The Doctrine of Signatures

A Defence of Theory in Medicine

Scott Buchanan

• Publisher: Routledge
• Year: 2014
• Print ISBN: 9780415614153
• eBook ISBN: 9781317829935
• Topic: Philosophy
• Subtopic: Philosophy History & Theory

First published in 2000. This is Volume II of six in the Library of Philosophy series on the Philosophy of Science. Written in 1938, this text explores the author's interest in the freedom of speculation, and the doubts and fears of individual thinkers who may doubt the intellectual process and fear its consequences. He considers the profession of contemporary medicine who has fought and won the battle for freedom of thought.

Chapter VI
The Human Body as Artist

I WOULD remind the reader again of the difficulties encountered by the modern mind attempting to bring this ancient lore into the context of scientific discourse. Patience is necessary not only in following the present exposition, but also in withholding adverse judgment of the doctrine whose familiarity in commonsense discourse has bred so much scientific contempt. It is said that the doctrine is sheer anthropomorphism, the ogre that dogs scientific progress at every step. I think that we shall find the ogre a spirit of light if we turn and face it at this point. In less dramatic language anthropomorphism is a constant inescapable phase of all science, and it is only by explicit recognition and rationalization that we can hope to divest ourselves of the illusion that we are free from it.

There are several senses in which science may be called anthropomorphic. In one sense it may be said that science is imputing human habits to inhuman or inanimate nature, and thus falsifying what is essentially neutral. It seems that the Greeks in the account just preceding were committing this pathetic fallacy in a shameless grand style. Nature is an artist; how could the fallacy be more directly and comprehensively stated? Or again it may be said that science is the verbal and symbolic expression of the nature of things, and in so far as the notations or symbols are artificial and conventional inventions they give a human twist to the truth and thus distort its unconventional purity. Finally, pursuit of science arises primarily from a boyish or apish curiosity, and the announcement of discoveries and secrets explained smacks too obviously of the many boastful and smart tricks by which we all too human beings deceive ourselves. Current as well as ancient science must plead guilty of all these charges, and much of the acrimony of current controversy is due to a feeling of guilt which is passed on to colleagues, predecessors, and finally to Aristotle himself, instead of being responsibly admitted.

There is still another sense in which science, particularly medical science, may be said to be anthropomorphic. In some sense human beings are always the subject-matter of science. Latter-day philosophic discussion of scientific method and epistemology repeatedly expresses one common article of faith, that the data of science are human sensations, the human effects of external causes, the results of human observation, the products of human manipulation. In the medical sciences, anatomy, physiology, and pathology, it is inescapable that the human body, which these sciences cannot completely reduce to chemical, physical, or biological materials without losing status, not only contributes but on the observable level wholly provides the subject-matter. The ubiquity of the human body is the source and the explanation for all the other grades and varieties of anthropomorphism. Man in relation to many other things is the inescapable and all-pervasive proper study of man. All the natural sciences are primarily medical in their origin and intent, as the myth of signatures suggests, and we shall be doing a service not only to medicine but to all the natural sciences if we make Galen speak again of the sciences that men study, the sciences that study men in the context of the arts that men practice. This is radical and unreserved anthropomorphism, and it is the Galenic medical man who will face his obligation to follow out its consequences, and reformulate that hard-headed humanism which is so indispensable not only for culture in general but for science itself.

When in the fairly recent history of European culture the financial arts had become important enough to draw the attention of trained minds, there was developed an art of accounting within which there were the suggestions of a science of accounting. In the course of time these suggestions blossomed into an elaborate set of economic sciences among which was double-entry book-keeping. It is no wonder that catastrophes like the great depression have been blamed on the vicious abstraction and speculative irresponsibility of the certified accountant who professes this art and science. Into his ledger there go symbols which distinguish between creditor and debtor when only one man is involved. One and the same item is entered twice in these subtle books, and the accounts are not approved unless one and the same sum appear on both sides of the ledger. The duplicity here is worthy of the subtlest lawyer, and I believe is only matched by the devious ways of the legal profession in modern thought. There it is supposed that the lawyer learned his distinction-making from the theologian, who found three persons in one God. It will be no news to the medical man that his own predecessors multiplied entities beyond the limits set by modern scientific styles in economy of thought. It may be news that he is still dealing with the multiplied entities but has no insight into the system in which they once made sense. The tendency to drop any kind of multiple book-keeping in the natural sciences is understandable as the consequence of current empirical enthusiasms, but it lays a heavy burden on the auditor who is called in to certify the accounts, a burden that obviously is too heavy for the philosophers who have volunteered their services and a burden beyond the competence of the empirical scientist, such as Lloyd Morgan, who has devised the infinitely multiple-entry book-keeping of emergent evolution. Emergent evolution is really a device for putting off the day of final accounting indefinitely, just as the theory of the migration of organs uses the rubrics of Darwinian evolution to avoid the application of any rigorous system of accounting to the riddles of human anatomy.

