An aim of this work has been to examine, not only Galen's opinions on bloodletting, but also the reasons why he held them; it is therefore necessary to consider whether he could have been justified in believing what he did. Galen, like most other practitioners of his time, used phlebotomy as an evacuant remedy in a great variety of diseases; he also employed it as a revulsive in a way that would seem quite incompatible with his knowledge of anatomy, yet which can be shown to have been justified in the light of the knowledge of his time. Is there any scientific justification for his use of venesection as a general evacuant, taking into account that the conditions under which Galen practised were different from those now prevailing? The arguments to be put forward would not be accepted by all authorities today; it is nevertheless however possible for a professional haematologist, making use of discoveries in medicine in the last thirty years, to put up a case of sorts for Galen's use of venesection as an evacuant remedy. Any such retrospective evaluation must, of course, be highly speculative. Two separate arguments can be used; one concerns resistance to infection, while the other is rheological. Infection will be considered first.

Most physicians today, if asked whether there were advantages to the patient in being anaemic, would probably not be able to think of many. And although most would certainly agree that degenerative disease of the heart and arteries is less prevalent in the undernourished, the orthodox view is that impaired nutrition makes for greater susceptibility to infectious disease.

This work originated from an interest in the history of ideas in medicine. I wanted to find out why our forefathers, almost to a man, believed that the proper way to treat most diseases was to remove blood from the patient, and as there was to my knowledge no published translation of Galen's three bloodletting works in any modern language, I made one from the Greek of Kühn's edition, and went on to consider where his ideas came from and how they developed in the course of a long and active life. The material was used in 1978 as a dissertation for the degree of M.A. in classics from the University of Natal. Subsequently the translations have been revised, and the discussion rewritten to make it more accessible to the general reader. An introductory chapter on Galen's system of pathology, based on subsequent reading, has been added, and the passages quoted in the text in Greek and in modern languages other than English have been translated. Although unfamiliar old terms are explained when first encountered, they have all been collected into a glossary for easy reference, together with such modern technical terms as may be unfamiliar to the non-specialist.

Kühn's text is corrupt in many places, and only one of the three works has had any critical attention. I have therefore examined a number of the manuscripts and early printed editions, which clear up some of the difficulties. I must make it clear, however, that the only aim has been to improve the translations, not to establish texts; I am not a philologist, even by inclination.

The dating of the three works will be considered later, but it is clear that the first work, the De Venae Sectione adversus Erasistratum, was composed soon after Galen's first arrival in Rome; it is representative, therefore, of his youthful opinions. There is nothing in this work to suggest that Galen, at that stage of his life, considered using any evacuant remedy other than phlebotomy at the onset of the patient's illness. He agrees with Erasistratus that it is necessary to empty the plethos; the only question is by what means it should be evacuated. ‘I have always thought that once evacuation has been agreed on, the easiest and most prompt remedy is to open a vein, since in this way the inflammatory matters, and these alone, are evacuated as quickly as possible.’ All patients with plethos, he says, are most quickly and effectively treated by opening the veins; although Galen mentions alternative remedies used by Erasistratus, there is no indication that he uses any of them himself in these circumstances. Not only the physicians of the rationalist sect, but also the empiricists, all use venesection; even Asclepiades, who condemned all the dogmas of his predecessors and described the Hippocratic methods as an exercise in death. It is in use in most diseases and the most acute, and Hippocrates himself, ‘whom we regard as the leader of all the distinguished men in the profession, and the other men of old clearly did use it’. The ancients, in Galen's opinion, thought it nothing less than the most effective of all remedies.

At the beginning of his first work on venesection Galen expresses his surprise that Erasistratus, a man so punctilious in matters of detail, should have mentioned venesection only once in all his works, and at that only in passing; for, says Galen, it is a remedy of such strength and efficacy that it was regarded by the ancients as nothing less than the most effective of all. It is made clear later that the ancients to whom he refers are, in fact, Erasistratus' predecessors in the profession, including Hippocrates; Galen frequently mentions Hippocrates' use of the remedy in this work, observing that he employed it in most diseases and in the most acute, and that even Asclepiades, who rejected almost all the other methods of Hippocrates, nevertheless still made use of venesection. In another work Galen maintains that venesection has been dealt with very completely by Hippocrates. He is not alone in this opinion. Littré observes: ‘When we enquire which remedies, among the many that were used, are most frequently mentioned as having been applied, we find that bloodletting and the evacuants – emetics and, in particular, purgatives – play the principal role in the therapy of the Hippocratic physicians, and hence of Hippocrates himself.’ Adams expresses a similar opinion in his commentary on Paulus Aegineta. ‘We have had occasion frequently to remark’, he says, ‘that Hippocrates practised venesection freely in various diseases. He has left no treatise, however, expressly on the subject.’

