The Circus Maximus

All of which was of course fascinating. But where did Galen come into this and how did he end up affecting our world over and above anyone else – and for so long? He was born in Pergamum and it was here he took up the work that would see him shape the world that was coming. He became a physician to gladiators.

At about the time Galen was 40 he was invited by Aurelius and his co-emperor Lucius Verus to join them in Rome. Here he continued to practise medicine and write and lecture. Not just about medicine but, by keeping 20 scribes on staff, he also wrote prolifically about philology and philosophy. He studied anatomy and physiology and wrote 17 books On the Use of Parts of the Human Body. He has around 500 dissertations to his name and his medical writings crystallised and expanded on all the best work of the preceding Greek medical schools and covered nearly every aspect of medical theory and practice of his time.

Galen rightly is one of the greats.

Having read some of his work you understand what an incredible mind he had and the wealth of accurate detail in his writings is astonishing even today. He truly deserves his place in history and in our consciousness today.

But why does his ‘contrary to suffering’ principle shape much of western medical care today?

To throw a light on this we need to take a look at who Galen was learning from – the gladiators.

It wasn’t just slaves who were gladiators; criminals were also sentenced to the arena as a means of execution; and even ordinary citizens took it up.

Among Romans, the choice of careers was limited: for most, it was the army, teaching, or the arena. Gladiators, if they were good, earned money and slaves gained their freedom. They were victorious over death or died with great dignity. Displaying the moral qualities that inspired the people, they could be heroes, celebrities, venerated sportsmen and symbols of their empire’s dominance and virtue.

If they lived today they would have their own branded clothing line, mobile phone marketing contracts and their pictures in the tabloids.

Back then they were fed three square meals a day and had the right to excellent medical treatment.

This was Galen’s area of expertise and he became known as the first sports physician. Frequently found in the bowels of the gladiator pits working on the casualties, he claimed to have ‘never lost one under my care’.

It could be here around the gladiatorial arena, the Circus Maximus 1,800 years ago, that the fate of medical progress was decided.

Over the ten days the games usually lasted at that time, the arena was thought of as ‘the threshold of the underworld’. Scattered around the amphitheatre were statues of gods like Mars and Diana, and of Hermes, who conducted souls to the afterlife. Men paraded the ground dressed as Mercury, escort of the dead, and Dis Pater, God of the underworld, in a very pagan, carnivalian celebration. The circus was a mocking festival with deity as the warm-up act, a comedian brought in to get the audience going.

The trumpets blared and the grand opening procession began with men carrying ornate chaise longues high over their heads. Known as ‘the couches of Libitina, goddess of burials’, these were stretchers for the soon-to-be-dead. In the prisons, the gladiators, slaves and criminals, were beaten with rods by staff dressed as demons. Noise filled the stifling dust and heat-drenched air. Swords were scraped sharp on oil-stones, and metal plates and rods lingered in hot coals ready to poke fallen gladiators and check they were really dead. In front of 200,000 spectators there was no faking it.

At the height of its power as a pagan nation, if you called yourself ‘Christian’ it was heresy against the Roman gods. It was enough to condemn you to a terrible death in the arena. Christians were regularly accused of taking part in crimes like ritual incest, baby-eating and high treason. Rejection of the state religion meant Christians were executed en masse to celebrate an anniversary of an emperor’s reign, burned at the stake or more often crucified.

At the winter solstice arena games, Christians were the morning’s entertainment, to be offered up ad bestias (to the beasts). They were made to face wild animals without weapons or armour, a capital punishment ranking alongside crucifixion as the most humiliating of all penalties.

Men with whips forced condemned Christians to face the charge of a lion. Or they were roped to a stake in the centre or rolled out shackled into a miniature chariot as meals on wheels.

It is in this setting that two men, totally unaware of each other, were about to influence the history of Europe forever. One was at the top of his game, the other just getting into his stride.

The first of our ‘combatants’ was of course Galen. A man with weighted eyes, heavy lids that turned to steel when provoked. He had a nose like the guard on a helmet; it ran straight down from his forehead into his neat moustache and beard. Seemingly always well groomed and calm, he looked like a man who wore a suit of armour underneath his toga. His service under four successive emperors (from Marcus Aurelius to Septimus Severius) coincided with a high point in the triumphs of the Roman Empire, and he was running a huge practice in Rome, with the royal court as his most illustrious clients. On a fiery, controversial quest for intellectual supremacy, he was the leading authority in his field. He had the ear of the emperor, the indulgence of the court and a supply of fresh bodies to study in the arena’s casualties.

Up in the gallery, watching the slaughter of criminals, including Christians, was the second player, an African theologian.

Quintus Septimus Florens Tertullianus, from Carthage (now Tunisia), was a man who looked like a hawk. He had round, sharp, swift eyes that noticed the smallest movement and a deeply lined face formed by relentless scrutiny and concentration. He was loosely turbaned, carried a short but unruly beard and wore flowing clothes like a man constantly on the wing.

He watched the Christian slaves in the arena in a ritual intended to degrade and humiliate them and he was deeply touched by the dignity they showed in the face of the taunts, jeering and degradation.25

Tertullian became the first theologian to write about Christianity in the language of Latin. This turned out to be the masterstroke Christianity needed to take the game.

The faith may never have survived beyond the Romans had St Paul not preached acceptance of outsiders (Gentiles) in opposition to every other Jewish sect. But it may also have receded back to its Jewish confines had Christianity never been given the winning pass from Latin – this is what enabled Christianity to sweep through Rome and then be carried all over the known world.