The metaphysics of form and matter supplies a system of double-entry book-keeping for any science, and although a science such as chemistry or physics may dodge the necessity, it seems that medicine which is man’s study of man should not take chances in its attempt to avoid the anthropomorphic tangles that such a study threatens to involve. It should construct a system which would meet the present multidimensions of its subsidiary sciences.

In the first place it should be noted that multiplication of entities is not an accurate description of the effects of Aristotelian doctrine in science. It is rather the opposite, the systematization of the entities that a supposedly single-entry science has produced, and the placing of entities in systematic connections. Previous to Plato and Aristotle the artist, his material, and his product were separate entities, and furthermore there was a sharp distinction between the artificial and the natural. The effect of the Platonic and Aristotelian dialectic was to define things in such a way that each one was a substance which was at the same time but still intelligibly and distinctly an artist, a material, and a product. At the first step in the dialectic it was recognized that everything had its appropriate form; at the second step it was discovered that this meant that one and the same thing was both form and matter. This parallels the dialectic in the development of accounting where debtor and creditor were first identified with separate persons, and then found to exist in the same person. The economist has still to discover the right way of reminding himself that any member of a market is both producer and consumer.

The next step in the Aristotelian system of accounting was the introduction of another dual scheme that would give cross references, and this turned out to be the agent and the product, taken from the notion of the artist and his work. The result is a system of quadruple entry book-keeping in which one and the same thing appears as matter, form, agent and end-product, or material, formal, efficient, and final cause. It is, of course, possible to build a science in which one of these terms sets the route for thought to take and leaves the others implicit, but such a science, for instance, chemistry, would not be medicine. Inanimate or inhuman matter may suffer such partial treatments without protest, but the human body will burst out with the suppressed principles and characters. It will claim consideration for the organism as whole and in all its guises. If medical men pay exclusive attention to muscles and bones, they will be haunted by ghosts, and will thus pay for their subterfuges by considering the formal and final causes in their sleep.

Of course our language is still loose. The human body is a substance which has a great variety of accidents, which may be classified grossly as essential, proper, and accidental, and these accidents are further subdivided according to their places in the genus-species matrix, and they are ordered according to the artistic rules which things obey. Finally the things thus understood in their many guises are the self-moving things that constitute the system of nature.

The human body thus becomes a most marvellous work of natural art. It is an artist fabricating tissues, organs, fluids, and gases out of the raw materials which it manages to procure from subsidiary arts. On the other hand it is the product of its own art; the body taken at any moment or over a period, is a most exhaustively worked or informed material. Form and matter are most intimately combined on many levels and in the smallest detail, and there is nothing in the body that can be called merely matter, nor yet pure form. The doctrine lends itself easily to Galenic rhetoric, but, as I have said before, Galenic rhetoric is not empty of theoretical content. Certain doctrines flow from the complicated insight so rhetorically expressed, and the proof of the oratory will be in the exposition of these doctrines.

First there is a consequence in the Galenic method, again a kind of double voiced exposition which we have come to call the deductive and inductive method of rational procedure. Each of Galen’s points of doctrine is expounded twice in his book on physiology, On the Natural Faculties, and for good measure there are dialectical interludes. One exposition is deductive and from the point of view of demonstration might stand by itself. The second exposition is inductive or descriptive of observation, dissection, or experimentation. Here, again, the modern mind is bored with what seems unnecessary verbal repetition, and a perverted sense of elegance. Actually Galen is making his verbal behaviour keep faith with his scientific process of thought. An ancient scientist did not think himself intellectually dishonest if he had made explicit beforehand what he expected or rationally should demand of observation and experiment. In fact he would have thought himself merely a sophist if he regularly met nature with a blank mind and waited to be persuaded by her many uncriticized charms. The only safe way to meet fact was to be well supplied with ideas in good order; the maximum order and even the maximum number of ideas can be handled only by logic. All else is elusive opinion. It is only because common sense has been through the discipline of ancient logic that we suppose we can dispense with a priori demonstration. Galen even wrote a book on logic in the orthodox Aristotelian style properly adjusted to the needs of medical science.