The impression conveyed by both these nineteenth-century writers, and by Galen himself, is that the Hippocratic writers frequently mentioned venesection, and used it freely.

Those who intend to use phlebotomy must consider first of all how many states of the body there are that call for evacuation. The next question is, which of these states require evacuation by phlebotomy; for there are many conditions, some of which need some other sort of evacuation, and certainly not bloodletting. The third problem is to decide which patients can stand the evacuation without harm, since sometimes the patient's condition demands phlebotomy, yet he cannot bear it either because of his stage of life, or the season of the year, or the nature of the country, or because of some disorder of the mouth of the belly. (This is often miscalled the stomach; in the interests of brevity, however, I shall nevertheless use the term from now on in the whole of this work). There are also some who cannot bear phlebotomy because of their general habit of body, even though by reason of their disease they need it very much. If we are to draw such distinctions, we must consider each occasion on its merits, just as we do with any other remedy. Our next question concerns the veins that are to be opened, since extensive research has been undertaken to decide whether it makes no difference which vein one chooses to cut, all being equally helpful in all conditions, or whether, as Hippocrates and the most celebrated physicians thought, it makes a great deal of difference whether one opens this one rather than that.

In Galen's own time, some proponents of venesection believed that it was immaterial which vein was opened, since the same effect could equally well be obtained by using any of them; others, Galen among them, thought that it made a great deal of difference which vessel was used. Hippocrates and the most celebrated physicians, he says, were of this opinion also. This is not an isolated opinion of Galen's; he expresses it in all three of his works on venesection, and he makes further mention of specific sites for bloodletting in the De Sanitate Tuenda, the De Methodo Medendi, Ad Glauconem de Methodo Medendi, and his commentary on the Aphorisms. Now Galen was an expert anatomist, and his view of the structure (as distinct from the function) of the vascular system was, except in insignificant detail, that of the anatomist of today; yet he approved of practices of revulsive phlebotomy which, it would seem, must be quite inconsistent with such a view of vascular anatomy. To try to understand why he did this it will be necessary to summarise not only his own anatomical opinions, but also those of some of his predecessors, particularly those who offered clear accounts of the peripheral vessels.

Since the vessels contain blood, and since blood has been a subject of interest to man from the earliest times, we find some reference to blood-vessels in the earliest Western literature. Homer describes how Antilochus, leaping on Thoon from behind, cut right through the vein that runs straight along the back till it arrives at the neck.

Higher agricultural education

A perusal of nineteenth-century scientific literature, especially the journals, soon reveals the large role that science was capable of playing in agriculture and the degree to which farmers and all sorts of politicians were coming to rely on scientists to tell them how to increase production. The patron saint of French agricultural education is Mathieu de Dombasle, who opened near Nancy the first serious agricultural school in 1824. This noble failure encouraged the engineers Polonceau and Auguste Bella to found in 1828, with royal support, the more scientifically oriented Institution royale agronomique de Grignon, near Paris. In 1848 the Second Republic created a national organization of agricultural education: seventy departmental farm-schools to produce good farm workers; regional schools of agriculture; and, capstone of the system, the Institut national agronomique de Versailles. In line with policies in most western countries, the Third Republic promoted scientific agriculture on a scale unprecedented in French history. An autonomous Ministry of Agriculture emerged in 1881 from the clutches of the ministries in which it had been held captive for most of the century. Nineteen different ministers of agriculture served the forty-two governments that ruled France from 1881 to 1914. Given the composition of the Chamber of Deputies, it is not surprising that the ministry fell victim to a near monopoly by lawyers and doctors.

