6 i i THE ORIGINS OF 40DERN SCIENTIFIC T H I N K I N G GREGORY I. ALTSCHULLER Consultant in Me(licine The Roosevelt Hospital New York, N. Y. M/[EDICINE always has had and always will have two aspects: one scientific and the other clinical, in the broadest sense of the words. In different periods of history one or the other has dominated the mind of the medical man but both aspects have always been present. Speaking of the origins of modern scientific thinking implies, there- fore, also discussing the origins of scientific medicine. Some of the great natural philosophers of ancient Greece, as well as some of the out- standing scientists of modern times, have been physicians who con- tributed greatly both to physical sciences and to medicine. However, specific problems of medicine, important as they are and however closely they are connected with the development of scientific thinking, will be discussed only briefly in this essay. Richard Mead, M.D. (i673-1754), physician to Sir Isaac Newton and physician-in-ordinary to King George 11 of England, was one of the most prominent and successful physicians in London, widely known for his professional skill and his literary reputation and respected for his kindness and generosity. He was a protege of Dr. John Ratcliff, who presented him with his famous gold-headed cane as a token of respect and friendship.1 Dr. Mead lived at the time when somewhat primitive iatrochemical and iatrophysical theories impressed the minds of many leading medical men. He belonged to a small group of English physicians who at the very beginning of the i8th century attempted to apply the methods and principles of mathematics and of physical science to medicine. He acquired knowledge of these methods and became an ardent adept of the iatrophysical school while studying medicine in Padua and Ley- den." However, he avoided the most extreme theories of his teacher, John Pitcairn, representative of the iatromathematical school in Eng- land, although in his paper on "Mechanical Account of Poisons" (I 702) Vol. 46, No. 8, August 1970 6 I 2 G. I. ALTSCHULLER Dr. Mead tried to explain the action of poisons as the effect on the stomach of "small knives and daggers" he had observed under his microscope. In his later works he attempted to explain the influence of celestial bodies on the course of various diseases by gravitational at- traction, by variations in the atmospheric pressure, and by similar fac- tors. His ideas about the importance of quantitative mathematical methods as applied to medicine are best expressed in the following passage: ... It is very evident that all other Methods of improving Medi- cine have been found ineffectual by the Stand It has been at these Three or Four thousand years, and since late Mathema- ticians have set themselves to the study of It, Men do already begin to talk so Intelligibly and Comprehensively even about abstruse Matters that it may be hoped in a short time, if Those who are designed for this Profession, are early, while their Minds and Bodies are Patient of Labour and Toil, initiated in the Knowledge of Numbers and Geometry, that Mathematical Learning will be the Distinguishing Mark of a Physician from a Quack, and He, who wants this necessary Qualification will be as ridiculous as One without Greek or Latin.3 Even if this enthusiastic prediction has not come true in the past 200 odd years, ours is the age of computers, and we are coming rather close to the ideas of Dr. Mead. What are the characteristics of modern science? Without making any attempt at an accurate definition, we might summarize them as follows. Modern science is characterized by a desire to discover the laws of nature. These laws must be of general order and few, the tacit assumption being, as in ancient Greece, that there exists in nature an order and that nature loves simplicity ("natura simplicitatem amat"). All laws of nature must be expressed in mathematical language, and qualities must be replaced by quantities. Numbers and measurements are the basic tools of modern science, and deduction is combined with induction.4 Newton's universal law of gravitation is of such a general order. Since the time of Newton two important forces have been added to the force of gravity: the electromagnzetic force, known since the time of Michael Faraday, and the intra-atomic, nuclear force, which became known in the 20th century. James C. Maxwell's field theory, first de- Bull. N. Y. Acad. Med. MODERN SCIENTIFIC THINKING 6 I MODERN SCIENTIFIC 6133 scribed in his paper "A Dynamical Theory of the Electromagnetic Field" (I865),5 gradually replaced the older Newtonian concept of force and became one of the most important discoveries of modern physics. It led to Albert Einstein's theory of relativity and