Canguilhem, G. (1991). The Normal and the Pathological. translated by Carolyn R. Fawcett, New York: Zone Books.
캉길렘 (2018). 『정상적인 것과 병리적인 것』. 여인석 옮김. 그린비.
1부 병리적 상태는 정상 상태의 양적인 변화에 불과한가?
2. 오귀스트 콩트와 "브루세의 원리" (Auguste Comte and "Broussais's Principle")
Auguste Comte asserted the real identity of pathological phenomena and the corresponding physiological phenomena at three principal stages of his intellectual development: first, in the period leading up to the <실증철학강의Cours de philosophie positive>, characterized, at the beginning, by his friendship with 생시몽Saint-Simon, with whom he severed relations in 1824; second, the actual period of the positive philosophy; and third, the period of the <실증정치학의 체계Systeme de politique positive>, which, in certain respects, is very different from the preceding one. Comte gave what he called Broussais's principle universal significance in the order of biological, psychological and sociological phenomena. [47]
...모든 질병은 증상에 불과하며 생명 기능의 장애는 기관, 또는 정확히 말하면 조직의 병변 없이는 발생할 수 없다는 것
It was in 1828 that Comte took notice of Broussais's treatise <과잉 자극 상태와 광기에 대하여De l'irritation et de la folie [On Irritation and Madness]> and adopted the principle for his own use. Comte credits Broussais, rather than Bichat, and before him, Pinel, with having declared that all diseases acknowledged as such are only symptoms and that disturbances of vital functions could not take place without lesions in organs, or rather, tissues. But above all, adds Comte, "never before had anyone conceived the fundamental relation between pathology and physiology in so direct and satisfying a manner." Broussais described all diseases as consisting essentially "in the excess or lack of excitation in the various tissues above or below the degree established as the norm." Thus, diseases are merely the ef fe cts of simple changes in intensit.y in the action of the stimu lants which are indispensable for maintaining health. [47-48]
From then on Comte raised Broussais's nosological conception to the level of a general axiom. It would not be exaggerating to say that he accorded it the same dogmatiC value as Newton's law or d' Alembert's prinCiple. Certainly when he tried to link his fun damental SOciological principle, "progress is nothing but the de velopment of order," to some other more general principle which could verify it, Comte hesitated between Broussais's authority and d'Alembert's. He refers sometimes to d'Alembert's reduction of the laws of the propagation of movement to the laws of equilib rium [28, I, 490-94], sometimes to Broussais's aphorism. The positive theory of the changeability of phenomena [48]
is completely reduced to this universal principle and results from the systematic application of Broussais's great aphorism: every modification - whether natural or artificial - of the real order concerns only the intensity of the corresponding phenomena . . . ; despite variations in· degree, phenomena always retain the same arrangement; every change in the actual nature, that is, class, of an object is recognized moreover as being contradic tory [28, III, 71]. [48]
Little by little Comte practically claimed the intellectual paternity of this principle for himself by virtue of the fact that he applied it systematically, exactly as he at first thought that Broussais, hav ing borrowed the principle from Brown, was able to claim it for himself because of the personal use he had made of it [28, IV, App. 223]. Here we must quote a rather long passage which would be weakened if summarized: [48]
In the case of living beings, the judicious observation of dis ease fonns a series of indirect experiments which is much more suitable than most direct experiments to throw light on ex plaining dynamic and even statistical notions. My philosophi cal Treatise did much to commend the nature and scope of such a procedure which leads to truly important gains in biology. It rests on the great principle, whose discovery I attribute to Broussais as it derives from the sum total of his works, although I alone constructed the general and direct formula. Until Broussais, the pathological state obeyed laws completely dif ferent from those governing the nonnal state, so that the ex ploration of one could have no effect on the other. Broussais established that the phenomena of disease coincided essentially with those of health from which they differed only in tenns of intensity. This brilliant principle has �ecome the basis of pa thology, thus subordinated to the whole of biology. Applied in the opposite sense it explains and improves the great capacity of pathological analysis for throwing light on biological specu lations . . . . The insights already gained from it can only give a faint idea of its ultimate efficacy. Those engaged in the ency clopedic task of compiling and classifying knowledge will ex tend Broussais's principle primarily to moral and intellectual activities where it has not yet received a worthy