One of the most striking areas of nineteenth-century scientific growth was in biology. Apart from anti-Darwinism, two of the most intriguing issues in French biology are the influence of Auguste Comte and of Claude Bernard, the odd couple who laid down nearly opposite royal roads to the great research empire that the French believed to be their birthright. The scientific community, backed by republican enthusiasm, worshiped Bernard as its great culture hero. Dumas put it so well that Pasteur quoted him: “Ce n'est pas seulement un grand physiologiste, c'est la physiologie elle-même.” On Bernard's death in 1878, the black-banded pages of grief in the Revenue scientifique morosely proclaimed his reputation even in Germany. “Claude Bernard était de tous les français celui que l'orgueilleuse science d'outre-Rhin osait le moins méconnaître.” The Chamber of Deputies paid 10,000 francs for his burial from Saint-Sulpice in the first public funeral for a scientist. Yet Comte's influence lurks in the inspirational ideology leading directly to biology. Some even believe that it has left its potent traces in the Bernardian gospel itself.

Did Auguste Comte and the divided band of positivists significantly influence the development of biology in nineteenth-century France? Many historians of biology, perhaps even most scholars, would not hesitate to answer yes.

The bourgeois context

In spite of the “rise of the bourgeoisie” – a universal constant in Western history whose explanatory power is exceeded only by the formula “It began with the Greeks” – France was a peasant country in 1870. In 1814 the population of France was 29,000,000 rising to 36,000,000 in 1871, more than Great Britain's but nearly 5,000,000 less than Germany's. Between 1846 and 1859, and again the period 1890–1946, the reproductive rate fell below 1.00. Although there was a rise in the rate between 1860 and 1889, the French population stood at only 39,500,000 in 1914, less than Britain's and way below Germany's 67,800,000. No comparison of economic or educational systems can ignore the direct implications of different population bases. According to the 1891 census, 46 percent of the population was living off agriculture, 25 percent off industry, 13.5 percent off commerce and transportation, and 6.6 percent off the liberal professions. The second half of the nineteenth century saw a decline in the percentage of the active population in agriculture and domestic service and a corresponding growth in other sectors, but the structure of the active population was not radically modified.

Yet enough profound change took place to justify the statement that a new France emerged between 1870 and 1914.

In his Histoire de la civilisation en Europe (Sorbonne lectures, 1828–30), François Guizot showed without difficulty that French civilization was the truest representative of European culture. That this judgment was a truism for cultured men of the day was evident in John Stuart Mill's ready assent that only a clod could not know that “the history of civilization in France is that of civilization in Europe.” What was the nature of this civilization that enthralled the European mind for at least two centuries? The superb German survey entitled The Civilization of France (1930) by Ernst Curtius makes it mainly a matter of literary culture: “Literature plays a far larger part in the cultural and national consciousness of France than it does in that of any other nation.” Victor Hugo summed it up: “Literature is civilization.” Curtius argued that “in France literature fulfills the function which among us [Germans] is divided between philosophy, science, poetry and music.” So even Cartesianism, “the most important factor in the intellectual history of France,” was distilled into the literary cliché of clarté française. France's intellectual hegemony in Europe was facilitated by the cultural universality of its language, characterized by “logic, lucidity, brilliance, naturalness, and taste.” This leaves little room for the cult of Isis, widely touted elsewhere as the goddess to whom we must pay tribute for our modernity.

At about mid-century, research and teaching in natural history and physiology in both the Muséum and the Collège de France were much stronger than in the faculties of science. In 1855–6 it was possible to classify the faculties into three categories according to the level of their teaching of natural history. In the first group, with a full faculty, including three professors in natural history, one for each “order” of the natural world, were Paris, Lyon, Montpellier, and Toulouse. The second group, with two professors of natural history, one of whom taught two different courses, included Caen, Dijon, Strasbourg, Besançon, Grenoble, Rennes, and Bordeaux. The third group, made up of new faculties having only one professor for all of natural history, included Lille, Nancy, Marseille, Clermont, and Poitiers. But less than a quarter century later the faculties had improved considerably in the whole range of biological science; in the last decades of the nineteenth century a great deal of new biological research was done in the faculties. In areas like marine biology, the faculties were the most productive institutions in research and in training researchers and teachers.