Galen’s inductive procedures are again puzzling to the modern mind. For instance, there is no talk of Mill’s methods, and very little generalizing from the particular. The inductive accounts are descriptions or rules for the arts of observation, dissection, and experimentation. Experimentation is perhaps the most illuminating illustration of the procedure. The idea suggested by the deductive theory is transferred to the medium of the material under inquiry, or even better to a material such as the body of an animal which is not directly under inquiry but particularly adapted for the special features relevant to the idea. It was Vesalius in the fifteenth century who rediscovered with great excitement that Galen’s anatomy had been done on animals rather than on man; Galen by animal dissection had been able to give inductive expositions of human anatomy which had carried the medical arts for over a thousand years. Vesalius continued the method in human anatomy. Experimentation for Galen was the application of practical reason to concrete materials; it was an art by which ideas in his mind induced ideas in things, and deduction was completed by operations on materials. He is very angry with his predecessors who allowed speculative Democritean atomism to take the place of detailed observation and experiment, and reports his own experiments with directions for repetition in order to refute childish mechanical theories put forth earlier by Erisistratus. Induction is not a method of proof; it is a check and fulfilment of deductive thought. In this he is bringing his own and his pupils’ rational souls to bear upon the activities of the vegetative and animal souls of men and animals. This is the traditional canonical form of medical research, a consistent and powerful extension of the diagnostic art practised at the bedside.

In order to get at the next important doctrine, the doctrine of the natural faculties, we must return to the hierarchy of forms and their various incidences in matter. Prime matter has infinite potentiality; it has the possibility of taking on an infinity of forms. However, there is an order of incidence with appropriate degrees of freedom within it at every step of the informative process. The first form achieved by a given matter, determines to a definite degree what further forms can be added. There will be impossible forms, possible forms, and necessary forms consequent upon the first substantial form attained. Thus it is that forms determine potentiality, or in briefer words, forms are potencies, powers of action and passion or change. Thus what is a formal cause of a tissue, namely its specialized tissue-form, is at the same time a potency of the organ to which the tissue belongs, and the form of that organ again a power of the organism to which it in turn belongs.

The science of physiology then consists, in so far as it is the investigation of dynamic properties of organisms, in the discernment and rational formulation of potencies of the parts of the body. When they are discerned and formulated they are called faculties. Formulation of potencies builds a rational science within which deduction is a legitimate procedure, and observation of bodily processes in their varieties and modes clarifies and amplifies a priori theory.

But we are already treading soil that has been consecrated by many battles of words. Powers, potencies, faculties, and other occult entities come ultimately from Macedonia, and Demosthenes was more prophetic than he knew when he warned the Athenians of the Macedonian dangers. King Aristotle ruled a vast intellectual empire well for two thousand years, but at the end of that time as everybody knows Macedonia has been a Balkan state. It is well to remember two things as we penetrate this land of barbaric superstitution. The first is that the body is an artist and that the powers which Galen called faculties are artistic powers. The second thing to remember is that Aristotle and Galen ruled by dividing the items of observation and analysis according to the rules of a quadruple-entry system of accounting. On one side of the ledger are the capacities of the parts of the body to operate in specific ways; by virtue of these powers the parts of the body are the artistic agents, or efficient causes. On another side of the ledger there are the elementary constituents of the body, earth, air, fire, and water, with their principles, the hot and the cold, the wet and the dry. These are relatively material causes in the artistic production. One can balance these two kinds of entry of items, for it is these materials with their minimum forms that determine the capacities of the agents in the process. A third entry can be distinguished in the higher forms governing directly the operations of the agents and through them the material constituents. These are the faculties which in Galenic physiology are usually attributed to the organs and the humours. Finally in the fourth column these same forms are integrated and entered as souls, the entelechies or actualities of the body. Again the two latter columns, forms and ends, balance if the observation and analysis has been sound, and finally the former columns with their balance between materials and agents balance with the latter pair and their balance, and we can say with some clarity and without intent to deceive that the soul is the well-balanced harmony of the body.

