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Polish School of Philosophy of Medicine |
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The School of the Philosophy and History of Medicine was
a research field in which Poland was undoubtedly a leader. Thanks to the
pioneering work of its representatives, the scholarly tradition which was
subsequently to culminate in the work of Ludwik
Fleck 
was born: the first chairs in the discipline to be created in
Europe were set up in Poland's five medical schools in 1920 and from 1924
onwards the journal Archives of the History and Philosophy of Medicine
[Archiwum Historii i Filozofii Medycyn], founded by the historian
A. Wrzosek (1875-1965), was published in Poznan. Even earlier, however,
Zygmunt Kramsztyk had founded the philosophy of medicine journal Medical
Critique [Krytyka Lekarska] (1897-1907), which was at the time the only
European journal devoted to theoretical and methodological problems in medicine.
The founder of the School was Tytus Chalubinski (1820-1889), who taught for a number of years at the "High School" in Warsaw and then at the Russian University. Above all he emphasised the importance for a doctor of serious training in logic and methodology, on the basis of which medical-semiotic investigation can be scientifically organised, and he viewed disease holistically as a perturbation of the overall functional structure of an organism. This stress on the importance of the functional structure led him to see disease not as something existing in nature but rather as an abstract representation, on the part of the physician, of certain phenomena separated from the natural context of their individual life. He therefore opposed contemporary trends in medicine which focused on disease, pointing out the central role of the patient, whose organic state, environment, living conditions and psychological state required individual investigation. He therefore never tired of repeating that a physician does not deal with sickness but with sick people.
The philosophical movement he inspired numbered several physicians of his generation, such as the oculist Wiktor Szokalski (1811-1891) and the histologist Henryk Hoyer (1834-1907).
A significant figure belonging to the next generation was Zygmunt Kramsztyk (1848-1920), a pupil of Chalubinski's, whose journal included contributions by all the major representatives of the School, both those of the previous generation and the younger members who were to continue his experience (such as Bieganski, Nusbaum and others). Inspired by the teaching of Chalubinski, Kramstyk tried to understand how a physician "constructs" a disease. His experience as an ophthalmologist taught him the importance of a priori ideas in generating clinical facts. This led him to criticise harshly the cult of scientific experiment, in which a disembodied figure comes face to face with "pure facts". He, on the other hand, stressed the importance of theory, the role of hypotheses in directing an investigation, as well as the role of teleological explanations in the field of medicine and biology. He therefore put forward with great clarity a constructivist vision of science, which saw the concepts of science as the result of a "construction" by scientists and viewed observation as being "loaded with theory". In addition, the importance he attached to accurate analysis of the historical development of medical knowledge generally led him to embrace a dynamic view of science, seen as a phenomenon in constant evolution which destroys old theories and excogitates new ones. The modernity of Kramsztyk's views is evident: they are not only essential to understand the subsequent thought of Fleck, but they also introduced, as early as the end of the last century, themes that have characterised philosophical and epistemological debate in the last few decades.
Closely linked to the School
and influenced in particular by the ideas of Chalubinski and, to a lesser
extent, Kramsztyk, was Wladyslaw Bieganski (1857-1917), who is considered the greatest representative of this
line of thought in Poland and is the best known overseas. Bieganski studied
in Warsaw and then specialised in Berlin and Prague. He combined his profession
as a physician (working for most of his life in the hospital at Czestochowa)
with an interest in philosophy, which was closely connected with his reflections
on medical science. He is considered to be one of the founders of medical
methodology.
In his most important work, The Logic of Medicine [Logika Medycyny]
(which was also translated into German), he outlined the first systematic
theory of diagnosis. He identified various methods of diagnosis, using the
classificatory method to capture the similarities and differences between
pathological phenomena. The aim was to formulate a hypothesis to explain
a given phenomenon, the validity of which could then be shown by checking
its implications. He completed his diagnosis by classification with causal
explanation, which he, like Chalubinski, particularly valued. He stressed
the fact that a physician cannot simply confine himself to identifying the
immediate causes of a disease, but has to try to trace it back as far as
possible: the more is known about the chain of causal relationships, back
to the most remote influences, the better the knowledge we can gain of physiological
and pathological phenomena. Of equal importance was his classification of
the errors of observation made by physicians, which he explained both psychologically
and methodologically, pointing out in particular errors of reasoning (such
as post hoc, and ergo propter hoc errors): his was the first
collection of diagnostic errors in medical methodological literature.
Besides causal explanation, Bieganski also attached great
importance in his work to the role of teleological explanation, which was
typical of medical and biological sciences, and whose scientific character
and extraneousness from any anthropomorphic conception he tried to demonstrate,
in opposition to the methodological prohibitions of the time. This conviction
was based on the observation that living organisms are complex systems,
structured as a functional collection of parts into a self-regulating whole.
