Ewa Kilar

The Historical and Contemporary Problems of the Philosophy of Medicine in Poland according to Władysław Szumowski  

Review of: Władysław Szumowski (2007), “Filozofia medycyny" [“The Philosophy of Medicine"], 2^nd edition, revised and supplemented, introduction and scientific editorship: A. Śródka i R. Gryglewski, Kęty: Wyd. Marek Derewiecki, 288 pages [ISBN: 9788389637581].

    “The Philosophy of Medicine" written by Władysław Szumowski (1875-1954) has reappeared (2007). It is a selection of philosophical-medical texts which were published in 1939, 1947 and 1948. The author studied at the Medical Department of the Imperial University of Warsaw (1894-1899).  He graduated his studies by writing a thesis on tuberculosis. He did supplementary historical studies at the University of Lvov, supervised by Prof. Ludwik Finkl (1858-1930) and philosophical studies supervised by Kazimierz Twardowski (1866-1938) at the same university.

   W. Szumowski's doctorial thesis in philosophy concerned the theory of feelings ("Descartes and Malebranche as the predecessors of Charles Lang's theory", 1905). The qualifying for professorship thesis was a historical-medical study ("Galicya in a Medical Sense during the Time of Jędrzej Krupiński, the First Protomedic 1772-1783", 1907). Władysław Szumowski worked at the Jagiellonian University (Cracow) most of the time, from 1920 to 1947, as the manager of the Department of History and the Philosophy of Medicine. During the 1938/1939 academic year, he was dean at The Medical Department of the Jagiellonian University. Tadeusz Bilikiewicz, Stanisław Konopka, Zbigniew Kukulski, Edward Stocki and Zdzisław Wiktor were his students.

    The most interesting literary achievements of W. Szumowski include his textbooks - "A History of Medicine Captured Philosophically" (1935, edition IV 2007) and "Logic for Medics" (1939). His essays in medical epistemology are most impressive e.g. "Medicine as a Science and Art" (1927), as well as historical-medical sketches e.g. "Nevroses et psychoses au Moyen Age et au debut des temps modernes" (1939). They were elaborated and added to later dissertations, which were published just after World War II. Szumowski's study "A History of the Philosophy of Medicine, its Essence, Name and Definition" – was the first extensive historical outline on the philosophy of medicine by a Polish author (57 pages), published by the Jagiellonian University in the form of a pamphlet with an index of surnames.

    “Logic for Medics" (1939) is an introduction to the basic logical problems for doctors as well as a review of historical, ontological and psychological questions. In his texts, Szumowski tried to show the principles of ‘solid reasoning' and a way of applying such categories as: scientific fact, observation, and experience, cause and result, hypothesis and scientific laws. It is a kind of ‘medical semiotics'.

    The original text of “The Philosophy of Medicine" (1948) was published 28 years after the subject "History and Philosophy of Medicine" was introduced at the universities in 1920, which has recently been removed from the list of classes. W. Szumowski's stand is considered to be moderate vitalism, distanced to the extreme tendencies of vitalism and German intuitionism.

   "The philosophy of medicine is a science which analyses medicine as a whole; it discusses its stand concerning mankind, society, nations and medical schools; it gives a glance at the entire history of medicine; it presents the most general questions of the philosophy of biology; it analyses the methodological forms of medical thinking, exchanging and explaining logical mistakes committed in medicine; it draws information and opinions from psychology and metaphysics, which are important for the whole of medicine; it discusses the cardinal values in medicine and formulates the general bases of medical ethics" (Szumowski 2007, p. 72).

   A historian and philosopher of medicine has to confront them with the works of Tytus Chałubiński ("The Method of Finding Medical Indications", 1874), Zygmunt Kramsztyk ("Critical Sketches on Medicine", 1899), Henryk Nusbaum ("The Philosophy of Medicine", 1926 ), Ludwik Zembrzuski  ("A History of Philosophical-Medical Trends, Theories and Doctrines", 1935), and the works of one of the most prominent doctors and philosophers of medicine in Poland, Władysław Biegański ("The Logic of Medicine, or a Critique of Human Cognition", 2nd edition, 1908), who referred to his approach to medicine as "previdism".

