Clinical Anatomy 17:454 – 457 (2004)

A GLIMPSE OF OUR PAST

Galen and His Anatomic Eponym: Vein of Galen

Cagatay Ustun*
Ege University, Faculty of Medicine, History of Medicine & Ethics Department, İzmir, Turkey

Galen or Galenus was born at Pergamum (now Bergama in Turkey) in 129 A.D., and died in
the year 200 A.D. He was a 2nd century Greek philosopher-physician who switched to the
medical profession after his father dreamt of this calling for his son. Galen’s training and
experiences brought him to Alexandria and Rome and he rose quickly to fame with public
demonstrations of anatomical and surgical skills. He became physician to emperor Marcus
Aurelius and the emperor’s ambitious son, Commodus. He wrote prodigiously and was able
to preserve his medical research in 22 volumes of printed text, representing half of all Greek
medical literature that is available to us today. The structures, the great cerebral vein and the
communicating branch of the internal laryngeal nerve, bear his eponym. Clin. Anat. 17:
454 – 457, 2004. © 2004 Wiley-Liss, Inc.

Key words: Galen, Vein of Galen

GALEN’S LIFE muscles, and to develop skill in treating fractures as

A Roman physician and philosopher of Greek ori-
gin, Claudius Galen or Galenus (Cladius Clarissimus
Galen, better known as Galen of Pergamum) was born
at Pergamum (now Bergama in Turkey) in 129 A.D.
(Fig. 1). His father, Aelius Nicon, was an architect and
builder with an interest in mathematics, logic, and
astronomy and a fondness for exotic mathematical and
literary recreations. Nicon had planned for his son to
study philosophy or politics, the traditional pursuits of
the cultured governing class into which he had been
born. But in 144 or 145 Asclepius intervened. In a
dream, Galen says, the god told Nicon to allow his son
to study medicine, and for the next four years Galen
studied with the distinguished physicians who gath-
ered at the Pergamum sanctuary of Asclepius (Fig. 2).
In 148 or 149 Nicon died, and Galen at age 19 found
himself rich and independent. He chose to travel and
further his medical education at Smyrna (today’s
name: Izmir), Corinth, Crete, Cilicia, Cyprus, and Al-
exandria. In 157 he returned to his native city and a
prestigious appointment: physician to the gladiators.
The need to keep these performers fit taught him the
importance of hygienic regimens and preventive mea-
sures. Treating the severe injuries that were part of a
gladiator’s existence enabled him to observe living
human anatomy, particularly of bones, joints, and
well as brutal chest and abdominal wounds. From
autumn 157 to autumn 161 he gained valuable prac-
tical experience in trauma and sports medicine, and he
continued to pursue his studies in theoretical medi-
cine and philosophy. When civil unrest broke out in
162, Galen left for Rome. The medical community in
Rome was competitive and corrupt. In Rome, Galen’s
ambition got the best of him and his high profile
created powerful enemies who caused him to depart
secretly in 166. After a couple of years in obscurity,
Galen was recalled by the Roman Emperors Marcus
Aurelius and Lucius Verus to serve the army in their
war against the Germans. When the plague hit Rome,
Galen was made personal physician to Marcus Aure-
lius and Aurelius’ son, Commodus. He died, probably
in the year 200 A.D. (or 201), in the reign of the
Emperor Septimus Severus. Among other talents, he
was a great experimental physiologist. Although he
followed the teachings of Hippocrates, he also made
deductions of his own (Shippen, 1957; Rosen, 1958;
Hiatt and Hiatt, 1994; Cochrane, 1996; Pötzsch, 1996).
*Correspondence to: Cagatay Ustun MD, PhD, Ege Üniversitesi
Tıp Fakültesi, Tıp Tarihi Anabilim Dalı, Bornova İzmı̇r 35100
Turkey. E-mail: custun@med.ege.edu.tr
Received 9 March 2003; Revised 24 October 2003
Published online in Wiley InterScience (www.interscience.wiley.
com). DOI 10.1002/ca.20013

© 2004 Wiley-Liss, Inc.

 Galen 455

nearly every aspect of medical theory and practice in

Fig. 1. Galen.
GALEN’S WORKS
Galen’s works fall into two main categories: medi-
cal and philosophical. His medical writings encompass
his era. A great many of Galen’s works have survived.
The Kühn edition of Galen (Greek with a Latin trans-
lation) runs over 20,000 pages. There are other Ga-
lenic works that only exist in Arabic translations. How-
ever, many of Galen’s works are lost, e.g., many of his
treatises on philosophy (logic, physics, and ethics)
perished in a fire that consumed the Temple of Peace
in 191 A.D.
Claudius Galen carried out dissections and wrote
numerous treatises on human anatomy. He was con-
sidered the authority on anatomy long after his death
by those who accepted his word rather than following
his investigative methodology. Galen studied the bod-
ies of animals to support his research. In particular, he
used apes and swine that are very similar in many
aspects of anatomy to humans. This type of research,
along with the dissection of human remains that he
conducted in Alexandria, led to the development of
his theory on the human body’s physiological system.
This was a remarkable, if slightly incorrect, develop-
ment that would allow physicians to clearly under-
stand the effects of the treatments given. He said: “A
physician needs to study anatomy, as an architect
needs to follow a plan.” He never understood the
circulation of the blood, but he distinguished between
the nerves that carry sense impressions to the brain
and those that control movements. He also classified
different variations of the pulse, distinguishing be-
tween slow, fast, and irregular beats and trying to
determine their relation to the patient’s health.
As an anatomist, Galen left many excellent descrip-
tions, especially of the nervous and locomotor sys-
tems, but his work was faulty and inaccurate, based

