The ‘prehistory’ of philosophy of science (2): Is there a doctor on board?
I would like to think that the first work devoted to something that we might call ‘the problem of scientific method’ was written by Democritus (around 460-370 BC), the author the philosophical systems of Plato and Aristotle were constructed against, and whose ideas were so revolutionary that it seems that nobody in the last centuries of the Ancient times worried about preserving a copy of his more than seventy books, for none of them survived till the Middle Ages. Perhaps the treatises called On the Foreknowledge of the Future, or On the Criterion of Thought, mentioned in the catalogue described in Diogenes Laertius Lives of the Philosophers, contained some more detailed ideas about how to carry out research than what the clumsy references by Aristotle and later authors on the topic (Plato never debased himself to mentioning Democritus explicitly) allows us to glimpse. But it is also possible that Democritus’ understanding of how to gain knowledge was too naive for the radicality of his Weltanschaaung, so that his naivety helps to explain in part the reluctance to accept his strange views about Nature and Man. Hence, we cannot presume that the father of atomism, besides being a prominent philosopher and an accomplished mathematician himself (he was the first to prove the formula for calculating the volume of a pyramid and a cone, sowing the first seeds of what many centuries later would become the infinitesimal calculus), was also a captivating proto-philosopher of science, and so he will not be, unfortunately, the real protagonist of this first chapter of my story.
The honour of being the first ‘book’ (actually, a very short treatise, not even twenty pages long; it’s a ‘book’ in the archaic sense of being a work fitting within a roll of papyrus, or biblion) that we can consider a philosophy-of-science forerunner corresponds to an anonymous pamphlet that today we wouldn’t even consider a ‘philosophical’ work, but rather a piece of sheer propaganda or blatant advertising. The date of the work is a little bit less uncertain, and very probably it is contemporary of the mature Democritus, around the last third of the 5th century BC, also the time of Socrates’ flowering, and also of the great ‘sophists’ Protagoras, Gorgias and Hippias, to which it is much more closely related by its style, structure and content. It has been preserved within the so called Hippocratic Corpus, a collection of around sixty short medical treatises attributed to the ‘father of medicine’, Hippocrates of Kos (also contemporary of the aforementioned intellectuals), but that most likely were, most of them (including ours), composed by his followers during the last decades of the 5th century and the first ones of the 4th. The succinct title with which the book has gone down in history is On the art (Perì téchnēs), though frequently it is also published or referred to as On science, for the Greek word téchnē had a wide meaning that covered all types of practical knowledge, from the most rustic craftsmanships to more illustrious skills like architecture, navigation, military engineering, and of course what we call the ‘fine arts’ (sculpture, painting, music…). In this case, of course, the téchnē that is the object of discussion is the profession of medicine, and actually the booklet’s title is some times translated as On medical science.
The question debated by the anonymous author is whether medicine can count as a science (or ‘art’), or not, and obviously the answer of the book is given in the affirmative. The work has the unmistakable flavour of sophist debates, so much that one almost imagines the existence of a lost, parallel treatise of equal length, in which the opposite conclusion was reached. Sophists, after all, were famous by the talent of being able of persuading their audiences both of any thesis and of its contrary. Actually, many of the arguments of Perì téchnēs are so obviously flawed (at least for us, fortunate enough to having known a medical science hugely more powerful than its ancient counterpart), that we cannot resist the feeling of its sophistry. The criticisms to medical science the author tries to counteract are the following (as I have said, it’s easy to imagine a previous chapter in which these theses were defended):
- Patients that heal recover by chance, not by the effect of the medical treatment.
- Many sick people recover without consulting the physician.
- Some patients die in spite of being treated.
- Physicians reject to treat incurable patients.
