Monday, October 5, 2009

2009.10.06

Version at BMCR home site
R. J. Hankinson (ed.), The Cambridge Companion to Galen. Cambridge Companions. Cambridge/New York: Cambridge University Press, 2008. Pp. xxi, 450. ISBN 9780521525589. $29.99 (pb).
Reviewed by Y. Tzvi Langermann, Bar Ilan University

Table of Contents

Galen was a scientist and philosopher of very broad interests, and this is reflected in the choice of topics covered in this volume; only four of the essays deal exclusively with his achievements in medicine. A very consistent picture of the man emerges from the essays. Here follow its main features; they are driven home by the various authors and justified by liberal quotations from a wide variety of sources. Galen was both a keen observer and a committed philosopher. He thus strove to integrate his observations into a rational system. Nonetheless, he was very aware of the constrictions that tempered this enterprise: there are individual cases that defy general rules, there are phenomena that are not accessible to the senses, and there are occasional doubts as to the correct conclusion to be drawn. None of these considerations justifies an extreme skepticism, the abandonment of observation, or giving up the task of systematization. Galen carries on his own work with verve, with his eye on the ball, his brain constantly processing data, his guns maintaining steady fire on his opponents.

In the first of his essays, "The Man and his work," R. J. Hankinson describes Galen's long life of research, writing, connections to imperial courts, and polemical engagements. As far as biography is concerned, Hankinson highlights Galen's admiration for his father, his sexual prudery, and his physical timidity. In his scientific work, Galen was gifted with enormous powers of observation, a very healthy dose of patience, but also some good luck. In particular, he strove to give medical science the required philosophical underpinning, and in this he was successful. Hankinson tries to modify somewhat Galen's image as a vainglorious self-promoter, arguing that the ferocity of his polemics--in addition to being part and parcel of the rhetorical climate of his times--was due to his love of truth. Galen saw himself "as a man with a heroic mission to rescue medicine, and science in general, from their degenerate decrepitude" (p. 24). G. E. R. Lloyd's essay gives us a closer look at one particular aspect of the biography, "Galen and his contemporaries". Though Galen did indeed confront rivals, at times in front of large audiences, he reconstructed these events in his writings with a polemical aim in mind. His main targets are the Methodists and the Sceptics. Teun Tieleman ("Methodology") emphasizes Galen's early training in mathematics, which led him to adopt "geometrical demonstration" as the model for his work in philosophy and medicine. Tieleman chooses to illustrate Galen's particular combination of empiricism and rationalism by means of a close reading of his attempts to discover the structure and location of the soul. Syllogistic proof and experiments using vivisection allow him to establish the central role of the brain in the nervous system.

The first of Ben Morison's two contributions is a fifty-page review of Galen's contribution to logic, helpfully detailed and full of fresh insights. The practical side dominates in this science as well. Galen was looking for logical tools that would be useful for demonstration, especially but not limited to medicine. He disliked Stoic logic; he borrowed a lot from Aristotle, but found the latter's categorical syllogistic not be of much use for his own scientific investigation. For one thing, medicine is concerned with particular patients; the body of a given individual may not observe a universal rule. Hence Galen admitted particular propositions into his investigations. Galen's investigation of hypothetical syllogisms is based on the idea that clauses introduced by the word "if" have different meanings; they may introduce denials ("If I'm wrong, I'm a monkey's uncle"), affirmations, or real contingency. More generally, he found "relational" propositions to be the most important for his investigations, and these were overlooked by both Aristotle and the Stoics. But just what are "relational" propositions? Clearly they are connected to mathematical reasoning, but it is difficult to say much more with any certainty.

Morison's essay does leave me with a few questions. (1) Morison is unaware of the important study of A.I. Sabra, published in 1965, on Ibn al-Salah's defense of the fourth figure. Ibn al-Salah apparently had access to some Galenic writings that are no longer extant in any language, and his report supports the view that Galen rejected the fourth figure. Sabra, similarly to Morison, suggests that the attribution of the "discovery" results from mistaking the scholiast's remark on "Galen's four figures" to refer to simple syllogisms, rather than the compound ones that Galen met in Plato.1 (2) The hope that al-Razi's critique of Galen would allow us to recover substantial portions of Galen's lost work On Demonstration has not materialized; al-Razi provides only a few passing references to that text.2 (3) Morison's search for a possible source or motivation for Galen's view that one and the same term can be used "to express a multitude of logical relations" leads him, with great caution, to "conversation theory". Why, however, can this opinion not be a product of his medical studies and experience, as indeed was Galen's overall warning to pay attention to meanings rather than expressions? After all, when a doctor says that the cause of a given ailment is a or b, a or b need not be in complete conflict. This is precisely where Galen differs from the Stoics on disjunctive statements. (4) The starting point for the relational syllogism is said to be, if a=c and b=c, then a=b. This is indeed how Euclid applies the first of his common notions in the first proposition of his book. However, it is worth noting that Apollonius took the common notion to be a statement of transitive equality (if a=b and b=c, then a=c), and proceeded to "prove" it, much to the dismay of Proclus.3

