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Chapter 13

The Governing Principle Of Medicine

269. Medical practice restores, or attempts to restore, the extrasubjective phenomena which accompany a better state of health. This is achieved either by leaving nature to work unaided (doctors call this the wait-and-see method) or by applying certain agents to the body (the active method).
In the second method, the power of the active force, whatever it may be, is associated with the forces of nature to produce an effect common to the united causes.

270. This effect is known only through experience which reveals two things: first, the extrasubjective phenomena which appear in the body to which the agent was applied; second, the subjective phenomena belonging to feeling and life.

271. We have to remember here that the subjective phenomena are bound together in such a way that they constitute a single satisfactory state in the animal. This depends upon the unity in the animal itself. As we have seen, the feeling principle constituting the animal, although unique, is not simply sentient; it is also active in such a way that, in virtue of its action, the extrasubjective body changes and takes on a state of life. Because the agent is unique, the extrasubjective phenomena themselves, which are the effects of this action, form a unity revealed by their association and harmony.
Hippocrates commented on this when he spoke about a single consensus, a single harmony, a complete agreement. Modern authors express the same truth in this way: `Each part of the living body has its explanation in the body taken as a whole.'(126)

272. There is no doubt that even the mechanical organisation of the human body(127) is interconnected to support an extraordinary suitability for the communication of movement. Nevertheless, the mechanical design of the body, in which only material forces operate, would not of itself produce the unity of movement we do in fact see. Such a design would lack even the principle of movement. We could also take into consideration chemical relationships, and add these to the mechanical forces and organisation possessed by the body. A new lesson, the most wonderful provided by the Author of nature, would show us the chemical forces of fluids and solids united to the mechanical organisation and forces and producing the circular action which instead of consuming itself provides an unceasing vortex of particles where, according to Cuvier, life is to be found. Nothing superior to this unity could be imagined.

What we have described is however only the preparatory stage of the total organisation. Besides the chemical forces, we could add special, unknown forces apparently without feeling, and include opportune internal and external stimuli such as the air, electricity, light and every kind of nourishment. And we would still have only a dead body, a statue as it were prepared for the life God would breathe into it but at the moment only a corpse. For this reason all truly great scientists realised that extrasubjective experience could offer no explanation of the principle of vital action, and appealed finally to a principle altogether outside the sphere of extrasubjective experience. They turned to an essentially internal principle that did not fall under external observation, and as a result we have Paracelso and Vanhelmont's `prime element', Stahl's `soul', Bordeu and Barthez' `life principle', and the `life force' of almost all modern physiologists.

273. Further observation showed that, given the principle of extrasubjective phenomena, these phenomena were posited in a suitably prepared body together with feeling. From this, it was deduced that only the feeling principle could be the source-principle of the extrasubjective phenomena, although this principle takes on the condition of recipient(128) relative to what is feelable, that is, to the interior body which serves as the term of the fundamental feeling. As a result, given the corporeal feeling and the space occupied by this feeling as a scene of the external, extrasubjective phenomena, the phenomena of life had to appear on this screen as action exercised by the feeling principle and manifested extrasubjectively.

274. We are now in a position to express in philosophical language the responsibility of medicine and its supreme principle.

1st. A person's state of health or fullness of life is known only by that person's conscious witness to the satisfactory state of his feeling of life. The aim of medicine, therefore, is to attain a satisfactory state of subjective phenomena, that is, the normal state of the animal whose essence is entirely subjective.

2nd. It is, however, impossible to act directly on this subjective state (at least, it is not the proper expression of medical practice). Medicine, therefore, directs its attention to a parallel series of determined phenomena, that is, the extrasubjective phenomena, which constantly correspond with the normal state of the subjective phenomena. The series of extrasubjective phenomena accompanying the normal state of the subjective phenomena can rightly be called the normal state of the extrasubjective phenomena. The aim of medical science is to produce this normal state of extrasubjective phenomena in a living, human body in order to obtain the normal state of subjective phenomena which make up essentially the fullness of life, that is, a good state of health. The law we have enunciated makes it clear that this second normal state is always accompanied by the first.

