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The Brain Takes Shape: An Early History
http://www.100md.com 《新英格兰医药杂志》
     This is a well-researched book about an important topic that is underrepresented in the history of science: the transformation, mainly during the 17th century, of the widespread belief that the heart is the primary locus of personhood to the belief that, in fact, the brain serves this function. The story Martensen tells, however, is not just of anatomical discovery. The author weaves a theme throughout the book about the declining importance in natural philosophy of "presence" — which he defines as the "tendency to imagine knowledge of the world and the world itself as dependent on the spiritual capacity and interaction of knower and known" — in favor of "likeness" — "the epistemic assumption that one may know substantial aspects of material nature and depict them accurately without relying heavily on spiritual capacities and relationships of the observer and observed." (Both terms are drawn from the German art historian Hans Belting.)

    The increasing importance of "likeness" (as we would now call it) in science brought with it a growing acceptance of, and even a preference for, precise imagery. Whereas medieval anatomical sketches tended to be rather crude and schematic, the Renaissance gave greater attention to accurate and detailed pictorial rendering. Martensen notes that this shift, ironically, occurred at almost the very time that the Protestant Reformation was downgrading the significance of religious imagery in favor of biblical text.

    The book has nine chapters. The first two set the scene by introducing a number of major background figures: Vesalius, Harvey, Paracelsus, Bacon, and Van Helmont. Then Martensen discusses the anatomical work of René Descartes, arguing that although pictorial imagery played a much greater role in Descartes's writings than in those of his predecessors, Descartes was still more beholden to the tradition of presence than to the emerging value of likeness in his thinking about the brain and its relation to the mind. At the center of the book is Thomas Willis and his seminal works on the anatomy of the brain. Willis and his fellow Oxfordians rejected Descartes's fascination with the pineal gland and his speculative view of the mind as an "unextended substance" in favor of a description of the nervous system in its own right. Martensen is careful, however, not to make the old mistake of casting Willis and his colleagues as "pure" scientists, wholly detached from the world around them. This was, after all, the time of the English Civil War, the execution of Charles I, Cromwell's Protectorate, and finally, the restoration of the monarchy. Throughout the book, Martensen details the religious and political pressures that informed Willis's work.

    Unlike Descartes, who believed the soul to be unitary, Willis, following Galen and Plato, held that there were multiple human souls — rational, sensitive, vital, and so forth — corresponding roughly to what we today might call different mental functions, and that these can come into conflict with one another. This concept enabled Willis, in turn, to reclassify a number of pathologic conditions, widely believed at the time to be humoral in origin, as neurologic disorders. Sometimes he was right (as in the case of convulsions) and sometimes wrong (scurvy), but his hypotheses marked an important transformation in the understanding of the person nonetheless. In one chapter, Martensen considers the transformational effect of Willis's "neurocentric" position specifically for the understanding of women's anatomy and pathology, especially of "hysteria."

    He concludes the book with consideration of the medical and broader philosophical consequences of Willis's approach. These include the empiricism of the 18th-century British Enlightenment, which, it may surprise the reader to learn, arose at least as much from a critique of Willis's method as from an adherence to it. Martensen also briefly traces the sequelae of these debates to modern times, in the works of figures such as Walter Canon, Antonio Damasio, and a variety of phenomenologists and cognitive scientists.

    Martensen's writing combines the expert technical knowledge of a working physician with the professional historian's sensitivity to matters of context and wariness of histories that are too eager to celebrate rather than to carefully describe and analyze. This is an excellent book.

    Christopher D. Green, Ph.D.

    York University

    Toronto, ON M3J 1P3, Canada

    christo@yorku.ca(Robert L. Martensen. 247 )