5) The Fabric of Life

Anatomo-Pathology as Ideological Project

During the first decade of the 19th century, disease became a reaction of the body, whose causes could be located in anatomical organs and tissues (anatomo-pathology), leaving the theory of species behind. Foucault identitifies Xavier Bichat as a founding figure of this new understanding, and Claude Bernard's work in the 1860s on the chemistry of vital functions marks the triumph of this new understanding. He discovered that the body makes its own chemicals as it was previously believed that only plants could do this which animals would eat, and thus give us the chemicals. He became the father of endocrinology. Bernard also dissected animals which saw the breaking down of barriers between animals and humans.

Georges Canguilhem argued that this new understanding of disease was conceptually flawed as he said that pathology couldn't be reduced to abnormal physiological function without a tacit, qualititative distinction between normal and pathological, health and disease. He was essentially asking how doctors decided on the figures of good blood sugar and bad blood sugar etc, and asked whether doctors deserved the admiration they received from the public. He maintained that the sustained effort to explain pathological phenomena in physiological terms must be understood as an ideological project. Although, he doesn't address how the anatomo-pathological project succeeded in becoming the dominant approach to understanding life, in all its manifestations, despite its conceptual flaws.

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The Rise of the Middle-Class

Throughout Europe, the French Revolution drew attention to the emergence of the middle class. After the post-revolutionary political settlements, the German middle class called for reforms that would recognise their growing economic and social importance. But, aristocratic reaction foreclosed any liberal compromise, and any alliance with the increasingly radical working class was neither viable nor desirable.

The middle class sought to further an emerging, alternative ideology that emphasised the corporate solidarity of the different classes in fostering the organic (as opposed to antagonistic) development of the state: nationalism. Entry from the more respectable ranks of the working classes into the middle classes was through professions like the clergy, law and medicine. But, this was no guarantee of economic prosperity and social respectability. Most physicans, for example, either worked in an open, unregulated market where they had to compete fiercely with lay healers, or they worked as Medical Officers of Health which entailed a return to the lower status of salaried worker. Like other members of the middle class, aspiring medical professionals called for the reform of the medical market.

The aspiring medical professionals within the middle classes emphasised education as key. Such education emphasised the disinterested pursuit of knowledge over either the practical arts (working class) or the fine arts (aristocracy). This provided the opportunity to promote their alternative ideology: the analogy between the unity of knowledge and the unity of the nation.

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The Unity of Nature

During the 1790s, there were arguments between Alessandro Volta and Luigi Galvani over the meaning of their experiments on electricity and muscular contraction. For Volta and his followers, the experiments demonstrated that life could be explained in terms of phenomena of physics like electricity, e.g. nerves are electrical conductors (materialist reductionism). For Galvani and his own followers, the experiments illustrated a similarity, but not identity, between different forms of moving forces in nature e.g. nerves and electrical conductors are alike, but not the same (vitalism). He said there was a spark in every living thing and that not everything could be explained with chemicals etc.

The second vitalist approach to understanding life was strongly advanced by German natural philosophers. They tried to demonstrate the unity of all natural phenomena. In the 1830s, Johannes Müller deployed the anatomical approach developed by Bichat and other contemporary anatomists to illustrate the unity of plan that underlay the formal and functional development of different animals. To show the unity of nature, he compared embryos of different creatures.

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Müller's notion of plan and purpose in nature echoed the nationalist's own idealism (a viewpoint similar to vitalism). This earned him an appointment at the University of Berlin and attracted a number of the brightest sons of the aspiring middle classes (du Bois-Reymond, Helmholtz and Ludwig). He encouraged them to pursue all kinds of investigations in the chemistry and physics of vital function. He enouraged and supported his students' research, but only if it contributed to understanding the unity of all natural phenomena. (he was a student of the old medicine)

Müller didn't want their work to produce the kind of materialistic and utilitarian emphasis which characterised the physiological work of the chemist Justus Liebig. Liebig blurred the difference between university and technical college, and undermined the principal thrust of natural philosophy, which was the disinterested pursuit of knowledge of the organic whole. In Liebig's lab, people were also assigned different jobs like a factory to increase efficiency.

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From Idealism to Practical Interest

By the 1840s, the younger generation of researchers, like in Müller's lab, became suspicious of the over-arching ideas that underpinned vitalism, which they saw as an elitist device to maintain their subordination in the universities. Basically, Müller was saying you have to listen to me to understand, and when asked if such things could be measured, he replied with no. The students couldn't contradict him because success depended on support of the professoriate.

The younger generation became enthralled by the mechanical apparatus that enabled their experiments which was developed in collaboration with students from industrial backgrounds instead of their own middle class background. Anyone could become a productive researcher, but practical hands and minds focused on precise problems. This is what the lab offered. The younger generation was shaping a new set of ideas and political values:

  • The nature of vital phenomena became what was measured by experimental equipment, regardless of philosphical implications. Physiology and philosophy were separate.
  • What matters politically is commitment to the advancement of science and technology to improve the material progress of the state. By extension, vitalism, as an approach to (human or other) biology, was devalued in many people's minds, in favour of materialism.

So, after 1848, students turned their attention from democratising the university (which was unlikely to succeed), to tying it to a new political mission: technical progress, which allowed them to form political and institutional alliances with powerful entrepreneurial, industrial reformers (liberal nationalism).

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The Emergence of Scientific Medicine

In the 1850s and '60s, the new alliances forged by the generation of the 1840s, were translated into reforms of German medical education so that maths, physics, chemistry, and physiology became central to the pre-clinical training of the physician (which effectively introduced regulation of access to the medical profession). However, the kind of work in labs advanced by the likes of du Bois-Reymond, Helmholtz, and Ludwig would not have any impact on medical practice until the 1870s and '80s.

What instead emerged was an understanding of medicine as a fundamentally scientific enterprise, where what mattered was only that which could be seen, measured and acted upon: materialism, medical positivism and rational therapeutics.

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