A Pathogenic Secret

I was called in to see a woman who was stated to be sleepless at night and to lie tossing about from one position into another. Finding she had no fever, I made a detailed inquiry into everything that had happened to her, especially considering such factors as we know to cause insomnia. But she either answered little or nothing at all, as if to show that it was useless to question her. Finally, she turned away, hiding herself completely by throwing the bedclothes over her whole body, and laying her head on another small pillow, as if desiring sleep.

After leaving I came to the conclusion that she was suffering from one of two things; either from a melancholia dependent on black bile, or else trouble about something she was unwilling to confess. i therefore deferred till the next day a closer investigation of this…

How would you investigate this case? How do you imagine Galen did?

After I had diagnosed that there was no bodily trouble, and that the woman was suffering from some mental uneasiness, it happened that, at the very time I was examining her, this was confirmed. When somebody came from the theatre and said that he had seen Pylades dancing, both her expression and the color of her face changed. Seeing this, I applied my hand to her wrist and noticed that her pulse suddenly b ecame extremely irregular (anomalous).  This kind of pulse indicates that the mind is disturbed thus it occurs also in people who are disputing over any subject. So on the next day I said to one of my followers, that, when I paid my visit to the woman, he was to come a little later and announce to me, 'Morphus is dancing today.' When he said this, I found that the pulse was unaffected. Similarly also on the next day, when I had an announcement made about the third member of the troupe, the pulse remained unchanged as before. On the fourth evening I kept very careful watch when it was announced that Pylades was dancing, and I noticed that the pusle was very much disturbed. Thus I found out that the woman was in love with Pylades, and by careful watch on the succeeding days my discovery was confirmed.

This case is taken from Stanley Jackson, "Galen--On Mental Disorders," J. Hist. Behav. Sci.,1969, 5, 365-384.  Jackson credits Brock, A.J., Greek Medicine, [London, J.M. Dent & Sons, 1929] pp. 213-14