic Corpus include age groups for interdifferaite between stages of children’s development following the 7 year pattern. In Hippocratic Corpus, it is clearly stated that children have significant distinctions at age 7, which is associated with the second dentition, while Galen made the same division as discussion in Part 1. Developing from the definition of ages, Hippocratic Corpus and Galenic Corpus differs from each other by their clinical application on age groups. In Prognosis, [Hippocrates] observed that one certain type of illness, that children from 7 to 15 years old are more prone to hardness and pain in bladder.[12] On the other hand, Galen gives deeper analysis upon the health conditions of children within different age groups. Galenic Corpus advise caregivers to pay attention to different aspects of a child’s development, body and soul following his/her increase in age. This may suggest that Galenic doctors started to conduct clinical applications on the basis of the phenomenon and theory compared to Hippocratic authors.

3§3 [Hippocrates] in On Head Wounds states that the bones of young children are thinner and softer because they contain more blood and are hollower and more porous than that of adults. In this way, he deemed that it was risky to perform trephination surgery on a girl with severe head trauma.[13] [Hippocrates]’ statement provided the insight of physiological difference between before and after puberty as the antecedence for Galen to conduct theory on treatments with the medical cases illustrated above. Galen adopted his medical theory, and furtherly made advancement in treatment.

3§4 For example, in Hippocratic On Sacred Disease, the author states that most children who suffered from epilepsy died and there was no treatment available for them. Hippocratic doctors believed children’s body has no clear warmth, moisture, softness or delicacy- a system not as open as adults’ which make doctors intervene less[14]. Although no similar statement was found from Galenic Corpus, during Galen’s time, he mentioned that there was a specific plan for treating epilepsy, including purgation in a spring and controlled diet. Galen claims that this treatment method is effective in a relatively short time and he cured many children with it[15]. This comparison between Hippocratic and Galenic medical viewpoint on children suffering from epilepsy shows that treatment for certain diseases in children changed from non-treatable to treatable from Hippocratic time to Galen’s time.

3§5 Another difference between the two is the difference on their amounts of traumatic injury cases. In Hippocratic Corpus, The Head Wounds was devoted in children patients[16] and among the six cases in Epidemics that were treated with trephination, five of them were children. On the other hand, Galenic Corpus mainly focussed on the internal diseases of children while the few cases, including one on treating a boy who had an eye pierced by a stylus[17] and one on treating a child suffering from spinal cord damage[18], scattered in different treatises. The lack of emphasis in traumatic injuries of child patients is reflected in Galenic Corpus’ comparison with Hippocratic Corpus.

Part 4: Evidence on if a pediatric system is reflected on Galenic Corpus

4§1 There was no extant evidence of a complete pediatric system in ancient Rome or Greece. However, the beginning of the formation of pediatrics can be speculated. Firstly, there was no dedicated treatise on pediatrics, which suggests the absence of a specific division of pediatrics.  For example, Galen’s two specific description on Commodus and the son of Cercyllius was just two example he had among all other cases on adults. Besides the few medical cases of children, the word “child” or “children” were merely used for analogies irrelevant to their health.

4§2 Secondly, there was no specific term representing the healing arts for young individuals solely found in Galenic Corpus. Although the modern term “pediatrics” originated from two Greek words, paedo for children and iatros for physicians, this word first appeared in the late 19th century[19], long after the time of ancient Greece or Rome. There was no summarization of putting them into one named category. All clinical cases on children mentioned above were individually examined by Galen. The absence of a medical term in pediatrics is also a possible evidence for the absence of a pediatric system in Galen’s texts.

4§3 However, Galenic Corpus has the advancement in the clinical practices based on divisions between ages groups. The thinking mode of collecting data from observation, to build a theory on differences within one large subject, then to develop different approaches on clinical cases, can be considered closed to the way of one large medical field consisting of many subspecialties in modern medicine. This sign can be recognized as a prelude to a forming pediatric system.

Part 5: Possible explanation for the lack of evidence of a pediatric system

5§1 The reason for lack of evidence of pediatrics system can only be speculated due to the inadequacy of ancient evidence. I propose three possible explanations.

