Disease as a way Of life Mike Shortland George Canguilhem, On the Normal and the Pathological translated from the French by C.R. Fawcett, with an introduction by Michel Foucault. Dordrecht, Boston, London: D. Reidel Publishing Company, 1978. “They began to doctor me with everything they knew; and every day I grew worse” B. Cellini, Autobiography commonly composed in a dichotomous ease as the lack of health, ill-health as the rting one. “It is by disease that health is hunger, satiety; by weariness, rest.’” (1). forms of suffering, the representation of nce has always held out the hope ofa k for, and be provided with, a Health and disease are familiar notions, order: health as the absence of disease, dis presence of disease. The image is a comfo! pleasant; by evil that good is pleasant; by Even isolated from the contagion of other life in the space bounded by absence and prese! consolatory therapeutics. The sick man could loo! 4 reassurance: what he had lost could be replaced and what had entered him could also leave. Yet the experience of sickness has seemed to confound all traces of distinction between ontological states. Most trivially: a person complains of an ordinary cold and declares herself ill, another ~ or the same — bears the burden of a broken legand lays claim to perfect health, At issueis the very basis of disease or illness conceived as anirruption of states within man, or inthe body. A hierarchy of pathologies founded on localised and identifiable symptoms and a therapy premissed on the specificity of causes and effects has ceded place to man’s personal experience of equilibrium and harmony. In place of the sharp-edged conformation of conquest and incision, the dynamic, totalising conception of disease proclaims the all-encompassing natural hedonism and spontaneity of the environment. a sai = a shared optimism — based on human techniques or the ways Yoh fecdatoreot = have one fundamental point in common. Foedera bai ioue peices po _ — replaced by the, foedera naturae. In disease, or betes dincneain ae, ‘a ‘envision a polemical situation: either the battle ae a foreign substance, or the internal struggle between esate eal . 0 a point, the development of medical thought has played on iternatives. Perhaps medicine only began when this poi . Bac , is point was reach poe : philosophy of works, the philanthropic purpose, and the o ac ol nature by obeying it queried the qualitati ie and to ative distinction between114 I&C the normal and the pathological. At the point when, as Canguilhem puts it, “to govern disease meant to become acquainted with its relations to the normal state”. The articulation of this theoretical need into therapeutic practice during the seventeenth century cannot simply be judged by the shadows it cast on thecure. It did not follow the popular outline which maintains that physiology governs medicine through the intermediary of pathology. These are historical relations and they can seldom be inscribed into a logic of scientific development or spoken in the language of maturation, growth and evolution (2). The line of descent from life to its concepts, which Canguilhem picks up in the nineteenth century, appears rather to have fol- lowed attempts firstly to classify and delimit sickness (Sydenham, Baglivi, Boerhaave) and secondly to link such a classification to anatomical analysis (Morgagni). On the Normal and the Pathological is concerned with the result of the translation of anatomy into physiology and examines what was involved in turning the study of disease into an extension of the study of health. The book astonishingly figures Comte, Broussais and Bernard as its historical core; for all three, it isargued, upheld the real identity of pathological and normal phenomena. Each saw in onea quantitative variation of the other. The result Canguilhem deals with is one which gives rise to a number of diverse disciplines, a regroupment around a principle which generates the possibilities of choices and exclusions. Quantifying pathology Biology appears to occupy an ambiguous place in Comte’s hierarchical classification of the sciences. In the early Cours de Philosophie Positive disciplines are organised according to the extent to which they have progressed towards the positive stage. In addition, the sequence also represents an order of complexity of phenomena under investigation and reflects important methodological features specific to each science. As it stands, biology is constituted as a separate domain in part because of the use it makes of observational and experimental techniques and the methods of analogy and comparison (which are specific to it) and in part because its object, the con- ditions of existence of organisms, was not open to investigation by concepts provided by the physicochemical sciences. Biology thus signifies both the abstract science of a general object — the vital laws — and the synthetic science of a fundamental activity of organisms — life. Nonetheless, if the aim behind the Cours was the codification of an overall, general methodology, its intention, clearly stated in the Systéme de Politique Positive but also present in his earlier work, was to establish scientifically a social and political