He therefore saw teleological explanation as the most suitable way to gain
an understanding of the relationship between the whole and its parts, as
each organism is a "closed system" in which there is a close functional
connection between the parts and the system as a whole. A modification in
one of its aspects affects all the rest and starts off a process of adaptation
by which the organism chooses one of the various possible reactions to a
given stimulus to achieve balance with the surrounding environment and still
maintain its integrity. It would therefore be more correct, in his opinion,
to replace the term "purpose" with that of "meaning"
and thus speak of the meaning that a given phenomenon has for the adaptation
and balance of an organism.
Bieganski also studied the role of reasoning by analogy in scientific discovery,
outlining its logical characteristics and, by examining concrete examples
taken from the history of science, identifying its four main variants, to
which he connected a number of cases. At a subsequent stage in his thought,
investigating the related logical concepts, he recognised logic as a separate
science from psychology which, like mathematics, uses idealised constructions
that make it possible to verify the correctness of arguments.
In the field of the theory of knowledge he supported a rationalistic stand, in particular the so-called "epistemological prediction", i.e. the thesis that the main aim of both theoretical and practical science is not the representation of what exists (thus rejecting a correspondence-based conception of truth, which he believed led to scepticism) but rather prediction in a broad sense, with reference to the past, the present and the future. Knowledge of reality is only possible in a mediated fashion, by predicting its behaviour. He thus emphasises the practical character of knowledge; thanks to its capacity for prediction, it enables living organisms to orient themselves and adapt to the surrounding environment. From this point of view knowledge cannot be of a conventional nature, as PoincarÈ maintained, or of a purely economic nature, as Mach believed. The task of science is not only to construct a harmonious, coherent picture of the world founded on conventions, or allow economy of thought, but to enable man to act effectively on reality by predicting facts and events a knowledge of which is indispensable for the development of human activity. Finally, in natural philosophy he inclined towards neovitalism, in the attempt to reconcile determinism and indeterminism.
Several other scientists, both his contemporaries and members
of the following generation, followed Bieganski's example and dealt with
medical methodology. They include the pathologist Edmund Biernacki (1866-1911),
the physiologist Henryk Nusbaum (1849-1937), the zoologist Tadeusz Garbowski
(1869-1940) and the biologist Bohdan Rutkiewicz (1887-1933). Without doubt,
however, the most famous representative of the most recent generation of
philosophers of medicine is Ludwik Fleck
.
- E. Bienarcki, Istota i granice wiedzy lekarskiej
(The Essence and Limits of Medical Knowledge), Bibl. Dziel Wyborowych, Warszawa
1899 (German translation by S. Ebel, Die moderne Heilwissenschaft,
B.G. Teubner, Leipzig 1901).
- W. Bieganski, Logika medycyny, czyli zasady ogólnej metodologii
nauk lekarskich (The Logic of Medicine, or The Principles of General
Methodology of the Medical Sciences), E. Wende, Warszawa 1894 (2ª ed.
improved 1908; German translation, Medizinische Logik, Würzburg
1909).
- W. Bieganski, Wnioskowanie z analogii (Deduction by Analogy), Lwów,
1909.
- W. Bieganski, Traktat o poznaniu i prawdzie (Treatise on Knowledge
and Truth), E. Wende, Warszawa 1910.
- T. Chalubinski, Metoda wynajdywania wskaza lekarskich (The Method
of Finding Therapeutic Indications), Gebetner & Wolf, Warszawa 1874.
- Z. Kramsztyk, Szkice krytyczne z zakresu medycyny (Critical Notes
on Medical Subjects), E. Wende, Warszawa 1899.
- The Polish School of Philosophy of Medicine. From
Tytus Chalubinski (1820-1889) to Ludwik Fleck (1896-1961), compiled,
translated and Introductions by Ilana Löwy, Kluwer Ac. Publ., Dordrecht/Boston/London
1990 (the books contains a good selection from the works of the main representatives
of the School).
- J. Doroszewski, Philosophy of medicine in Poland at the turn of the
19th and 20th centuries, in "Metamedicine", 3 (1982), pp.
75-86.
- I. Löwy, Medical critique [Krytika lekarska]: A Journal of medicine
and philosophy 1897-1907, in "Journal of Medicine and Philosophy",
15 (1990), pp. 653-73.
- I. Löwy, From Zygmunt Kramsztyk to Ludwik Fleck: Medical observations
and the constructions of clinical facts, "The Polish Sociological
Bulletin", 1, 1989, pp. 39-48.
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