to his con- cept of a four-dimension continuum that forms the world of events.6 In its final development matter and field became only two forms of energy which differ quantitatively but not qualitatively.7 Modem physicists accept the force of attraction that holds things together, such as the force of gravity and a centrifugal force which causes the expansion of the universe or the repulsion of particles with an opposite electrical charge. Of great importance is the use of models and experiments instead of the simple observation of nature. Niels Bohr's model of the atom and the double helix as the model of DNA described by James D. Watson and Francis H. C. Crick are examples of the use of models in modern science. Experiments are the most important tools in modern scientific research, whether the laws of nature are discovered on the basis of experiments, as in Newtonian theory or, as in the epistemo- logical approach of Einstein and other modern scientists, an experi- ment proves or disproves theoretical concepts deduced by the scientist from certain a priori assumptions. The results of his theoretical investigations are applied by the modem scientist to problems of practical importance. This last point is the one which makes such a great difference between the work of ancient natural philosophers and of modern scientists. In ancient Egypt, as well as in Babylon and Assyria, there was a highly developed technology but no science in the proper sense of the word. Pyramids were built, and also temples, an elaborate system of roads, mines on the Sinai Peninsula, and endless canals on which the very life of Egypt depended. In medicine hundreds of detailed pre- scriptions-some empirical, others rather magical-were recorded in papyri. A perfectly organized hierarchy of physicians existed that would gladden the heart of the i8th century professor Johann Peter Frank, famous author of the Systemv einer vollstdndiger medicinischer Polizey. There was a Chief of the Secrets of Health, the Guardian of the Imperial Anus, and a whole network of inspectors, supervisors, and superintendents of various ranks who controlled the activities of thousands of physician-specialists; each took care of only one part of the Voil. 46, No. 8, August 1970 6 I 4 G. I. ALTSCHULLER body. In addition to these there were ordinary physician-magicians.8 But behind this imposing structure there was very little knowledge of pathology, very little rational theory. Physiology begins when man enters into speculations about the significance of three basic substances essential to life: air and food, both coming from the outside world, and blood within the body itself. The only rational pathology created by ancient Egypt was the theory of WeHeDuW, or perittoma in its later Greek version, related to the universal observation of the decay of all organic matter. It was probably based on the observation that the decomposition of a corpse starts in the large intestine. The decay of organic matter produces heat and odor. In the body of a sick man this decay or the process of putrefaction produces a pyogenic principle WeHeDuW which can pass into the bloodstream and cause fever and rapid pulse. Thus a state of pyemia is created which, if not treated properly, endangers health and life. Before the poisonous residues are absorbed into the bloodstream, they must be removed by enemas or purges or, later, by bloodletting. The Egyptian idea of putrefaction of the ingested food in the intestine as the major etiological principle of most illnesses was taken over by the Cnidians, still later elaborated by Galen,9-" and became the logical basis for bloodletting, which dominated therapeutics for centuries, until the beginning of the i9th century. The wide use of enemas and purges known to the Egyptians and to many African tribes since time immemorial could also be ra- tionalized by physicians on the basis of the theory of WeHeDuW or perittoma. It is interesting to note that the absorption of poisonous mat- ter from the intestines with advancing age was believed to be an in- escapable process, which led eventually to the destruction of the body.12, 13 The theory of WeHeDuW seems to be the only rational patho- logical idea created by the Egyptian physicians. The Egyptians and Babylonians knew much more about astronomy through millennia of observation of the movements of celestial bodies. They knew, for in- stance, the difference between the calendar year and the solar year. They had a very cumbersome system of mathematics based on the decimal system but with separate symbols for the numbers i, IO, 100, iooo, and so on. All this had been all-important for the practical prag- matic minds of the Egyptians. But there was very little theoretical basis for this knowledge. Bull.