The Art and Science of Medicine
Science and Well-tested Experience
Source: Aphorismorvm Hippocratis, Venetie MDCXXIX
The art of medicine is about making proper use of available knowledge. In the past this knowledge came from folk medicine, that is, customs involving how to prevent and deal with diseases. Hippocrates (c. 460–370 B.C.E) is regarded as “the father of medicine.”
From Hippocrates’ writings we learn that for the art of healing to advance we need knowledge of “what human beings are,” as he puts it. He also states the precept for the work of doctors that still applies today: “ …to prevent, cure, relieve, and console.”
The art of medicine entails a knowledge of diseases and injuries and their cure, and it is based on so-called empirical research. Diagnosis and treatment are guided by what is called “science and well-tested experience.” The research sets up an assumption (theory, hypothesis) and by gathering appropriate information (data, observations) you can either reject the hypothesis as invalid or support it as compelling. The amount of data must be sufficiently large, and there are certain rules when it comes to establishing a cause-and-effect relationship. There are also ethical rules for how research on humans and animals can be carried out. Besides the systematic quest for knowledge, there is another important consideration. We need to be willing to question previous findings. The growth of knowledge can lead to a new way of viewing the cause and treatment of specific disorders.
To:
- Make proper use of available knowledge
- Understand bodily and mental functions
- Attain new knowledge
- Be prepared to change the conventional view of the cause and treatment of specific diseases
– is how we view the art of medicine today.
In the following we will take up what the preconditions were for the art and science of medicine in the 18th century and how Linnaeus made use of these conditions as a medical practitioner and researcher.
Faith and Science
In the 18th century certain dogmatic conceptions began to be questioned. Researchers had to maintain a delicate balance. The consequences of calling into question orthodox doctrine in an authoritarian society could be dire. Linnaeus grew up in a clerical home. He had religious convictions and had to balance his view of nature against these beliefs. He pointed out the similarity of humans to apes and places humans in the system of the animal kingdom, but he nevertheless avoided calling into question the biblical story of creation. In his travels he encountered a great many folk beliefs. From these folk beliefs he would extract whatever met the requirement of being such well-tested experience that it could be put to use.
Source: Linné och hans apostlar (Linnaeus and his apostles) S Sörlin, O Fagerstedt, Natur och Kultur, 2004
The Position of Science
Utility, or usefulness, was a key concern in Linnaeus’ day. He was commissioned by the Estates of the Realm to take inventory of Sweden’s natural resources and how they could be used in new medications, for example. Science was poorly regarded. Theologians were better paid and had higher social status. The resources for medical science at the universities were inadequate. But change was in the air. Linnaeus and a circle surrounding him established the Academy of Sciences in support of scientific research. The political system was also inclined to promote science. Sweden was in economic crisis following Karl XII’s warfare and needed to take stock of the country’s resources and to establish international collaboration and exchange of knowledge in the study of nature. The ability to pursue research at that time, as in ours, was tied to sponsors. A true enthusiast was needed to muster the energy, ambition, and ability to interpret and order knowledge to make it accessible, and not least to present findings in a way that political leaders understood and were willing to be convinced by. Linnaeus was that enthusiast.
Linnaeus’ Personal Qualifications
Linnaeus was driven by a powerful thirst for knowledge and had the capacity to see details in his surroundings and to systematize his observations. In today’s research policies we encounter the concepts of basic research and applied research. Basic research is more unconditionally devoted to the creation of a store of knowledge. Applied research has a more utilitarian aim. Linnaeus’ work included both the basic research question of the cause of a disease (pathogenesis) and studies of appropriate treatment, that is, how certain information can be used. Linnaeus must have possessed a great deal of buoyant and persuasive charisma. This is something he had even as a child. As an adult he gives the impression of easily being able to win the confidence of those around him. Those in power supported him. The great number of students he attracted indicates that Linnaeus could enthuse others, arouse interest in research, and be the leader, in the sense that he was authoritarian and at the same time inspiring. Of course, we might perhaps question how much concern he felt for the students he sent to distant parts of the world. His time as a medical practitioner was relatively short. His interest in research and more academic work occupied most of his time. In his encounters with patients, however, he does seem to have inspired trust.
Human Beings and the Balance of Nature
What we today call ecology describes the living conditions for animals and plants. Although the term ecology did not come into use until the 1860s, we can in fact discern the fundamental concepts of the economy of nature in what Linnaeus taught as a physician. We encounter this in two ways in Linnaeus. As a scientist, Linnaeus urges us not to disrupt the balance of nature. As a physician, he teaches us the importance of seeing human beings in their environment. We are affected by the climate we live in, our access to food, our protection against contagious organisms, etc. There is a mutual dependency among everything that is included in nature – there is a balance in the economy of nature (Oeconomia Naturae). There is also a regulatory system for how this equilibrium among the elements of nature is maintained (Politia Naturae). Humans are an integral part of nature.