   In the first part of W. Szumowski's "The Philosophy of Medicine" (2007), the history of medicine is described in continental Europe (in Germany, France and Poland mainly). The author turns our attention to Polish doctors and philosophers such as Tadeusz Bilikiewicz ("The Question of Life in the Light of the Principles of Comparative Psychology", 1928), an author of a psychotherapy textbook (1937) and an expert in psychoanalysis and psychiatry, Izaak Wasserman ("A Historical and Critical analysis of the Notion of Intuition in Medicine", 1939), Ludwik Zembrzuski, an author of articles (e.g. "Intuition in medicine", 1931, or "Origins of General Ethics and Some Thoughts on Medical Ethics", 1936, "The Question of Life, Health and Illness from the Perspective of the Contemporary Philosophy of Nature and Medicine", 1936), Józef Marzecki, ("Homo Normalis in the Microphysics Formulation. Statements and Postulates of Scientific Philosophy of Medicine Based on Contemporary Physics and the Relativity Theory", 1932), a psychiatrist Kazimierz Wize ("The Scope of the Philosophy of Medicine", 1931; "Democritus and his Approach to Medicine", 1932), Antoni Mikulski ("A Textbook of Psychology for Medical Students and Doctors", 1925), Ludwik Fleck "On Some Special Features of Medical Thinking", 1927), Henryk Sochański ("What is Life", 1935).

   In the second part of "The Philosophy of Medicine" the following problems are discussed: scientific medicine, less scientific medicine (homeopathy, biological medicine, Schweninger and his successors), unscientific medicine (the ill person, process of recovery, healer, the interpretation of the healers' success, Julian Ochorowicz as the "grumbler of medicine"). W. Szumowski encourages to read the works of Eddington "The New Face of Nature" (Polish translation 1934), Zimmer Umsturz Weltbild der Physik (5th ed., 1940) "in order to appreciate the whole importance of the contemporary understanding of the nature" (Szumowski 2007, p. 76) and the "beautiful book by Delore" - "Tendences de la medecine contemporaine" (1936), which shows the meaning of the synthesis in medicine.

   "Synthesis, unity and movement are biological facts. Life is dynamism. The analysis did not see life, because dynamism escapes analysis". We read further: "analytic medicine did not have neither any bases nor the ability of organic reacting. It did not see the essence of questions. For example, all analytical materials on cancer were collected, but a principal fact escaped attention - that cancer was a question of cytobiology, cytophysics and a disorder of cellular dynamics. Similarly, artificial separation of the basis from the germ lead to disregarding the synthetic character of the course of many illnesses. By overestimating the meaning of the tuberculosis germ, we disregarded the biochemistry of the basis so that we misunderstood the whole problem" (Szumowski 2007, p. 77).

   In diagnosis, it is necessary to get to know our patient's biotypology (cf. Nicola Pende,  1927), because every type disposes us to different illnesses (cf . Jacquelin, 1935). The nervous basis is of great importance (the sympathocotonics and vagotonics). "Susceptibility to the loss of organic equilibrium is equivalent to the disposition to disease. These views expand the notion of the basis considerably, directing our thoughts to cellular physics, especially to the rhythm of electrons in a cell" (Szumowski 2007, p. 80). Diagnosing cancer can be provided as an example here.

   As Szumowski writes, "Medicine has known the relationship between chronic inflammation and cancer for a long time. It is generally acknowledged that arthritic states dispose to cancer too" (Szumowski 2007, p. 81). "The question of the basis is of great significance in cancer. The evolution of views on cancer in the last 60 years was very typical. In the beginning of the Pasteur era, cancer was considered an illness that external factors, special micro-organisms and parasites cause. The innumerable researches on this problem, as we know now, denied that possibility. Later investigations of the so-called cancerigenic factors also failed to give the answer to this question." (…) "If this were true - as Delore believes - cancer would result from two factors: a susceptible basis as the main cause and chance factors as secondary causes" (Szumowski 2007, p. 82).

   Observations connected with the cancer investigation seem very topical: "In studies of the basis that is susceptible to cancer, attention was paid to different disorders of the equilibrium, such as glycolysis disorders in cells, susceptibility to alcalosis, predominance of potassic ions over the ions of calcium and magnesium, the growth of cellular penetrability, neuro-vegetative and psychical disorders, disorder in the rhythms of cells. Neuro-vegetative disorders have been underestimated until now. Yet it appears that the sympathetic nervous system holds back the development of cancer, and vice versa, removing this factor encourages the development of the tumour. Hypertension (excessive tension) from the vagus nerve is a stimulant factor, and hipertonia from the sympathetic nervous system is a suppressive factor for the malignant floating cells (cf. Reding). Policarpine favours cancer, atropine disturbs it. Numerous epithelial precancer changes have neurotonic origins. The fact is that neither histologists nor cancerologists, whose attention was directed to the cancer cell only, were not involved in investigating the influence of the vegetative nervous system so far" (Szumowski 2007, p. 83). Seemingly, they still aren't.