The second contribution by Morison, "Language", is almost as long (41 pages) but in this case the length does not seem to be justified. Once again, the principal theme is Galen's insistence upon meaning rather than upon naming; the main purpose of language is to communicate, and do this one must make oneself understood, to the speaker of Greek, or of a particular dialect of Greek, or some other language. This same point is driven home time and again. Morison shows that many of the fine points that Galen ostensibly raises concerning language are in fact convenient launching points for digs at Chrysippus. There is, however, one matter on which medieval students of Galen would take issue strongly with Morison, and that is his discussion of the excursus on language near the beginning of book II of Differences of Pulses. According to Morison (p. 145) Galen's insistence on proper Greek usage is not "mere snobbery about the Greek language"; indeed, Galen "would be quite happy to use a foreign language, instead of ordinary Greek, if everyone followed suit." Morison leaves out of his discussion, however, the pungent remarks which were not lost upon those who read Galen in Arabic: "Greek is the most pleasant language ... and the most fitting for humans. If you observe the words used by other peoples in their language, you will see that some closely resemble the wailing of pigs, others the sound of frogs, others the call of the woodpecker." Abu Bakr al-Razi and Moses Maimonides among others were moved to respond. Interestingly, neither rejected Galen completely. Al-Razi simply remarked that each people finds its own language to be the most pleasing to the ear. Maimonides asserted that Galen did not mean that Greek alone was best suited for rational discourse; Galen's remark holds true for all the languages of people inhabiting the temperate zones.4

Hankinson's second essay ("Epistemology") is rich in quotations and examples which serve to reinforce the scientific profile that has already been established. Galen is a practical scientist, aiming for the most reliable epistemology in a field where knowledge is intrinsically insecure. He rebuffs skepticism but maintains a healthy sense of doubt. Neither reason (logos) nor experience (peira) is sufficient by itself. Instead, one must reason on the basis of observations, and test the results of one's reasoning against further observations. One of the most important points in this essay is made in an endnote (n. 29): "every patient and every ailment is sui generis, and determination of their idiosyncrasies is extraordinarily difficult and plagued with imprecision." This is due to the fact that there were several variables in even the healthy human constitution, making it very hard to decide just what had gotten of balance and how balance ought best to be restored. Gender, age, and ethnos, as well as the bodily dispositions (heavy, wet, etc.) were all factors.

The essay on psychology by Pierluigi Donini is concerned mainly with Galen's attempts to establish that the soul is tripartite and to locate each of the three faculties in the proper organ. Galen's location of the rational part in the brain is singled out for praise (p. 191): "In its combination of direct observation, experimental tests and logically rigorous argumentation, one might well say that from a modern standpoint that this is one of the finest results obtained by Greek science." Donini relies mainly on two texts, On the Doctrines of Hippocrates and Plato, written in Galen's maturity, and a later "pamphlet" (as Donini chooses to call it), The Faculties of the Soul Follow the Mixtures of the Body. There are some significant differences between the two, for which Donini proposes an interesting and original interpretation. There is an "original conceptual nucleus (which is effectively present throughout Galen's thought)", which is clearly evident in the earlier tract. The later views are but an outgrowth from this nucleus.

The third contribution by Hankinson ("Philosophy of nature") ranges widely. Two points are strongly emphasized: Galen's contribution to a theory of the elements, which he thought to be critically important, even if (as usual) he had some lingering doubt whether his own theory was correct; and his teleology, which was stricter even than Aristotle's. Julius Rocca ("Anatomy") highlights the crucial role of anatomy, which combined epistemic, teleological, empirical and practical ends. Most of his attention is devoted to Galen's precise investigations into the brain. Armelle Debru's offering ("Physiology") is one of the strongest pieces in the volume, a very thorough piece that explains fully how Galen believed the body (including the governing soul) carries out its functions. In fact, Galen has no concept of function in the modern sense of the term. Instead, he speaks of energeia, "capacity in action" to use Debru's translation, which has its places in an Aristotelian framework of active and passive components. No part of the body is useless, each producing something that Galen calls ergon, "work". Every faculty (dunamis), psychic and corporeal, has a purpose; teleology reigns supreme.