5§2 The first possible explanation is the lack of clinical cases, especially of infants. The Roman and Greek superstition regarding infants born with defects may have impeded physicians from forming medical theories about infants. Seneca the Younger (4 BC/1 AD – 65 AD) said, “unnatural prodigy we destroy; we drown even children who at birth are weakly and abnormal.”[20] . According to the archeological evidence from Athens, most children died from natural causes by their skeletal remains, including birth defects, infections, etc.[21] People in ancient Rome and Greece disregard the infants who were born with abnormalities as signs of evil and misfortune. Therefore, children who were born with conditions would be disposed of without being treated. In fact, among all the medical cases recorded by Galen, only 19 out of 358 are confirmed to be of children or infants’ cases[22], taking merely 5.31% of all the patients in his written books. This is associated with Galen’s writing on the measures (spraying salt and wrapping) to take after childbirth were only on healthy newborns. It can be inferred that Galen only treated healthy babies while sick ones were abandoned. This neglection towards the infant patients significantly decreases the number of sick children that were in physicians’ care, in other words, physicians in antiquity only have the access to relatively healthy children. Consequently, the physicians, in this case, Galen may lack enough clinical cases to make conclusions on infants’ specific diseases for building a system.

5§3 Secondly, the absence of a pediatric system may be caused by the lack of in-depth understanding on most diseases in children. Physicians of ancient time only paid special attention on few conditions, for example, epilepsy or the deformities in extremities as mentioned above. There were only two or three sentences of description on other diseases or injuries. For example, in Hippocratic Epidemics, there is a description of a girl who was paralyzed in both right arm and left leg, but there was not any treatment information or the exploration of the cause of symptoms in the texts[23]. The formation of a pediatric system depends not only on the number of clinical cases, but also the depth of analysis of symptoms and mechanisms. Without digging into the conditions, the rushed conclusions would be scattered and superficial, leaving the treatment of young patients unable to become systematic.

5§4 Thirdly, the lack of understanding towards the internal structure of children could also be an explanation. In pre-Alexandrian time, the theory of human body only originated from assumptions. The turning point was when the vivisection and dissection of human beings were initiated by Alexandrian physicians, Herophilus (330-260 BC) and Erasistratos (315 -240 BC). They helped physicians in later generations, including Galen, in providing with unprecedented discoveries and insights of internal body structures[24]. However, there were no records of any description on children’s anatomical structure or its’ influence on understanding the pathology. There are two possibilities in explaining it. According to Celsus, the human bodies used in vivisection or dissection by them were those of criminals[25]. Therefore, the first possibility is that bodies of dead children were not dissected at all. In this case, there was no exploration into the inside of children’s or infants’ body in antiquity. Without the support of knowledge on the anatomical structure, a branch of medicine cannot be established. The second explanation is that the children bodies were dissected but the physicians who conducted the dissections didn’t separate them from adults, showing that no discussion of the bodies’ ages in Galen’s work about Alexandrian dissections[26], namely they didn’t realize they should be separated in the first place.

5§5 Also, because there is only very limited amount of Galen’s primary texts that was translated to English and is available through college resources, including eight books in Loeb online library[27], 7 treatises on attlus website[28], and one book in Franklin & Marshall College library. Only five books out of five in Loeb online library were found to have information on children’s medicine, while none of the seven on attlus website did. The exampled sample size of this research is not large enough to rule out the possibility that there is more written description on the untranslated, even undiscovered texts of Galen that provides evidence of his pediatric system.

Part 6: Conclusion

6§1 In conclusion, the examination of the existing Galenic Corpus leads to the conclusion that there was specific treatment for children for some diseases, but there was no evidence of a formed pediatric system during that time. However, there was traces of forming pediatrics in Galenic Corpus. The absence may have been caused by the lack of clinical cases, the lack of in-depth understandings of medical conditions, and the lack of anatomical information of the child body. In addition, the limitation of available translated texts of Galenic Corpus has a possibility of providing opposite evidence against this conclusion.

 

Notes on sources used

The Loeb Classical Library and the Table of Cases (based on LSJ and Durling (1993)) in Susan P. Mattern’s book are the main sources for medical cases. In case of the description of the cases shows ambiguity because of insufficient information or word use (pais could mean both slave and child[29]), the medical case is compared to the translation of Loeb Classical Library if available. If both of the interpretations show the probability that this particular case was not about a child or infant, or the translation is not available in Loeb Classical Library, this medical case is excluded from this research.

 

[1] Galen. Hygiene. Book I. 2.

[2] Galen. Hygiene. Book I. 4.

[3] Galen. Hygiene. Book I. 12.

[4] Galen. Hygiene. Book VII. p47.

[5] Frier, Bruce W. “Demography.” The Cambridge Ancient History, edited by Alan K. Bowman et al., 3rd ed., vol. 11. 787–816. The Cambridge Ancient History.

[6] Galen. On Simple Medicine. Book VI. 3

[7] Galen. A Method of Medicine to Glaucon. Book II. p547

[8] Galen. Method of medicine. Book VIII. p399

[9] Galen. Method of medicine. Volume 9. p177

[10] Galen. Method of medicine. Volume 11. p359

[11] Galen. Method of medicine to Glaucon. Book I. p371

[12] Dean-Jones, L. “The Child Patient of the Hippocratics: early Pediatrics?”. 110. The Oxford Handbook of Childhood and Education in the Classical World.