application, hence their diseases surprise or move us without instructing us . . . . In the general system of positive education, besides its direct usefulness for biological problems, this principle will be an appropriate logical preparation for analogous procedures in any science. The collective organism, because of its greater de gree of complexity, has problems more serious, varied, and fre quent than those of the individual organism. I do not hesitate to state that Broussais's principle must be extended to this point and I have often applied it to confinn or perfect sociological laws. But the analysis of revolutions could not illuminate the positive study of society without the logical initiation result ing, in this respect, from the simplest cases presented by biol ogy [28, I, 65/-53]. [49-50]
Here then is a principle of nosology vested with a universal au thority that embraces the political order. Moreover, it goes with out saying that it is this last projected application which confers the prinCiple with all the value of which it is already capable, ac cording to Comte, in the biological order. [50]
The fortieth lecture of the Cours de philosophie positive - phi losophical reflections on the whole of biology - contains Comte's most complete text on the problem now before us. It is concerned with showing the difficulties inherent in the simple extension of experimental methods, which have proved their usefulness in the phYSicochemical sphere, to the particular characteristics of the living: [50]
Any experiment whatever is always designed to uncover the laws by which each determining or modifying influence of a phe nomenon effects its performance, and it generally consists in introdUcing a clear-cut change into each designated condition in order to measure directly the corresponding variation of the phenomenon itself [27, /69]. [50]
Now, in biology the variation imposed on one or several of a phe nomenon's conditions of existence cannot be random but must be contained within certain limits compatible with the phenome non's existence. Furthermore, the fact of functional consensus proper to the organism precludes monitoring the relation, which links a determined disturbance to its supposedly exclusive effects, with sufficient analytical precision. But, thinks Comte, if we readily admit that the essence of experimentation lies not in the research er's artificial intervention in the system of a phenomenon which he intentionally tends to disturb, but rather in the comparison be tween a control phenomenon and one altered with respect to any one of its conditions of existence, it follows that diseases must be able to function for the scientists as spontaneous experiments which allow a comparison to be made between an organism's vari ous abnormal states and its normal state. [50-51]
According to the eminently philosophical principle which will serve from now on as a direct, general basis for positive pa thology and whose definitive establishment we owe to the bold and persevering genius of our famous fellow citizen, Broussais, the pathological state is not at all radically different from the physiological state, with regard to which - no matter how one looks at it - it can only constitute a simple extension going more or less beyond the higher or lower limits of variation proper to each phenomenon of the normal organism, without ever being able to produce really new phenomena which would have to a certain degree any purely physiological analogues [27, 175]. [51]
Consequently, every conception of pathology must be based on prior knowledge of the corresponding normal state, but conversely, the scientific study of pathological cases becomes an indispens able phase in the overall search for the laws of the normal state. The observation of pathological cases offers numerous, genuine advantages for actual experimental investigation. The transition from the normal to the abnormal is slower and more natural in the case of illness, and the return to normal, when it takes place, spontaneously furnishes a verifying counterproof. In addition, as far as man is concerned, pathological investigation is more fruit ful than the necessarily limited experimental exploration. The scientific study of morbid states is essentially valid for all organ isms, even plant life, and is particularly suited to the most com plex and, therefore, the most delicate and fragile phenomena which direct experimentation, being too brusque a disturbance, would tend to distort. Here Comte was thinking of vital phenomena re lated to the higher animals and man, of the nervous and psychic functions. Finally, the study of anomalies and monstrosities con ceived as both older and less curable illnesses than the functional disturbances of various plant or neuromotor apparatuses completes the study of diseases: the "teratological approach" [study of monsters] is added to the "pathological approach" in biological investigation [27, 179]. [51-52]