This explosion of Christianity is considered to have begun when Tertullian presented a fierce argument for Christians, called the ‘Apologeticum’, to the provincial governors of the empire in 197 AD. This is an acerbic and dazzling argument for Christianity and a declaration, in the ruling language of Latin, of its absolute superiority. History notes that this fantastic speech, the Apologeticum, gave Christians the means with which to meet paganism on its own ground and defeat it.26

Galen had a reputation as the most prolific, cantankerous and effective leading authority on medical thought. Having collated nearly all preceding medical knowledge, he added his own papers and promoted his ‘contrary to suffering’ tenet as an accepted standard.

By general agreement between writers both ancient and modern, Tertullian was aggressive, sarcastic and brilliant. Combined with writing in the language of power, Latin, he caused Christianity to leap into the mainstream. With Latin propping up the cause, the belief that all there was to know was known, and all there was left to achieve was salvation. So persuasive was the argument, sanctioned by Tertullian, that ‘investigation since the Gospel is no longer necessary’, all progressive thought stalled in Europe.

The glory that was Greek philosophy and the grandeur that was Rome, mystery cults, oriental and magic, alchemy, astronomy and science, stood on the pitch with the Lord and were overawed.

The new faith took the tournament, in a victory that would influence the next 52 generations. Medical progress was merely one of the casualties of the battle between pagan Rome and Christianity.

Galen was in the right place and time. As the leading player in his field when the whistle went, Galen’s vast medical legacy was accepted as total and the general belief was that nothing needed expanding on; it just needed a Christian twist. So Galen’s work became the manual that influenced medicine for the next 15 centuries.

The Empire of Christ took Galen’s law and wove it so tightly into the fabric of those beliefs that today we can’t see it any more. Like a richly embroidered rug, when you are standing on it you only see the pattern and are not aware of the threads that make it up.

The fight back against the Church was not won when Galileo’s campaign for ‘Copernican heliocentric cosmology’ (a sun-centred universe) succeeded or the flat earth was rounded off. It was won when medical science superseded the church as the authority nearest to the heart of the state.

Picture the glorious days, just over 100 years ago, when Pasteur and Koch were finally piecing together the mysteries of the invisible world of germs. Europe must have been in the grip of a feverish excitement, watching scientists pulling stunts with rabid dogs and pens full of anthrax-infected sheep. At a time of great poverty, when housing and sanitation were poor, rickets was common, and life expectancy was around 30 years, breakthroughs into worlds invisible to us must have been a thrill.

The world of microbiology enabled us to see at last what it was that had been troubling us, and the smaller the microbe, the larger the promise of our salvation.

At last we could step beyond mere faith to control our destinies; we had a way to evolve past being victims of the whim of nature.

We invested heavily in the hope of science, we committed emotionally, politically and financially in what was, we believed, our new deliverance. Western medicine sought absolution in science, rushing forward to create the future unable to retrieve the past.

Kitale is a Northern Frontier District town near the Ugandan border. It’s a well-kept secret by the many who live there, from everybody else who never wants to come anyway. This is where my parents paid two horses and £50 they had to borrow from my grandfather for a patch of poor soil, called it a farm, and coaxed it to yield a life for us.

They poured their sweat and souls into a thousand acres of bush, to build a family out of the dust and dirt-turning and disease that is a farmer’s life in Africa. You plough and plant and herd and play the decks with the weather, the bank manager, nomadic herds, plagues of locusts and sickness stacked against you. I didn’t know anything else. It was normal. It was simply our life, it was who we were.

I grew up with witchcraft, home remedies like flat coke for stomach upsets, and ‘wonder drugs’, expensive drugs from a distant, unknown ‘home’ country. A country I only knew about from Enid Blyton stories, week-old Sunday papers and the World Service. Now I’m here in a leafy-green English garden, reading newspapers that are no longer a week old and drugs are a very ordinary part of our every day and available in the high street. But at some point we lost our home, our livelihood and our life as we knew it – we lost what we were.

Culture shock is about getting used to a different kind of normal.

That sense of dislocation is immense: it is not just about losing a sense of who you are or where you came from; it is about losing any way to remember it.

The foundation of our medical system is rooted somewhere on the other side of a 1,300 year-long void, a religious intermission.

After Galen, medicine’s job evolved to endorse theology. There was not much call for anything more. Its greatest use was to patch up the wounded on crusade, disease was divine punishment best purged from you, and death was a release to a better place. After being distracted for so long, the world of western medicine behaved as though it had a profound sense of dislocation from its roots, as though it had lost any way of recovering the centuries of practical experience. Unable to look in a mirror, it had no idea who it was.

Science showed us there was a way we could find ourselves. With its laboratories, technology and techniques of prediction, science promised to by-pass the need for years of practice.

Is it any wonder we grabbed hold of that possibility?

We couldn’t go back to get what we had left behind and so rushed headlong toward the future. The pinnacle of our achievements is the programme of immunisation, as the ‘provable’ saviour of world health it is the legacy of our time.

The immunisation programme is so great it even spells out the rules we left back in 200 AD.

More than a principle method of treatment, it clearly defines the next two rules. Its triumph shows us how staggeringly vital good principles are.

Science works by looking for a pattern to allow us to understand confusion. The more repetitions there are in an experiment, the more it is considered valid. The more repeatable the results, the more weight the proposal gains. Then what tends to happen is the more people who approve of an idea, the more an idea is accepted as right.

Science also expects that if something is ‘true’ then it is true all the time.

There are no exceptions.

Which is what my family were – an exception.

I guess science is then obligated to look for another pattern to understand the new confusion of an exception. The exceptions within the immunisation programme turn out to lead directly back to forgotten universal rules that make sense of today’s problems. They turn a spotlight on ancient principles that make sense in a world searching for a magic bullet.

The immunisation programme taught me the hard way the next rule, which is that the individual is most important.

Not the disease.

The second rule is treat people and not disease.