It should not be difficult to see this hierarchy of potencies and forms as levels of analysis and integration, and to realize that the accounts will eventually balance if they are not fudged. It is not so easy to see that a fourfold account has any advantages that compensate for the risks that such complication always involves. Galen’s answer to that question if given to-day would be direct and up to date; he would say that a fourfold accounting system is also a check on irresponsible speculation and would add that it is also a check on irresponsible observation. On the one hand, the material and efficient causes demand analytical observation and the anchoring of the theory in the discrete parts of the body; on the other hand, the inquiry and formulation of the formal and final causes insures the clarity and consistency of the rational content of the science. It can hardly be hoped that these two large divisions will advance pari passu or with smooth agreement. There must be times when the physiological budget must go unbalanced, but the explicit scheme for balancing will act as a constant reminder of scientific obligations. Galen’s own physiological theory and his very elaborate anatomy were not always in agreement, notably in the case of the pores in the septum of the heart which he theoretically demanded but admitted he had never observed. It is interesting to note here that it was observation dictated by a theory taken from Aristotle that enabled Harvey to revise the Galenic theory of the circulation of the blood.

With regard to the controversy over the occult entities that reached its height during the Renaissance this can be said. Late medieval Galenists named the faculties in the organs according to the theory of forms and matter. They then reified them as bodies and inserted them in the organs. Their double book-keeping had slipped a column and then had materialized all the columns, so that one looked for corporeal fairies and hobgoblins in the brain, behind the liver, and above the heart, and the rational immortal soul was expected to spread its wings on the death of the body and soar to the stars. They not only multiplied entities, they duplicated and quadrupled bodies, much as the keepers of the gold reserve would do if they completely lost functional insight and control of the commercial world. The name for such entities should not be occult; they are all too obvious. They were the creations of imaginations whose intellectual light had slipped into the lower phase of corporeal matter, and the result was a Balkanized science, and Europe was quite right in its intolerance. This is the constant danger of systems of book-keeping, and the better the system the more numerous and probable are the degradations. The dominance of the mechanical style of explanation and the reliance on bacteriology as the basis for contemporary pathological theory is an extension of the same imaginative ingenuity to our own time. The one human body is multiplied and distributed without benefit of certified accountants. It would seem that single-entry book-keeping also has its devices for the mass production of entities. Galenic theory finds one body enough and turns to abstract thought for its distinctions and the enrichment of its insights; Galen sometimes suggests that not four but five causes should be found if the artistic operations under inquiry show that much subtlety.

The book On the Natural Faculties applies this machinery to the analytical exposition of the nutritive arts of the body. These are the arts over which the vegetative soul presides, but he says at the outset that he personally would prefer not to call these faculties souls. Apparently he already, even in Alexandria, felt the dangers of too much talk about the soul, although he says he does not object if his readers understand what he has to say in those terms.

In this account the body is understood as the artist fabricating itself, and the various internal organs, mouth, stomach, intestines, liver, heart, and spleen, are engaged in specialized subsidiary arts that contribute to the total making. Galen is tireless and acrimonious in discrediting his predecessor, Aesclepiades, who thought that his ingenuity in mechanical speculation relieved him of the necessity to dissect and observe the mechanisms that they imputed to the body. Galen defends the body from such slander of its admirable artistry. I am reminded of the modern faith in the circulation of the blood which has left it unexplained to the present how the venous blood returns to the heart when the hydrostatic pressure in the veins of the leg is never equal to the demands of the observed facts, and this in turn reminds one of the acceptance of Harvey’s theory of circulation before the observation of the capillary circulation. Harvey merely speculatively moved the pores in the heart to the arteries and veins. In Galen’s day the problem was a simpler one of how the urine went from the kidneys to the bladder, and we should credit him with the insistence against the mechanists that the already observed duct had something to do with it.

Galen is also tireless and rigorous in his inference from the generic nature of processes like genesis, growth, and nutrition to the specific processes of bodily fabrication. The nature of these fabrications is stated in terms of Aristotle’s Physics, which, with Plato’s Timaeus, is always the source of Galen’s first premises. These premises are concerned with the formal and final causes for which Aristotle and Plato supply the proper deductive machinery. As can be seen genesis, growth, and nutrition, are cases of the three pairs of kinds of change, generation and corruption, increase and decrease, assimilation and differentiation, respectively. At the other end of the process of fabrication there are the nutriments which are vari...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• CONTENTS
• Introduction
• I The Liberal Arts
• II The Laboratory Arts
• III The Clinical Arts : Descriptive
• IV The Clinical Arts : Analytic
• V Nature as Artist
• VI The Human Body as Artist
• VII Wanted : A Strictly Medical Science
• Index