Fig. 2. Treatment center (Pergamum Asclepion) with water channels and pipes.
456 Ustun
largely on the dissection of apes and swine. Galen
made many mistakes, especially concerning the inter-
nal organs. For example, he incorrectly assumed that
the rete mirable, a plexus of blood vessels at the base
of the brain of ungulate animals, was also present in
humans. In addition, he sometimes postulated the
presence of structures not there to fit his theories. He
studied osteology in the ape (Macacus ecaudatus) and
from stray human skeletons, such as that of the robber
he once found on a lonely mountainside. His myology
was based mainly upon the study of the musculature
of the Barbary ape (Macacus inuus), but he clearly
understood the difference between origin and inser-
tion and knew most of the muscles and their func-
tions. Galen showed that arteries contain blood and
gave the first description of the cranial nerves, the
lymphatic system, and the phenomenon of paraplegia
after division of the spinal cord. He believed the
cerebellum to be the origin of the motor nerves and
the spinal cord. The cerebellar vermis he considered
to be a valve regulating the flow of animal spirits
within the cerebral ventricles. The term “thalamus,”
meaning chamber or anteroom, was applied by Galen
to the organ to which he believed the optic nerves
were connected, providing vital spirits for vision. He
described the nervous system, the brain, spinal cord
and nerves, as one functional unit. He observed loss of
sensation and paralysis of all muscles supplied by
nerves originating from the spinal cord after complete
resection below that level. He distinguished the dura
mater and pia mater, the corpus callosum, the third
and fourth ventricles with the iter (Sylvian aqueduct)
the fornix, corpora quadrigemina, vermiform process,
calamus scriptorius, hypophysis, and infundibulum.
Of the 12 cerebral nerves, he knew seven pairs, also
the sympathetic ganglia, which he described as the
reinforcers of the nerves. Galen also described a net-
work of blood vessels surrounding the pituitary gland
at the base of the brain and assumed this existed in
man. Berangario da Carpi (1460 –1530) dissected 100
brains and failed to find it. He wrote “Galen imagined
a rete but never saw it.” Galen was the author of some
500 papers and gave his name to the great cerebral
vein (of Galen) and also to the nerve of Galen, the
communicating branch of the internal laryngeal nerve
with the recurrent laryngeal nerve. He studied the
anatomy of the respiratory system and of the heart,
arteries, and veins. He did not, however, discover the
circulation of the blood throughout the body, and
believed that blood passed from one side of the heart
to the other through invisible pores in the dividing
wall (Fielding Garrison, 1929; Nuland, 1995).
A particular characteristic attached to the name of
Galen was the large-scale use of medications. He
gathered medicinal plants and prepared his own pre-
scriptions, out of mistrust for the rhizotomists and
drug sellers. The many ingredients that he put to-
gether in a single preparation have sometimes been
referred to as Galenicals, but the term has no precise
meaning. He carried polypharmacy to an extreme,
mixing and blending agents whose properties he clas-
sified according to the humors and their qualities of
hot, cold, dry, and moist. For example, an illness
categorized as hot required a drug that was in the cold
category, a classification system founded on specula-
tive doctrines (Lyons and Petrucelli, 1987; Tan, 2002).
During his brilliant career Galen compiled more
than 300 books, of which some 120 are still available
for our study. It is small wonder that this medical
colossus reigned like a dictator over the world of
medical science for almost 1,500 years.
GALENISM
Galenism is a system of medicine that belongs to
Galen. It is a blend of the humoral theory and
Pythagorean number lore.
If the work of Hippocrates can be taken as repre-
senting the foundation of Greek medicine, then the
work of Galen, who lived 6 centuries later, is the apex
of that tradition. Galen, for all his mistakes, remained
the unchallenged authority for over 1,000 years. After
he died in 200 (or 201) A.D., serious anatomical and
physiological research ground to a halt because every-
thing there was to be said on the subject had been said
by Galen, who, it is reported, kept at least 20 scribes
on staff to write down his every dictum. Although he
was not a Christian, Galen’s writings reflect a belief in
only one god, and he declared that the body was an
instrument of the soul. This made him most accept-
able to the fathers of the church and to Arab and
Hebrew scholars. Galen’s mistakes perpetuated fun-
damental errors for nearly 1,500 years until Vesalius,
the 16th century anatomist, although he regarded his
predecessor with esteem, began to dispel Galen’s au-
thority.
VEIN OF GALEN (GREAT CEREBRAL
VEIN OF GALEN)
The single great cerebral vein (of Galen) receives
the paired basal veins (of Rosenthal), the paired
basal veins of Rosenthal, the paired occipital veins,
and the posterior vein of the corpus callosum, and
sometimes the superior cerebral vein. The paired
occipital veins are superficial cerebral veins that
drain the inferior and medial surfaces of the occip-

Fig. 3. Sagittal, T1-weighted MR image shows a thrombosed
vein of Galen malformation. Citation: R.N. Sener, O. Yalman, O.
Kitis, S. Tamsel, C. Calli. 2000, Sep 11. Completely thrombosed
aneurysm of the persistent, primitive prosencephalic vein of
Markowski (http://www.eurorad.org/case.cfm?UID⫽643). Luxem-
bourg: Euromultimedia.
ital lobe and adjacent parietal regions. The posterior
vein of the corpus callosum drains the splenium of
the corpus callosum and the adjacent surfaces of the
brain. The great cerebral vein (of Galen) is a short
vascular structure that passes caudally beneath the
splenium of the corpus callosum and empties into
the straight venous sinus (Fig. 3) (Pernkopf, 1980;
Rouvière and Delmas, 1991).
It is probable that Galen did not recognize that
the vein he described drained the deep brain. In
addition, no historical data is available on descrip-
tions of any pathology related with the great cere-
bral vein (of Galen).
Galen 457
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