doctrine. Biology serves as the arm of sociology, politics as a physiological reflex. Though the historical component distinguishes the social entity from the bio- logical and physical, family structure, political institutions and rational behaviour are in every sense reliant upon the biological and physiological characteristics of man. The elemental terms in Comte’s biology serve to disrupt its positional status: the ‘organism’ seems to establish the science as autonomous whilst the ‘milieu’ witholds its independance (3). The identity of the normal and the pathological allows disease to perform the role of an ‘experiment’ on the organism, yet as a quantitative variation of a norm its analysis demands prior knowledge of the normal. Again, theDisease as a way of life 115 general object of biology functions as the basis for the investigation of analogous states resulting from the play of vital laws even though the equation of normal and pathological prevents these states being separated into their constituent mechanisms and effects. With this in mind, it is perhaps easier to appreciate Comte’s motivation in numbering Broussais amongst the ‘best representatives of humanity’ in his Calendrier Positiviste (to the exclusion of Saint-Simon and Cuvier) and hisintention in isolating and distorting a principle from his work (4). Broussais has undoubtedly suffered at the hands of medical historians — justice perhaps for the grognard who hoisted his ridiculous obsession with gastroenteritis above the barbarity of a blood- letting therapeutics. The revenge would have been milder if he hadn’t (successfully) promoted a doctrine through political machinations and personal chicanery (5). If he hadn’t presented himself as another Laénnec or Pasteur. In any case, Broussais importance liés elsewhere, less in doctrine than in orientation. His role in inaug- urating a physiological medicine rests only informally on the tenet, ce se case from Brown (6), that health was in some degree equatable with ill-health. 4 ganization of the medical Formally, it rests on what Foucault has termed the ‘‘new org: i — i ay from symptoms and essence: gaze” (7), on the direction he gave to physiology away " + nt. &, real Evuily and towards localism and lesions. The notion ot ee date arto earth independent of the organism of course underscored this org: 9 iali inder me ~~ is? nce of the materialist legacy u! principle as doctrine isto bypass FROME ae only possible as the result of the Idéologues. For Broussais, IIl¢ «a+ n in tissues above OF ann bos wee afinacth All diseases consisted in ee kell serttailon below the level established by thenorm. It was this ee a biologically based social which Comte raised to the status of a universal axiom zs or artificial ~of the eal physics, such that ‘every modification ~ whether nalvtt (Comte cited in On the concerns only the intensity of corresponding phenomena "| By stating in a general Normal and the Pathological, p. 17). Canguilhem writes: = ys ried in seating tbat way that diseases do not change vital phenomena, Comte 1s oer saentialend the cure for political crises consists in bringing societies back to permanent structure, and tolerating progress only within the limits of variation of the nies . +. rincipl natural order defined by social statics. In positivist doctrine, Broussais’ principle remains an idea subordinated toa system, and it is the physicians, psychologists, and men of letters, positivist by inspiration and tradition, who disseminated it as an independent conception’ (p.28). In like manner, this tradition and inspiration have formed the ground for sub- sequent readings of Bernard’s philosophical position and for monotonous references to his ‘vitalism’, his ‘materialism’, or his ‘idealism’. As its presentation unfolds, the Introduction a l’Etude de la Médecine Expérimentale (8) seems to offer a straightforward verification of the recommendations for the formulation of a single Scientific methodology. Canguilhem has shown elsewhere that just such treatment befalls the text if it is isolated from Bernard’s properly ‘experimental’ works, dissected into one treatise on reasoning and another on applications of this reasoning, or if it is read as a pattern of116 I&C man’s progress towards scientific discovery (9). Each assimilation suggests, in different ways, that Bernard set up a model and simply appropriated Broussais’ principle as the basis for his own determinism. The implication is a serious one: in so doing, Bernard unconsciously undercut his own claims to have originated an experimental physiology. The central problem is the theoretical locus of Bernard’s work and, stemming from this, its relation to vitalism and materialism. Here Canguilhem demonstrates the extent to which Bernard’s opposition to vitalism (by virtue of his principle of physicochemical determinism) and his opposition to materialism (by virtue of the creative and directive idea he attributed to life) were both founded in physiological research and not the product of a universal, principled methodology. Bernard’s reading and annotation of Comte’s works led both to an adoption of his doctrine of three states, with sciences being characterised and differentiated according to the