3rd. If the extrasubjective phenomena were not bound together systematically, medical practice would be impossible. Taken individually, these phenomena are so numerous and of such variety that it would be totally impossible for human effort to assess or calculate all their possible variations, and take account of each one. Experience shows, however, that the variations and systems of extrasubjective phenomena are limited and determined, and even indicates that `every partial extrasubjective phenomenon corresponds to a whole series, more or less extended, of different extrasubjective phenomena'. This law of sympathy and synergy, which binds the phenomena together, makes medicine possible and reveals its supreme principle.

275. In fact, the supreme regulating principle of experience in medicine can depend only on this general problem: `Given a more or less extended phenomenon, or several phenomena bound together, how can we determine the complex or series of other phenomena which will follow?' All experience in medical practice seeks to solve this problem. If it could be solved, medicine would have reached its perfection.

276. What is illness? Simply a series of phenomena ordered according to certain consensual, synergical laws. That is, in every illness the presence of an initial phenomenon of varying extension (which may be simple or complex) immediately produces other phenomena which in their turn produce other phenomena and so on until health returns or the phenomena of death intervene. It is clear, therefore, that pathology would be perfect if experience could show `which phenomena necessarily follow each more or less extended phenomenon,'(129) granted, of course, that the state of the body were known in the first place.

277. The same can be said about any special treatment. Medication applied to the body immediately produces certain phenomena. These immediate phenomena are not, however, those which the doctor is aiming at. As a result of the law of synergy mentioned above, the first phenomenon or phenomena produce more numerous, extended phenomena which, bound together, produce still more phenomena. Each order or series of phenomena constitutes a better or worse state until signs of health appear, or the final order of fatal phenomena is reached. Only knowledge of the initial action of the medication, and of the chain of orders of phenomena which unceasingly follow one another, can bring curative medicine to perfection.

278. We can also see that in individual cases medical opinion embraces or at least indicates the universal principle of medicine. Doctors speak about symptomatic illnesses or of a state they call irritative. Symptomatic illness is an effect or sign of more serious, deeper illness; an irritative state is a disease of the body dependent for the most part on some localised cause. But if we take, for example, the inflammation produced by a dental abscess, we see that it is a second-order phenomenon following upon an initial phenomenon (to which it is bound by hidden laws of animality), and giving rise to third-order phenomena. On the other hand, a symptomatic illness is simply second-order phenomena dependent upon scarcely known first-order phenomena, and again giving rise to third-order phenomena.

In every illness, however, as we said, the phenomena follow one another in stages. This is not a characteristic of symptomatic or irritative illness alone, although it is easier to note the distinction between the first and second steps in these illnesses. In irritative illnesses, the localised cause, when uncovered, soon draws attention to its effect, which normally provides more serious phenomena than those in the cause itself. In symptomatic illnesses, the phenomena connected with the effect are normally less serious than those constituting the cause. But if the distinction between first- and second-order phenomena is not obvious, an illness is not called symptomatic or irritative, although subject to the same law of linkage as all other illnesses. Discovering these links and what we may call the hierarchy of phenomena in this kind of illness must also be the aim of wise medical science.

279. These considerations seem to provide a governing principle for experience in medicine, which should no longer be ruled by chance. They show that the aim of experience is to indicate `first-order phenomena, and the orders of all other phenomena'.

280. It is clear that this has not always be the guiding principle of medical science, and it is also clear that medicine is still a long way from achieving this aim, which is certainly difficult and perhaps never entirely possible. Nevertheless, it is the sole obligatory, essential aim for those who devote themselves to medicine, and every step taken towards it is a gain.
It follows that only this principle is suitable as a solid base for the philosophical classification of disease, and as a path for reducing nosology to scientific form. The different stages of phenomena associated with illness must constitute different orders and periods of disease itself.

281. One other important observation is necessary before I conclude this chapter, which is already too long.
Although there is a reciprocal action between the different parts or rather systems of the human body, it is certain that there is an order of phenomena even in a healthy state, and that concomitant actions result from this order. For example, it would be difficult to place a change of the different fluids separated out in the human body amongst phenomena that precede some defect in the organs of secretion. Rather, deleterious change would be found in an order following the normal change that takes place in the functioning of the organs of secretion. Nevertheless fluids inadequately or wrongly treated by the action of the organs separating them out would themselves become stimuli affecting and harming the action of these organs. In this case, the harm done to the functioning of the organs appertains to third-order phenomena, not to first-order.

