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The Epic Story of the 1918 Pandemic
by John M. Barry
According to Kuhn, the prevailing paradigm tends to freeze progress, indirectly by creating a mental obstacle to creative ideas and directly by, for example, blocking research funds from going to truly new ideas, especially if they conflict with the paradigm. He argues that nonetheless researchers eventually find what he calls "anomalies" that do not fit the paradigm. Each one erodes the foundation of the paradigm, and when enough accrue to undermine it, the paradigm collapses. Scientists then cast about for a new paradigm that explains both the old and new facts.
But the process (and progress) of science is more fluid than Kuhn's concept suggests. It moves more like an amoeba, with soft and ill-defined edges. More importantly, method matters. Kuhn's own theory recognizes that the propelling force behind the movement from one explanation to another comes from the methodology, from what we call the scientific method. But he takes as an axiom that those who ask questions constantly test existing hypotheses. In fact, with a methodology that probes and tests hypotheses(regardless of any paradigm) progress is inevitable. Without such a methodology, progress becomes merely coincendental.
Yet the scientific method has not always been used by those who inquire into nature. Through most of known history, investigators trying to penetrate the natural world, penetrate what we call science, relied upon the mind alone, reason alone. These investigators believed that they could know a thing if their knowledge followed logically from what they considered a sound premise. In turn they based their premises chiefly on observation.
This commitment to logic coupled with man's ambition to see the entire world in a comprehensive and cohesive way actually imposed blinders on science in general and on medicine in particular. The chief enemy of progress, ironically, became pure reason. And for the bulk of two and a half millennia (twenty-five hundred years) the actual treatment of patients by physicians made almost no progress at all.
One cannot blame religion or superstition for this lack of progress. In the West, beginning at least five hundred years before the birth of Christ, medicine was largely secular. While Hippocratic healers (the various Hippocratic texts were written by different people) did run temples and accept pluralistic explanations for disease, they pushed for material explanations.
Hippocrates himself was born in approximately 460 b.c. On the Sacred Disease, one of the more famous Hippocratic texts and one often attributed to him directly, even mocked theories that attributed epilepsy to the intervention of gods. He and his followers advocated precise observation, then theorizing. As the texts stated, "For a theory is a composite memory of things apprehended with sense perception." "But conclusions which are merely verbal cannot bear fruit." "I approve of theorizing also if it lays its foundation in incident, and deduces its conclusion in accordance with phenomena."
But if such an approach sounds like that of a modern investigator, a modern scientist, it lacked two singularly important elements.
First, Hippocrates and his associates merely observed nature. They did not probe it.
This failure to probe nature was to some extent understandable. To dissect a human body then was inconceivable. But the authors of the Hippocratic texts did not test their conclusions and theories. A theory must make a prediction to be useful or scientific (ultimately it must say, If this, then that) and testing that prediction is the single most important element of modern methodology. Once that prediction is tested, it must advance another one for testing. It can never stand still.
Those who wrote the Hippocratic texts, however, observed passively and reasoned actively. Their careful observations noted mucus discharges, menstrual bleeding, watery evacuations in dysentery, and they very likely observed blood left to stand, which over time separates into several layers, one nearly clear, one of somewhat yellowy serum, one of darker blood. Based on these observations, they hypothesized that there were four kinds of bodily fluids, or "humours": blood, phlegm, bile, and black bile. (This terminology survives today in the phrase "humoral immunity," which refers to elements of the immune system, such as antibodies, that circulate in the blood.)
Copyright John M Barry 2004. All rights reserved
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