conceptual formation of their specific objects (10), and to the presentation of a unified synthetic physiology founded on the concepts of milieu intérieur and regulatory functions maintaining the stability of the living organism (11). The experimental explanations of these phenomena serve as the guarantee for the validity of the methodological princples in the Introduction. Bernard’s discovery of Se esietie function ofthe liver was not an application of these principles, but the ns to establish a relation to philosophical currents. The distinction between the Faia of glycogen and the transformation of this substance into sugar founded the physiology therefore underla i ae Phenomena of attrition. Experimental principle of the specificity of $i I malts > ee a “a iva a henowt it Ly’ 10 logical functions, and the determinism of biological r nena. As Canguilhem puts it, “the discovery of internal secretions, the ormation of the concept of milieu intérieur, the demonstration of some phenomena of constancy and some mechanisms of regulation in the composition of this milieu ~this is what allows Claude Bernard to be a determinist without being mechanistic, and to understand vitalism as an error and not as a stupidity”’ (12). Bernard’s assertion of the continuity between normal and pathological pheno- menacan be seen as solving one of the antinomies in Comte’s biology. It is directed against the thesis that there exists a qualitative difference between the mechanisms and the products of the vital functions of the normal and the pathological states. The phenomena of life fall into two groups: those of organic synthesis (principally those of creation and organisation) and those of organic destruction. If the latter could be explained by the laws of physics and chemistry alone, the phenomena of the first group eluded such explanation notwithstanding their conformity to the laws governing inert matter. Though both Comte and Bernard identified physiological and pathological phenomena, whereas disease served for Comte as the substitute for an impossible experiment on mankind, the imaginable or ideal experiment led Bernard to the con- ceptualisation of disease. Whilst both viewed science as identical with the discoveryDisease as a way of life 117 of laws, the distinction between them was fundamental. Whereas Bernard saw these laws as supported by the explanatory principles generated by an experimental physiology, Comte based them on the codification of an abstract science. Living pathology Bernard’s reduction of quality to quantity, the unrecognised requirement in Comte’s system for prior knowledge of the normal, and the logical necessity for procedures of measurement imposed on research by Broussais’s principle all pose an initial problem of consistency and subsequently raise a more general issue concerning the relation of disease to the living organism taken asa whole. In the case of Bernard, for instance, notions of quantitative variation and difference of degree are used inter- changeably (13) in such a way that a pathological phenomenon is definable either in terms of quantity or in terms of quality depending on whether vital phenomena are considered as expressions or as mechanisms. The price Bernard pays for solving an ambiguity in Comte’s biology is to pose another at the heart of the experience and feeling of ill-health. If glycosuria [the urinary excretion of carbohy d symptom of diabetes, the presence of sugar i tatively different from normal urine. In terms 01 pathological state, when identified with its principal sympto! ne But if in considering urine as a product of renal secretion, the phy‘ thought turns to the kidney and the relationship between the ee composition of the blood, he will consider glycosuria as excess & ly naa present in the blood] pouring over a threshold. The glucose ot ae threshold is qualitatively the same as the glucose normally he , a threshold. The only difference is, in effect, one of quantity (p. 37). posed which can be considered in terms of 's viewpoint. In terms of results, the disease chanism, it appears only as a demands that physiological ction of drates] is considered to bea major n diabetic urine makes it quali- f the physiological state, the m, is anew quality. Thus a pathological phenomenon is quantity or quality depending on one’ appears as a new quality. Viewed as a disruption in met quantitative variation. To reduce quality to quantity functions be treated as mechanisms, e.g. that glycosuria be merely a fun glycemia, and that the kidney operate simply to regulate the filtration of glucose by means of a constant threshold. This mechanistic conception imposes clear limits on thereapeutics since it takes no account of clinical context and simply traces symptoms back to partial functional operations. But Canguilhem stresses a more general drawback: that this approach bypasses the level and the extent to which the play of pathological and physiological functions sets up a new organism, a coherent alteration in modes of life. Since in the living organism all functions and rhythms are co-ordinated and interdependent, renal behaviour as it is described by Bernard can only theoretically be divorced from the behaviour of the total