Therapeutics, meaning both the "care" for a healthy body as well as the "cure" of a sick one, is covered in a nice essay by Philip J. van der Eijk. Galen details a procedure, based mainly on a process of elimination (diairesis, "division", and diorismos, "specification"), whereby the trained physician sorts out the data available to him on a given patient in order to arrive at the most appropriate strategy for treatment. The physician's experience is again critical, and there is an inevitable element of conjecture involved. Galen emphasizes the proper raising of children; a sound regimen begun early in life will lead to an optimal krasis (mixture of humours, temperament) for a particular individual. Galen was less successful in applying theory to practice in pharmacology. Sabine Vogt explains that in this field as in others, Galen felt that there ought to be a logos that would direct the measurement of the intensity of a simple's qualities (on a scale of one to four), as well as the much more difficult task of computing the net quality of a compound drug. Only about a third of the simples listed by Galen list the degree of intensity; and Galen was not able to come up with "a consistent theory of how their powers add up in a compound to a new, 'compound' power" (p. 312). Medieval scholars attacked this second issue with vigor, and several competing systems emerged.5 Moreover, the various systems that were developed by Latin pharmacologists were taken over by physicists, whose deliberations were small but important steps towards the mathematization of physics.6

A good deal of Galen's literary output took the form of the commentary. His exploitation of this platform fits in very well with the norms of the period, but his combination of medical and philosophical exposition is an innovation. The survival rate of his commentaries to Hippocrates, relative to his complete opus, is high; but all his thirty-eight commentaries to Aristotle are lost. Galen strives to demonstrate the correctness of Hippocrates' teachings no less than he does to clarify obscure points. He has not, as some might aver, constructed a Hippocrates in his own image, but rather has shored up the image of Hippocrates as a rationalist. These are some of the highlights of the extremely rich study by Rebecca Flemming ("Commentary").

The final item in the volume written by Vivian Nutton, is a magnificent panoramic of "The Fortunes of Galen," from Galen's lifetime down to the early twenty-first century. Nutton sketches out the transmission, neglects and rediscoveries of the Galenic corpus; the effect of print; the various spheres--anatomy, logic, focus upon the individual patient--where the impact of Galenism made its strongest impression in the course of (mainly European) history. Nutton modestly begins his essay by asserting that a description of the fortunes of Galen is almost like writing a history of medicine, and, in a note, he defers to the Owsei Temkin's classic book on Galenism. In fact, though, this essay is itself a triumph of scholarship, based for the most part on primary sources written over the past two millenia, by a scholar who has a played a lead role in the recent flowering of Galenic studies; Nutton has authored some twenty-five of the items listed in the very rich bibliography found at the end of the volume.

There are fourteen essays but only eleven authors. The editor, R.J. Hankinson, has contributed three essays, and Ben Morison two. Hankinson discloses his tribulations in putting together the volume in the final paragraph of the preface. Those ordeals notwithstanding, Hankinson has produced a very useful and informative volume, which, much in keeping with new appreciation of Galen described by Nutton, addresses the many facets of Galen: physician and medical researcher, to be sure, but also philosopher and man of letters.



Notes:


1.   A. I. Sabra, "A Twelfth Century Defence of the Fourth Figure of the Syllogism," Journal of the Warburg and Courtauld Insitutes 28 (1965), 14-28; reprinted in idem, Optics, Astronomy and Logic, Variorum Collected Studies, Aldershot, 1994.
2.   Al-Razi has nothing to say about the fourth figure book-length critique of Galen, Kitab al-Shukuk ala Jalinus, edited by Mehdi Mohaghghegh (Tehran, 1993).
3.   T. L. Heath, The Thirteen Books of Euclid's Elements, second edition, Dover reprint, New York, 1956, vol. I, pp. 222-3.
4.   The pertinent passage is not found in Joseph Schacht and Max Meyerhof, "Maimonides Against Galen on Philosophy and Cosmogony," Bulletin of the Faculty of Arts, Cairo, 1939, 43-88, and the relevant portion of the new edition and translation of Maimonides' Aphorisms by Gerrit Bos has not yet appeared. For now I refer to the Judaeo-Arabic text and facing Hebrew translation by J. Kafih, Maimonides, Iggerot (Letters), Jerusalem, 1987, pp. 149-150; for al-Razi's views see his critique (cited above, note 2), p. 87.
5.   See Y. Tzvi Langermann, "Another Andalusian Revolt? Ibn Rushd's Critique of al-Kindi's Pharmacological Computus," in Jan P. Hogendijk and A.I. Sabra, eds., The Enterprise of Science in Islam, MIT:Cambridge USA and London, 2003, pp. 351-372.
6.   See e.g. Edith Sylla, "Medieval Quantification of Qualities: The 'Merton School'," Archive for History of Exact Sciences, 8 (1971), 9-31.

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