The Pharmaceutical Journal
Vol 268 No 7189 p376
16 March 2002

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Father of pharmacy [more]
Facing the music [more]
Music and the brain [more]

Father of pharmacy

In Science for 1 February, Vivian Nutton of the Wellcome Trust Centre for the History of Medicine has drawn attention to that remarkable figure from antiquity, Galen, from whose name pharmacists everywhere derive their adjective "galenical".

Claudius Galenus, sometimes called Clarissimus Galenus, was born in Pergamum in AD129 or 130 and became celebrated among his contemporaries as a man of enormous energy, wide learning and massive self-confidence. He was the son of a wealthy architect and was given a first-class education in rhetoric and philosophy in Pergamum. He then turned his attention to medicine, which he studied in Smyrna and Alexandria.

In 157 he returned to his native city, where he was appointed to supervise the welfare of a troop of gladiators, and in 162 made his first visit to Rome. Here Galen achieved some notoriety by performing public dissections of animals. Four years later he retreated to Pergamum again, but whether from fear of a smallpox epidemic or irritation by less successful rivals is unknown. In 169 he was back in Rome, having been summoned to attend the Roman emperors on their military campaigns.

Claudius Galenus wrote many works, sometimes estimated to be 500, but probably far fewer — in the region of 100. They covered every conceivable subject from grammar to gout and from ethics to eczema. He was a great admirer of Plato, Hippocrates and Aristotle, and gained in his lifetime a reputation as philosopher as much as doctor. He insisted that any good doctor should also be a thinking person with ability in logic, and the faculty of linking physical with mental problems. Moreover, he stressed the necessity to experiment practically as well as reason from obvious appearances. He made a systematic study of the nervous system, and incessantly performed anatomical dissections, although the human body was a forbidden subject in his time.

One thing we can learn from Galen is the peril that arises from rigid specialisation in medical matters, which he regarded as unforgivable. For him a sound diagnosis of a disease involved taking into account every detail and not ignoring any finding that might be hastily judged insignificant. He held that disease was an imbalance of some bodily system that caused qualitative changes in the life of an individual.

Galen held a religious conviction that he was under the personal protection of Asclepius, the god of healing in Greek mythology, whose snake-encoiled staff became the symbol of medicine everywhere.

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Facing the music

One of the prominent features of our time is the unwillingness of individuals to take responsibility for their own actions and decisions. Politicians are notorious for their almost invariable custom of passing the buck to someone who is in the sad situation of having no alternative but to hold it.

Incidentally, the expression "passing the buck" is attributed to Mark Twain in 1872, and its logic is obscure. The alternative expression "carry the can" is older, and believed to refer to menial tasks carried out by subordinates and slaves. To be responsible is to be accountable to someone, in the last resort oneself. It means, in its critical sense, culpable morally, legally or causally for some deed done or neglected.

Ascription of responsibility depends upon an individual's state of mind at the time of an action. Violence may be excused, at least legally, if the perpetrator took action in the belief that his or her life was in danger and that there was no way of evading the confrontation. Action under orders from a superior official may be legally valid but morally indefensible. Much depends on the role of the person in an organisation.

Role responsibility may be professional or social, and involves expertise. To be a responsible pharmacist one is obliged to maintain a high level of expertise; hence the enormous importance of continuing study and evidence from examination results. Apart from accepting responsibility for actions and decisions carried out personally, a pharmacist has to face the challenge of delegating responsibility, which is sometimes difficult. We know that there are situations where a trained assistant has to be relied upon, since a pharmacist cannot be in two places at the same time, or perform two tasks simultaneously. To delegate means to appoint as a representative, and critical judgement is required to do it safely and effectively.

Thus W. B. Yeats was right when he remarked that ''In dreams begins responsibility" — perhaps nightmare might be a more apt word. And Bernard Shaw took the cynical approach when he stated in 'Man and superman' (l903): ''Liberty means responsibility. That is why most men dread it."

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Music and the brain

In Nature for 7 February, Thomas Münte, a neurophysiologist from Magdeburg, discusses the lack of musical ability exhibited by some individuals. He comments that music educators, faced with a dearth of musical aptitude in their students, often ascribe the failing to lack of practice. However, others puzzled by the situation have described a developmental disorder which they call "congenital amusia", which ranks beside developmental dyslexia and specific language impairment. The possibility that some individuals suffer from an inborn deficit of ability to process musical stimuli has been mentioned for more than a century, although there are scant reports of actual cases.

Research has indicated that memory for songs, perception of tone intervals, melodic contour, rhythm and metre are distinguishable from one another and can be selectively impaired in patients who have suffered damage to particular areas of their brain. In tests of unmusical subjects, those involving pitch perception have indicated a general failure, whereas testing for appreciation of rhythm and metre have shown a wide variety of degrees of failure. Unmusical individuals have proved insensitive to distortions of familiar tunes, and indifferent towards deliberate dissonant chords, although able to recognise familiar voices, song lyrics and sounds of the environment.

The question then arises whether such a deficit is specific to music, or whether it extends to other aspects of pitch communication, such as spoken language. Modulation of pitch contour is crucial for communication via speech. Long ago, geneticists discovered that ability to discriminate pitch is a hereditable factor.

It is now concluded that congenital amusia must be regarded as a specific developmental disorder. To determine anything further it will be necessary to investigate the combined behavioural and genetic characteristics of those people who experience defects in musical processing. Without this, the biological origin of the faculty of musical appreciation will remain obscure.

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