organism. This play of functions sets up a range of options and exclusions. For example, it becomes possible to deny the quantitative threshold detectable by objectiveOOOO Ee ee 118 I&C measurement and to posit a qualitative distinction between the normal and the pathological in terms of the different effects of the same cause. Knowledge of the physiological would then be derivable from clinical and therapeutic experience. Consequently, physiology would be established as the study of the functions and modes of life, and disease would become one aspect of a mode of existence. In fact, Canguilhem goes one step further to assert that disease itself is another way of life. It is ‘‘a positive innovative experience in the living being and not just a fact of decrease or increase. The content of the pathological state cannot be deduced, save for a difference in format, from the content of health; disease is not a variation on the dimension of health” (p. 108). Like healthy life, disease is characterised by norms; but norms which are cramped, narrow, and inflexible. It is ‘‘anorm of life but ...an inferior norm in the sense that it tolerates no deviation from the conditions in which it is valid, incapable as it is of changing itself into another norm”? (p. 106). Such norms are relative terms creatively established by human life in its relation to the environment. The ontology of psyche and soma—the fact of the psychosomatic relationship —infuse such norms with value and distinguish them from statistical averages (particularly arithmetical means) and from ideal types; from the double illusion of indeterminism. Contrariwise, health is a way of tackling existence with the certainty that ‘‘oneis not only possessor a but also, if necessary, creator of values, establisher of vital norms’’ (p. ; Having certified the original, normative character of life Canguilhem locates the impetus for medicine in personal demands stemming from differing modes of life. Physiology and pathology are the result of collective requirements, or, more properly, individual demands which find an echo. Changes in modes of life are, of course, experienced by the individual and it is to him that falls the responsibility for defining states as normal or pathological. Bearing in mind the philosophical dis- tinction between both states, an exclusion is enforced: there are no such entities as diseased cells, tissues, or organs. There are only negative values for specific individuals in specific environments. In a key passage, Canguilhem comments: Cells of the renal or pulmonary or splenic parenchyma can be called sick today or sick with a certain disease by a certain anatomist or pathologist, who has perhaps never set foot in a hospital or clinic, only because these cells were removed, or they resemble ones which were removed, yesterday or a hundred years ago—it doesn’t matter—by a practising physician, clinician, and therapist, from the cadaver or amputated organ of a man whose behaviour he had observed (p. 133). The object of pathology is morbid experience; and pathology is not enjoined — nor indeed is it permitted —to pronounce previously unrecognised events as abnormal unless these have had, or contiue to have, some constraining effect on vital norms. Implicit here is the fact that Canguilhem has in effect bypassed the processes which organise ‘subjective’ perceptions of the normal and the pathological. Perceptions ofDisease as a way of life 119 pathological states are ultimately depicted on the basis of their simple relation to the phenomenon of adaptation. What defines the normal and the pathological is the result of a decision: the choice a living being makes when he decides whether “‘to shield himself from or submit to certain influences’? (p. 104). Again, normality is seen as a mode of judgement subordinate to, and frequently reducible to, the biological and physiological make-up of the individual establishing norms (p. 70). Either a problem concerning the production and reproduction of discursive practices has been collapsed into a natural history of changing responses to environmental challenges. Or, these practices and responses must belong to the same complex. In the early part of this book (written in 1943) the first option seems more in evidence as Canguilhem ponders on the possibility of a recovered Lamarckism (14). At this point, the direction the text points to depends largely on the resolution, or the handling, of a range of issues and dichotomies posed primarily at the interface of the subjective and the objective, the scientific and the non-scientific, the individual and the environment. — i That the normal is not aconcept of existence susceptible to objective measurement does not in itself challenge the scientific status of physiology, or of biology _ pathology (15). Or rather: it does so only for a positivism a Satan a scientificity of a discipline on the basis of general ane ga ae witch according to the nature of a pre-given object: for an ae clesl how? and the specifies that scientificity in the simple responses'o i rei oll in this trail objective what? It is difficult to see Canguilhem’s own is solo y and pathology is since the examination of the predominant features of Som