[13] Hippocrates. Epidemics V.28

[14] Dean-Jones, L. “The Child Patient of the Hippocratics: early Pediatrics?”. 109. The Oxford Handbook of Childhood and Education in the Classical World.

[15] Bradley. K. “The Roman Child in Sickness and in Health”. 82. The Roman Family in the Empire: Rome, Italy, and Beyond.

[16] Dean-Jones, L. “The Child Patient of the Hippocratics: early Pediatrics?”. 121. The Oxford Handbook of Childhood and Education in the Classical World.

[17] Galen. On the Causes of Symptoms. I.2.

[18] Galen. On the Parts Affected by Disease. I.6.

[19] “paediatrics.” Oxford Dictionary of English. Ed. Stevenson, Angus.: Oxford University Press, 2010. Oxford Reference. 2010. Date Accessed 15 Dec. 2017

[20] Seneca the Younger. On Anger I.15.2

[21] Liston, Maria A., and Susan I. Rotroff. “Babies in the Well: Archeological Evidence for Newborn Disposal in Hellenistic Greece.” The Oxford Handbook of Childhood and Education in the Classical World.

[22] Mattern, Susan P. “Table of Cases”. 173-202. Galen and the Rhetoric of Healing. Baltimore, Johns Hopkins University Press.

[23] Hippocrates. Epidemics. II.7

[24] Von Staden, H. “The Discovery of the Body: Human Dissection and Its Cultural Contexts in Ancient Greece.”

[25] Celsus. On Medicine. Volume 1, Book 1. 24. Translated by W. G. Spencer.

[26] Galen. On Anatomical Procedures. 9.3, 9.5. Translated by Longrigg. J.

[27] Loeb Classical Library. https://www.loebclassics.com/search?f_0=author&q_0=Galen

[28] Attalus Website. http://www.attalus.org/info/sources.html#Gaius

[29] “pais.” Thesaurus Linguae Graecae. A Digital Library of Greek Literature.


Bibliography

Celsus. On Medicine, Volume I: Books 1-4. Translated by W. G. Spencer. Loeb Classical Library 292. Cambridge, MA: Harvard University Press, 1935.

Edwards, I. et al. The Cambridge Ancient History. 3rd ed. Vol.11. England, Cambridge: Cambridge University Press, 1970.

Galen. Hygiene, Volume II: Books 5–6. Thrasybulus. On Exercise with a Small Ball. Edited and translated by Ian Johnston. Loeb Classical Library 536. Cambridge, MA: Harvard University Press, 2018.

Galen. Method of Medicine, Volume I: Books 1-4. Edited and translated by Ian Johnston, G. H. R. Horsley. Loeb Classical Library 516. Cambridge, MA: Harvard University Press, 2011.

Galen. Hygiene, Volume I: Books 1–4. Edited and translated by Ian Johnston. Loeb Classical Library 535. Cambridge, MA: Harvard University Press, 2018.

George, Michele. The Roman Family in the Empire : Rome, Italy, and Beyond. Oxford: Oxford University Press, UK, 2005.

Grubbs, Judith Evans, and Tim G Parkin. The Oxford Handbook of Childhood and Education in the Classical World. Oxford Handbooks. Oxford: Oxford University Press, 2013.

Hippocrates. Epidemics 2, 4-7. Edited and translated by Wesley D. Smith. Loeb Classical Library 477. Cambridge, MA: Harvard University Press, 1994.

Mattern, Susan P. Galen and the Rhetoric of Healing. Baltimore: Johns Hopkins University Press, 2008.

“paediatrics.” In Oxford Dictionary of English, edited by Stevenson, Angus. : Oxford University Press, 2010. http://www.oxfordreference.com/view/10.1093/acref/9780199571123.001.0001/m_en_gb0597900. Retrieved on 16th May, 2018

“pais.” LSJ: The Online Liddell-Scott-Jones Greek-English Lexicon. Thesaurus Linguae Graecae. http://stephanus.tlg.uci.edu/lsj/#eid=79122&context=lsj&action=from-search Retrieved 17 May, 2018.

Roberts, J. W, and Oxford University Press. The Oxford Dictionary of the Classical World. 1st Ed. ed. Oxford: Oxford University Press, 2007.

Seneca. Moral Essays, Volume I: De Ira. Translated by John W. Basore. Loeb Classical Library 214. Cambridge, MA: Harvard University Press, 1928.

Von Staden, Heinrich. “The Discovery of the Body: Human Dissection and Its Cultural Contexts in Ancient Greece.” Yale Journal of Biology and Medicine 65 (1992): 223-41.