   As W. Szumowski claimed: "basis means more than bacterium. Actually, it has already been predicted by Claude Bernard, who said: Le microbe n'est rien, c'est le terrain qui est tout" (Szumowski 2007, p. 85). So the treatment of the basis is most important - treatment with climate, sun, irradiation, mineral waters, diet, movement etc. "Therapy cannot start too late and should take care of preclinical states, dispositions to illnesses, nervous and psychical states. Medicine should not be just the science of illnesses, but a science of health too" (Szumowski 2007, p. 85).

   Another question that W. Szumowski analyses covers the chemical agents applied in medicine, especially the great role that sulphamide played. He evaluates the importance of histology, embryology, chemistry, pharmacology, pathological anatomy, bacteriology and serology, clinic, medical science and art. In the field of less scientific medicine, homeopathy - the science of strong dilutions and treatment by similarities - plays an important role. It is criticized despite rational arguments and "healing" effects. Biological medicine – orientated towards the "biological whole" and "life" - has a similar mixed status.

   For a long time, there has existed an extreme stance which criticizes and ridicules the scientific treatment of medicine (e.g. Schweninger). According to this stance, a doctor is an artist (Kunstler) who possesses intuition: "Treating is practicing art and not a science" (Szumowski 2007, p. 93). A scientist investigates "interesting cases" that a doctor has to treat. What is needed is to "empathize", "see through" and have "intuition", which plays a great part, especially in differential diagnosis.

   Medical psychology studies personality features of those who treat. Some people believe that "a doctor has to reign over the ill person. And depending on the case, has to be an absolute monarch, a constitutional king or even a tyrant in some cases. He should tell the ill person as little as possible. And his hand, laid on the ill body, works miracles under some influence which science does not even know how to explain" (Szumowski 2007, p. 93). We can read further that "the ill person cannot wait until numerous tests are done or a hypothesis gets confirmed. Medicine does need scientific help, but it is not a science itself - it is an art" (Szumowski 2007, p. 95).

   The unscientific medicine is concerned with what is material and immaterial. Particularly, many methods of treatment depend on the patient's psychic mood, his personal faith in good or evil powers (spirits), in science, in drugs, in doctor, in the hospital etc. It is necessary to know that "in illness and misfortune, when life and existence are threatened, the inclination for mysticism increases. It is commonly known that wars and disasters increase religiousness and mystic moods in societies" (Szumowski 2007, p. 102). Hence the popularity of "healers" can be noticed, who base their work on the deficits of psychology which applies the scientific approach.

   The important role of the psychological components in being ill and in healing, the meaning of the will to live and to be healthy have to be confronted with the will to be ill or to die. Their effect is that among people diagnosed with the same illness some recover and live, while others do not, that one doctor "heals", while another, giving the same medicaments "does not". Thus, the role of subjective factors in healing is enormous. A separate group of people who heal has appeared – "healers" – especially in Germany. It has been estimated that out of 197 different legislations which exist on earth (in 1935) only 19 forbid people with no diploma to heal (cf. Szumowski 2007, p. 115). In Poland, the legislation and the approach to healers have always been quite restrictive. The attitude to Julian Ochorowicz can serve as an example.

   The next part of the book reviewed entitled "The System of Life", discusses definitions of life in materialistic, teleological, holistic, spiritualistic (metaphysical) and vitalistic doctrines. Not only are they important historically, but they also seem valid in contemporary medical thinking. At the end, we find a chapter about methological forms of thinking in the selection of medications, about the image of the doctor in the past and today, about medical ethics, where not only the doctor's knowledge is discussed but also his conscience: "A doctor with pure conscience, driven by noble motives only, has a right, in exceptional cases only, to act as his conscience tells him to. But it is only a flawless doctor, the "best one" that can do so. Such ethics would be aristonomic" (Szumowski 2007, p. 183).

   In the third part ("Logic for Medics") we find the following problems analysed: scientific facts and their analysis, observations and remarks, experimental researches (in vitro and in vivo experiments and experiments on humans). Furthermore, such topics are discussed: inductive reasoning (Mill's principles), finding causative relations in biology, statistics, reasoning through analogy, generalizing – scientific laws, systems – hypothesis – classification, logical mistakes in medicine. A bibliography, a subject index, an index of people and a table of contents can be found at the end. As the author intended, these studies are elementary, both useful and demanding for every past and contemporary doctor. This excellent book by W. Szumowski fills in the bibliographical and historical gap concerning the issues on the subject and the object in medicine in Poland.

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