The last objection is probably the one that is more easily responded by the author: no art/science has an infinite power, and all have limits that are fixed by nature; only ignorants could demand that medicine can heal every sickness, for, are not all men mortal, after all? Knowing in which cases the illness is going to be more powerful than the instruments of the physician is, then, not a sign of lack of learning, but of wisdom. However, the answer provided is in a way too easy, as it is clear from the fact that it sounds so bizarre to us that Hippocratic doctors just refused to treat patients that were too sick. The progression of an illness is usually not ‘deterministic’ (as we would say), but often very unpredictable, and hence we are amazed by the fact that those physicians were not more inclined to trying different therapies in the hope that some might work, at least in a few cases. Of course, it is also possible that the professional behaviour of those physicians were not, in practice, as ruthless with the seemingly incurable as the letter of the text suggests, and in fact, many specialist think that the author was probably not a doctor himself, and was more interested in the sophistical debate than in precisely reporting the practice of medicine.
The other three points are more interesting, though the answers are rather disappointing. We, moderns, would expect an argument in the style of a proto-statistical analysis of the effectiveness of being treated against that of not-being treated, something like the suggestion that the chance of recovering is higher when the patient is treated by a doctor than when it is not (have you not thought of something like that when reading points 1 to 3?). Nonetheless, we find nothing like that. It even seems that the author tacitly acknowledges that the chance of being healed by a doctor is actually not higher than that of recovering spontaneously. For the answers he offers (I am obviously assuming the author was a man, though we cannot know for sure) are of the following style:
“I do not exclude the operations of Fortune, but I think that those who receive bad attention usually have bad luck, and those who have good attention good luck. (For) what else but medical skill can be responsible for the cures of patients when they have received medical attention? (…) (The patients) didn’t want to trust in the shadowy form of Fortune, but in the art of medicine, (and so) the share of chance is excluded, but that of art is not.
(…) No one who is cured without the services of a doctor can ascribe his cure to chance. Indeed, upon examination, the reality of chance disappears: Every phenomenon will be found to have some cause, and if it has a cause, chance can be no more than an empty name”.
And, as for the patients that recover without the intervention of a doctor:
“Should they be cured, it is because they have employed the same remedy as a doctor would use. And this is a considerable demonstration of the reality and the greatness of the medical art, when we realize that even those who do not believe in it are nevertheless saved by it”.
Lastly, about the patients that do not heal, in spite of the physician’s efforts, the answer is still funnier’:
“It is fare more likely that the sick are unable to carry out the instructions than that the doctors prescribe the wrong remedies. Physicians come to a case in full health of body and mind, and compare the present symptoms of the patient with similar cases they have seen in the past, so that they can say how cures were effected then. But the patients do not know what they are suffering from, nor why, nor what will succeed, nor have they experience of similar cases. Their present pains are increased by fears for the future. They are full of disease and starved; they prefer an immediate alleviation of pain to a remedy that will return them to health. Such is their condition when they receive the physician (…) Is it not more likely that they will disobey their doctors rather than that the doctors (…) will prescribe the wrong remedies?”
In a nutshell, what the author of On the art is telling us is that:
- When medicine intervenes, there is no place to chance.
- When a patient heals without the help of a doctor, it is because by accident he or she had done what the doctor would have prescribed nevertheless.
- When a patient does not heal in spite of being treated by a doctor, it is because he has not followed the physician’s prescription.
As you see, these arguments would be more reasonably found nowadays within a lawyer’s plea of defence in a trial against a physician’s malpractice than in a methodological essay on medical procedures. I’m sorry that, perhaps, if you were waiting for a deeper example of ancient wisdom about ‘what science consists in’, you are a little bit disappointed with the first author I have examined in this series. Don’t blame him too much, after all, as I said, it was probably the first attempt of jotting down some systematic ideas about the working of the sciences (or the ‘arts’), and we can be sure that the implicit knowledge of their practitioners about this question was substantially more advanced than the awkward answers our anonymous sophist was able of assembling. I will just finish mentioning the two ideas the author of this book got definitely right:
First, medical science is not a matter of superstition or religion (no single reference to gods appears in the book, if we discount the mention of Fortune, which is discarded), but of experience and nothing but experience (“there is no science that is not based on facts”).
Second, medical science is far from perfect, and we should always keep on researching in order to make more and more new discoveries.
Hippocratic Writings, ed. by G. E. R. Lloyd, Penguin, 1978.