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the formation of a specific style in the grasping of its problems and of a specific way
of treating medical phenomena, i.e. to a specific type of thinking.” A few lines later,
he exemplified this assumption: “Even the very subject of medical cognition differs
in principle from that of scientific cognition. A scientist looks for typical, normal
phenomena, while a medical man studies precisely the atypical, abnormal, morbid
phenomena. And it is evident that he finds on this road a great wealth and range of
individuality of these phenomena which form a great number without distinctly de-
limited units, and abounding in transitional, boundary states. There exists no strict
boundary between what is healthy and what is diseased, and one never finds exactly
the same clinical picture again. But this extremely rich wealth of forever different
variants is to be surmounted mentally, for such is the cognitive task of medicine.
How does one find a law for irregular phenomena?—This is the fundamental prob-
lem of medical thinking. In what way should they be grasped and what relations
should be adopted between them in order to obtain a rational understanding?” Fleck
emphasized two points:
•
The first of these was the impact of the knowledge explosion in medical sci-
ence. Accelerated progress in medical research had led to an enormous number
of highly visible disease phenomena. Fleck argued that medical research has “to
find in this primordial chaos, some laws, relationships, some types of higher or-
der”. He appreciated the vital role played by statistics in medicine, but he raised
the objections that numerous observations “eliminate the individual character
of the morbid element” and “the statistical observation itself does not create
the fundamental concept of our knowledge,which is the concept of the clinical
unit.” Therefore “abnormal morbid phenomena are grouped round certain types,
producing laws of higher order, because they aremore beautiful andmore gen-
eral than the normal phenomena which suddenly become profoundly intelligible.
These types, these ideal, fictitious pictures, known as morbid units, round which
both the individual and the variable morbid phenomena are grouped, without,
however, ever corresponding completely to them— are produced by the medical
way of thinking, on the one hand by specific, far-reaching abstraction, by rejec-
tion of some observed data, and on the other hand, by the specific construction
of hypotheses, i.e. by guessing of non observed relations.” [27, p. 39f]
•
The second point that concerned Fleck was the absence of sharp borders between
these phenomena: “In practice one cannot do without such definitions as 'chill',
'rheumatic' or 'neuralgic' pain, which have nothing in common with this book-
ish rheumatism or neuralgia. There exist various morbid states and syndromes
of subjective symptoms that up to now have failed to find a place and are likely
not to find it at any time. This divergence between theory and practice is still
more evident in therapy, and even more so in attempts to explain the action of
drugs, where it leads to a peculiar pseudo-logic.” [27, p. 42]
Clearly, it is very difficult to define sharp borders between various symptoms in the
set of all symptoms and between various diseases in the set of diseases, respectively.
On the contrary, we can observe smooth transitions from one entity to another and