hysioloy. What is loosely governed by the formula that pathology proces ositivism grounded in offered is more strictly a post-morten of nineteenth century Pi +. Physiology is the latter’s own terms, but conditioned by today’s clinical ae is a earch for deemed a genuine science of stabilized modes of life in terms of 1 + astiiel constants and invariants, its metrical procedures, and its general ana yt ; approach” (p. 119). And, to the extent that pathology works from sa pat te 7 study of morbid experience might be thought to simply inherit the latter Fi procedures. Nonetheless, approving a subjective but scientific pathology hallmarke by an objective method not only resurrects the primacy of the clinical diagnosis but, more importantly perhaps, allows the distinction between physiology and pathology to have no more than clinical significance. The role of this clinical context is crucial. To write that ‘‘it is first and foremost because men feel sick that a medicine exists” (p. 138) can only serve as a general argument to the extent that universal — as opposed to individual — subjective feelings of health and ill-health are deemed to give rise toa therapeutics (16). But because Canguilhem equates those preconditions with the object of that therepeutics and legitimises the pre-existing categories of ‘doctor’ and ‘patient’, he is led to deny the constitutive role medicine plays in manufactur- ing, in organising, and in formulating natures of health and disease. Whilst the clinic might operate to distinguish pathological and physiological forms prior to therapy—a notion which in itself is open to question—it cannot alone120 I&C differentiate a pathology of “‘renal or pulmonary or splenic parenchyma’”’ from a pathology of (say) masturbation. Yet within the terms set, there is no source from which to draw in order to extend this differentiation. The clinic becomes a single site to which patients bring common experiences of varying values and from which they are dispatched with re-stabilized modes of life. Second thoughts Only in the later section of On the Normal and the Pathological—the ‘‘New Reflections’’ (1963-1966) —does Canguilhem attend to the fact that the norm is inseparable from normality and normalisation. What twenty years earlier had been a marginal feature of his account now becomes the central core. There is the implication here that a new book might have been written: the norm is now quite unknowable outside the processes of normalisation. Still, it is perhaps unwise to overstress the theoretical changes that have taken place. Canguilhem after all poses only very carefully and cautiously the problem of the specification of norms within the technical and nature operations which effect and correct normativity. There is certainly a rejection of adaptation as the locus for a definition of the normal and the pathological, and Canguilhem clearly rescinds what had earlier appeared as an anthromorphic reduction of the establishment of norms to biological normativity. A similar concern is apparent in Canguilhem’s introduction of the notion of error in pathology as a means of conceiving both man’s relation to disease and the complex links between knowledge and its object. More substantially, the usage of social norms comes to be seen as assuming in the human conditions of life the role hitherto attributed to biological norms, e.g. Canguilhem suggests that the social appropriation of power comes to define certain norms as biologically valid. That usage comes in turn to be implicated in the specifically cultural and anthropological experience of normalisation. ‘At any given moment the experience of normalisation cannot be broken down, at least not inte projects ... Between 1759, when the word ‘normal’ appeared, and 1834 when the word ‘normalised’ appeared, 2 normative class had won the power to identify —a beautiful example of ideological illusion —the function of social norms, whose content it determined, with the use that class made of them” (p. 151). Such words are then decipherable — ‘‘if social norms could be perceived as clearly as organic norms, men would be mad not to conform to them”’ (p. 160)—in the terms passed into popular language, with the specific vocabularies of the hospital, the clinic, and the pedagogical institution. ‘Normal’ is the term used by the nineteenth century to designate the scholastic prototype and the state of organic health. The reform of medicine as theory, itself rests on the reform of medicine as practice: in France as also in Austria it is closely tied to hospital reform. Like pedagogical reform, hospital reform expresses a demand for rationalization which also appears in politics, as it appears in the economy, under the effect of nascent mechanization, and which finally ends up in what has since been called normalization.” (p. 145)Disease as a way of life 121 It is best then to see these suggestions as recharting the ground laid out in the earlier parts of the book and, in so doing, reorganizing their levels into a history of the processes of normalisation. This is not playing geologist to Foucault’s archaeology (17) but instead offering a double interception of Foucauldian work. Firstly, and most obviously, the ‘New