On the historical contingency of medical knowledge

Abstract

A commonplace view amongst philosophers is that the function of the heart is obviously to pump blood around the body. Given this, one might think that facts about whether patients’ heart are failing to function properly are simple to discover, fully determined by the given nature of human physiology, and independent changing human cultures. I argue against this view, noting that doctors in the present day do not believe that the function of the heart is simply to pump blood. I argue that medical knowledge about heart failure is not progressing towards an ultimate truth, but rather that this knowledge is historically contingent. To do this I explore the development of knowledge of heart failure over the last two centuries, focusing particularly on the early nineteenth century research of James Hope, and the early twentieth century research of James Mackenzie. I compare the facts produced about heart disease by these two historical actors, noting that they produced very different ways of understanding heart disease, and diagnosed heart disease in different ways. For instance, Hope argued that the stethoscope was a powerful diagnostic tool, whereas Mackenzie argued that the stethoscope had probably done more harm than good. I analyse these differences using Ludwik Fleck’s work, drawing especially on his account of the active and passive elements of knowledge. I argue that if Fleck’s epistemology is read as a form of conventionalism, and augmented using the work of Henri Poincaré, then these active and passive elements of knowledge are suitable tools for analysing how Hope and Mackenzie produced the facts that they did. Using Fleck in this way, I will argue that medical knowledge can be historically contingent and objective, at once invented and discovered. I also use my longue durée account to argue that the way heart failure is understood today cannot be explained without taking the full sweep of this history into account. Consequently, I argue that medical history is valuable to the evaluation of diagnostic practices in the present day.