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Asklepios und die Philosophen: Paradigmawechsel in der Medizin im 19. Jahrhundert, ed. Claudia Wiesemann, Barbara Bröker and Sabine Rogge, Medizin und Philosophie, Band 2, Stuttgart-Bad Cannstatt, frommann-holzboog, 2008, pp. 272, 48.00 (paperback 978-3-7728-1635-2).
This posthumously edited monograph of the Münster philosopher and historian of medicine Nelly Tsouyopoulos (1930–2005) examines one of the key developments in western medicine: the change in the early nineteenth century from humoral theory to the cell theory of the human body. Tsouyopoulos conceptualizes this important change as a paradigm shift in the sense of Thomas Kuhn and also draws upon Michel Foucault’s notion of discontinuities in history and upon Ludwik Fleck’s “thought collectives” and their different “thought styles”.
Building on her earlier studies on Brunonianism and Romantic medicine, in particular on the influence of the Brownian physician Andreas Röschlaub (1768–1835), the author argues that John Brown’s system in the late eighteenth century seriously shook the old paradigm by defining life as an organism’s power to defend itself against stimuli from the outside. Brunonianism thus overcame the traditional mind-body dualism that had characterized Galenist humoral pathology as well as the medical systems of the Enlightenment period, such as Herman Boerhaave’s iatromechanism and Georg Ernst Stahl’s animism. Crucial (in the author’s view) for the acceptance of the new Brownian understanding of the body, especially in Germany, were Immanuel Kant’s criticisms of Cartesian dualism and Friedrich Wilhelm Joseph Schelling’s distinction between the defensive and the self-reproductive powers of the living organism. Another key factor in bringing about the paradigm shift was the so-called “identity principle”, i.e. the view, forcefully argued by the Paris clinician François Joseph Victor Broussais and the philosopher Auguste Comte, that there was no ontological difference between life processes in health and disease, or between physiology and pathology. This became the credo of the new Physiological Medicine, which inspired Rudolf Virchow in the 1850s to postulate that cells were the loci and smallest units of life in the body. Moreover, following on from Schelling’s interpretation of the humours as a second, inner environment (in addition to the outer environment of Brunonianism), Claude Bernard developed in the late 1850s and 1860s his concept of the “milieu intérieur” as a regulating mediator between the outside world and the organism’s cells. This concept, according to Tsouyopoulos, completed the new paradigm.
With her final work Tsouyopoulos has given us an impressive history of ideas, a synthesis of history of medicine and philosophy that has become all too rare nowadays. In the light of some recent secondary literature that has not been considered in this work, such as Hubert Steinke’s Irritating experiments: Haller’s concept and the European controversy on irritability and sensibility, 1750–90 (Rodopi, 2005) and this reviewer’s Drugs on trial: experimental pharmacology and therapeutic innovation in the eighteenth century (Rodopi, 1999), readers might now be inclined to see incipient changes towards modern medicine somewhat earlier in the eighteenth century than Tsouyopoulos did. Nevertheless, she has bequeathed a powerful narrative and historical interpretation that deserves attention beyond a German readership. It should inspire today’s historians of medicine to exploit fully the potential of intellectual history and to pay close attention to the philosophical underpinnings of medical change.