Reflections”’ are a contribution to the understanding of the role of the institutional structuring of clinical experience (18). Secondly, the text as a whole (and the earlier passages dealing with Bichat, Broussais and Bernard particularly) provides more discreet and varied lines of contact with other analyses of the explanatory structures of vital properties and organic functions, and even with the distinctive epistemology of the classic age (19). Without the benefit of these analyses, On the Normal and the Pathological was necessarily limited in scope; but even with its deficiencies it stands as a monumental contribution to our awareness of the formation of a system of concepts in accordance with a set of notions of normality and pathology. Without the benefit of this book we should be led to misunderstand these notions. More seriously still, we might be tempted to surrender them to medical chroniclers of health and ill-health, and to the cosy familiarity of health and disease. Bibliographical Note ical i A version of Michel Foucault’s preface to On the Normal and i Sis thie translated as ‘Georges Canguilhern, philosopher of error’ in Aig Cle Recanangs the Human Sciences, Autumn 1980. 7 George Canguilhem’s essay ‘Qu’est-ce qu’une Idéologie Scientifique? is a. in translation as ‘What is a Scientific Ideology?’ in Radical Philosophy , 29, (Autumn 1981), with an Introduction by Mike Shortland. NOTES 1. Heraclitus, Fragments, 99. : a - 2 i “L’Objet de l’Histoire des Sciences’ in Etudes d'Histoire et de Philo- spike We Scien, Faris, 3s le de I’Epistémologie dans l’Historiographie sophie Sciences, Paris, 1975; ‘Le Rol dan: , Selentifigne Contemporaine’ in Idéologie et Rationalité dans! ‘Histoire des Sciences dela Vie, Paris, 1977; Suzanne Bachelard, ‘Epistémologie et Histoire des Sciences in XHe Congrés International d’Histoire des Sciences, Paris, 1968; and Mike Shortland, “Explanations Explanatory of Things Explained’, History of European Ideas, 3, March 1981, 3. Canguilhem develops this point in his ‘La Philosophie Biologique d’Auguste Comte et son Influence au XIXe Siécle’ in Etudes. 4. See George Sarton, ‘Auguste Comte, Historian of Science’, Osiris, 10, 1952 for an English translation of Comte’s Calendrier Positiviste. 5. For an account of Broussais’s political, personal and scientific influence, see Erwin H. Ackerknecht, ‘Broussais or a Forgotten Medical Revolution’, Bulletin for the History of Medicine, XXVII, 1953. His physiological views are adequately summed up in E. Boinet, Les Doctrines Médicales, Paris, 1907. 6. — Broussais’ views are often depicted as a kind of Brownism in reverse. Brown and Glisson are treated in Canguilhem, ‘Une Idéologie Médicale Exemplaire, le Systéme de Brown’, |122 [&C 11. 12, 13. 14, 15. 16. 17. 18. 19. in Idéologie et Rationalité. O. Temkin’s ‘The Classical Roots of Glisson’s Doctrine of Ir- ritation’, Bull. Hist. Med., XXXVIII, 1964 is a useful overview. See M. Foucault, The Birth of the Clinic, London, 1973, esp. Chapter 10. Translated as An Introduction to the Study of Experimental Medicine, New York, 1957. See Canguilhem’s ‘L’Idée de Médecine Expérimentale selon Claude Bernard’ and ‘Théorie et Technique de l’Expérimentation chez Claude Bernard’ in Etudes. See Claude Bernard, Philosophie; Manuscrit Inédit, Paris, 1938 for Bernard’s notes on Comte, written from 1865-67. Therole of the milieu interieurin Bernard’s physiology is treated in Canguilhem, ‘L’Evo- lution du Concept de Methode de Claude Bernard 4 Gaston Bachelard’ in Etudes, especi- ally pp. 168ff. See also note 9. Etudes, p.139. See Canguilhem, ‘Aspects du Vitalisme’, in La Connaissance de la Vie, Paris, 1975, es- pecially pp. 86-98 for treatment of this point. Canguilhem writes: ‘‘We take the liberty of asking ourselves whether the theory of the en- vironment’s action on the living being were not on the verge of recovering from long dis- credit”? (p.104). As a measure of Canguilhem’s subsequent shift in the ‘‘New Reflections” (1963-66), Canguilhem later writes ‘‘We no longer take the liberty of asking ourselves this today’’ (p.184). As Canguilhem himself later recognises, e.g. in ‘Sur une Epistémologie Concordataire’, Hommage a Gaston Bachelard, Paris, 1957 and in ‘Dialectique et Philosophie du Non chez Gaston Bachelard’ in Etudes. See La Connaissance de la Vie, p.167-69 “Making Foucault into a kind of geologist amounts to saying that he naturalises culture by withdrawing it from history’? Canguilhem, ‘Mort de !’Homme ou Epuisement du Cogito?’ (A Review of Foucault’s Les Mots et les Choses) Critique, XXIII, July 1967, p.603. Canguilhem is referring hereto Michel Amiot’s review ‘Le Relativisme Culuraliste le a Foucault’ Les Temps Modernes, No. 248, January 1967, especially pp. cf. M. Foucault, The Birth of the Clinic, London, 1973, Chapter 4. Aside from Foucault’s The Birth of the Clinic and The Order of Things, London, 1970, see also William Randall Albury’s ‘Experiment and Explanation in the Physiology of Bichat and Magendie’, Studies in the History of Biology, 1, 1977, especially pp. 84-96 and his ‘Physiological Explanation in Magendie’s Manifesto of 1809’, Bulletin for the History of Medicine, XLVIII, 1974 for discussions which draw on Foucault’s analysis.