If we now ask how stimuli produce this modification when applied to the organs of secretion, we certainly have to indicate at least the fibre contractility, swelling and other acts received by the body from the life principle, and maintained for some time by the body after the life principle has ceased to act. We have to point principally, however, to the relationship between the internal organs, especially their muscular bulk, and the nerve substance where the phenomena of life are more immediately evident. In all probability, we shall have to indicate modification in the nervous system as the principle of all other modifications.

In this case, the phenomena directly concern the principle of life whatever the place, part or system at which the disease begins. The principle of life reveals its activity principally in the nerves, the action of which is used to propagate the phenomena to other systems. It will be necessary, therefore, to investigate the action of the nervous system finally for the explanation of the universal consent of the various parts of the human body, a consent which gives rise to alteration in the whole mechanism when a single system, or a single part alone, is affected. Disease in the lungs, for example, provokes a whole series of ill effects which we call symptoms of tuberculosis. Here it is very obvious that a single agent irritated by a localised lesion then works throughout the body, producing its deleterious effects, and it is certain that the total, multiple change, accompanied by various complications throughout the mechanism, cannot be produced by the immediate, mechanical or chemical effect of the localised wound. We have to say that the wound stimulates the principle presiding over the whole complex, debilitates it, and prompts it to react by propagating the disturbance throughout the entire complex, communicating it to the different systems which in turn act successively and reciprocally according to the laws underlying the immediate influence of the life principle, or the laws' reciprocal influence.

The reaction of the life principle, immediately visible in the whole mechanism, to a single lesion in an important part of the extrasubjective body is certainly a very mysterious matter. It is, however, a fact without which such a harmonious response of the phenomena in all the parts, organs, systems and complex of the body to a single lesion-phenomenon could not be explained. The unity and harmony of the response is such that it must follow from a single, first cause whose action is then modified and changed by the various states of the different organs in which it takes place.

282. It may be objected that the action which produces so many extrasubjective phenomena cannot be the same as that with which the soul feels. We must therefore presuppose in the soul some power, other than the feeling principle, to modify the external body.

Careful attention, however, will show that all the activities of the soul can be rooted in the single activity of feeling. As we have already noticed, the feeling principle does not lie inactive in feeling. Although it has a degree of passivity, it concurs actively in the production of feeling (this perhaps explains why certain insensitive parts of the body become sensitive, while sensitive parts sometimes lose their sensitivity - the soul contributes its action in different degrees).

This action of the soul, which is necessary for the generation of feeling, is without doubt the same as that which gives the body its aptitude for manifesting extrasubjective phenomena. The vital state of the external body, therefore, is an effect of that act with which the soul concurs in producing feeling. Feeling and the state of external vitality or animation of the body as commonly understood is brought about by this same first activity of the soul. If such a connection between the extrasubjective phenomena of vitality and those of feeling exists without their being cause and effect of one another (although they both depend upon the activity of the soul for their first cause) we should not be surprised if, on the occasion of a forced change in the extrasubjective body, the activity of the soul reacts according to its own hidden laws and places itself in a different attitude towards the whole body manifested extrasubjectively.

Notes

(126) Kant. The Bibliothèque Universelle (Geneva, July 1833) maintains that Cuvier was the first to state the principle: `Every living being forms a complete system whose parts mutually correspond, working together towards the same definitive action by means of reciprocal action.' It is certain, however, that this principle was known long before Cuvier. Brown's attempt to simplify medicine by reducing it all to the principle of incitability presupposed Cuvier's more general principle.

(127) This mechanical organisation corresponds to a class of extrasubjective phenomena.

(128) Although the feeling principle is passive in corporeal sensation, it assists in the sensation, as we have said (cf. 248), and indeed places itself in a receptive state. Having done this, it often attains a new activity. As we shall see, movement originates in great part from feeling.

(129) This is valid for theory. In practice it is impossible to note all the phenomena because the internal phenomena of the body do not fall under external experience; they have to be conjectured through symptoms which are sometimes misleading. Doctors, therefore, study the effects of their medication (another source of conjecture about internal phenomena) according to their own principle: `If it helps, use it; if it harms, discontinue it.' Medical practice can never be more than conjecture which, however, will approximate to the truth in so far as careful, daily experience indicates the way in which phenomena are bound together.