Armelle Debru, Le corps respirant, la pensée physiologique chez Galien. Studies in Ancient Medicine, 13. Leiden: E.J. Brill, 1996. Pp. viii + 302. $112.50. ISBN 90-04-10436-4.
Reviewed by Rebecca Flemming, University College London, email@example.com.
Word Count: 1,206.
The essential connection between breath and life has been very variously conceived and construed down the ages; but, within the western tradition, the specific conception and construal of the human body as a breathing body articulated in the late second century A.D. by the physician Galen is of particular importance. For his treatment of respiration is embedded in an oeuvre which was proposed, and subsequently accepted, as a summation of classical medical thinking. Its surviving substance stands, therefore, as an incomplete but nonetheless imposing monument to both Galen's own aspirations and achievements and those of his predecessors and more immediate interlocutors, whose supersession has otherwise left them largely speechless; and its substantial survival is itself the mark of success, of that acceptance, of the dominance of Galenic physiological and pathological models in medicine up to, and even beyond, the European Enlightenment.
As Debru points out, historical studies of Galen's respiratory notions have thus far tended to focus on their forward movement rather than their background, or the fullness of their contemporary setting. The concentration has been on the ways in which they provided positive precursors for, or intractable impediments to, the development of the modern understanding of the matter -- in particular as this depends on William Harvey's discovery of the circulation of the blood in the early seventeenth century -- and not on the ways in which they work within Galen's medical system as a whole, the ways in which they fit into the wider patterns of his thought, and indeed, the deeper, precedent, patterns of thought on the subject more generally. It is this imbalance that Debru seeks to redress with this monograph.
Debru embarks, therefore, on her detailed descriptive and analytical journey through Galen's theory of respiration with a few introductory remarks about the persistence of the problem of breathing in his work, and about some of the basic elements of the way in which he approaches this problem -- conceptually, methodologically and terminologically. Indeed it is Galen's linguistic attitude, as evinced in his efforts to forge a more precise respiratory vocabulary than that used by his predecessors -- to distinguish inspiration and expiration both from each other and their sum, for instance -- that receives the most attention here.
Issues of language remain prominent; but it is the matter of method -- and of the interplay between empirical observation, even "experimental" enquiry, and the exercise of reason along paths prescribed, or simply proposed, by a pre-existing interpretative framework, in particular -- that is the real focus of the extensive treatment of the physiology and anatomy of breathing that follows. Debru certainly gives the former priority as she describes the way in which Galen rejected the cardio-centric respiratory models of Aristotle and the Stoics to formulate a theory of breathing, or at least of the mechanisms involved, in which the thoracic muscles, and the nerves that govern them, play the central role: the lungs expand and contract, air passes in and out, with the muscular movements of the thorax wall, as directed by the nerves, not under the direction of, or otherwise motivated by, the heart. In this Debru sees Galen as building on some (but not all) of the insights and ideas of the great Alexandrian anatomists, especially Erasistratus, with his own programme of dissections, his own series of demonstrations. Somewhat paradoxically it is in his delineation of the respiratory organs themselves that Debru considers Galen to have been more bound by a set of preconceptions about what constitutes an organ and how they work. And, of course, the key question of why, on account of what, humans breathe at all is both posed and answered (answered, as Galen claims Hippocrates had before him, with reference to the twin needs of nourishing the psychic pneuma and maintaining the innate heat) within the frame of Galen's overall system of understanding the human being in the cosmos rather than arising directly from the bodies he delved into. Here too, however, Debru is concerned to defend Galen's teleology from the charge that it was a paralysing principle, a barrier to real progress; for she sees the notion of the final cause as essentially heuristic, as a way of making the practical and polemical problems confronting the medical investigator and philosopher tractable, as a road to a coherence that would otherwise have been damagingly lacking.
Internal relations within Galen's medical system then come to the fore as Debru completes her coverage of his treatment of respiratory issues with detailed discussions of human transpiration -- the permanent passage of air and other substances through the skin -- and respiratory diseases; showing how his thinking and therapies in these areas fit in with principles and patterns already established. Lastly, a wider, social, and more particularly religious, dimension appears in her final chapter on respiratory exercises as part of various kinds of regimen; for Debru provides the vocal gymnastics recommended for general health as well as declamatory proficiency with a purificatory background.
Debru's systematic approach to Galen's theory of respiration is entirely laudable. The attempt to relate the various parts of any individual conceptual complex within Galen's oeuvre both more intimately to each other and more generally to the broader themes of his thought, surely promises to be most productive in gaining a real understanding of both Galenic specificities and generalities. Moreover, since these themes clearly have a background, and a contemporary context, they can provide a way into wider patterns of medical and philosophical thinking about the human being. Such an approach, however, poses considerable challenges in terms of the organisation of argument and material; challenges which have not really been met entirely satisfactorily in this case. Loosely, Debru prefers to start with respiration itself, to break it down into its parts and to follow them wherever they may lead within Galen's thought world, rather than to begin by outlining the overall shape and structure of that world itself, establishing the nature of his vast literary project as a whole, and then methodically setting about locating, pinning down, respiration within it. A degree of clarity and coherence is, I feel, lost as a result; and I suspect that less seasoned Galenic campaigners than myself will particularly regret the relative slightness and selectivity of the introductory chapter in this respect.
Much is achieved, however, in terms of analytic specifics, and I found the discussion of Galen's teleology, and the emphasis on its flexibility and dynamism, particularly useful. I was less happy, though, with Debru's treatment of the other side of the methodological and epistemological equation -- her assertion of the unequivocal primacy for Galen of dissection and "experimentation", of the direct examination and investigation of somatic phenomena, over the application of reason, the force of established explanatory grids -- for (quite apart from doubting the accuracy of speaking of any kind of "experimental method" in antiquity), I see Galen's observation and rationalisation as caught in a much closer embrace, so close that the question of priority cannot be resolved, indeed perhaps cannot even arise.
Nonetheless, I do hope that Debru's advocacy, both of Galen's oeuvre as an incredibly rich and inviting subject of study from any number of angles, and of one approach to it in particular, will be heeded.