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Finally, Professor Karem Sadegh-Zadeh's book is a stimulus and an opportunity
to reflect upon the epistemological statute of medical knowledge and its impact on
the analysis and development of medical knowledge engineering.
8.2
Science and Medicine
Like other scientific areas, Medicine began its development from a fundamentally
mechanistic tradition that depended on the subjectively observable world. In this
stage of development, Medicine included contingency as an argument of causality.
The studies on puerperal fever carried out by Doctors Wendell-Holmes, Ignaz Sem-
melweis and Etienne Stéphane Tarnier are examples of this kind of argumentation.
Their work in favour of hygiene during child birth is not justified by rational ar-
guments, but rather an accumulation of evidence led them to induce that there is
a relation between maternal mortality and the type of medical practice. The trial
and error method which prevailed during the early stages of modern Medicine is
the consequence of this inductive knowledge. The next stage in the construction of
knowledge that constitutes Medicine is linked to the appearance of causal reasoning
which, in contrast to the contingency reasoning, strives to explain the relationship
between certain facts and the consequences that could be derived from them. In-
duction was replaced by deductive processes which allow consequences beyond the
specific cases being studied to be explained. This stage of development coincides
with the appearance of what would become basic knowledge in Medicine, guided
by the principles of Positivism. Next, the first interpretative models appeared: the
model based on the idea that disease stems from 'injuries' (clinical, anatomical);
the model based on the belief that disease was caused by corrupted processes in
the functioning of the organism (physiopathological); and the aetiological model
which seeks the causes of the disease outside of the organism. Regardless of the
implications of each model for medical practice, for the first time a scientific corpus
was established regarding what is 'normal' and what is 'pathological'; as a result,
Medicine was transformed into expert knowledge on what is normal and what is
pathological. At the same time, these models sustained two principles:
•
medical knowledge is based on Biology and
•
only that which can be observed, measured and quantified is worthy of being
considered when explaining the causes of an illness.
“In innumerable areas, medicine has succeeded by imposing the rigid and positivist
model on those ideas that it accepts as true. But it has also ruled out as being deviant
ideas that have later proved to be important in understanding a given problem” [4],
p. 734.) In other words, Medicine took a positivist approach to knowledge that only
considers knowledge certain if it is based on information that is not subject to in-
terpretation. The later development of Biochemistry, Bacteriology, Genetics, linked
to Biogenetics, and Biology, Microbiology and Histology, gave a new impulse to the
