Galen's anecdote of the fallen sophist: on the certainty of science through anatomy.

In this paper the author recounts an anecdote presented by Galen of Pergamum (circa 130-200 A.D.) about a sophist named Pausanias, who fell from his mount and struck his back against a rock. The patient developed a subsequent loss of sensation in the fingers of his left hand with complete sparing of motor function. Numerous medications were applied to his hand but to no avail. Galen stated that he applied the same medications to the original point of dorsal tenderness, resulting in the patient's dramatic and full recovery. Galen attributed the healing to local drug action at the site of a presumed spinal root injury, at the level of C-7. Galen repeated this anecdote elsewhere to illustrate the remote effects of spinal cord and nerve injury and the importance of treating the site of pathology, rather than its somatic manifestations. Galen's observation is interpreted in light of his earlier experiments on spinal cord and nerve transections in live animals and his evolving concepts of functional and correlative neuroanatomy. This anecdote is also discussed as a striking example of the dangers of conjecture and the temptation to confuse association with causation when interpreting the effects of therapy in light of widely accepted paradigms.