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The Ideas of Thomas Kuhn in Relation to Medical Advances in the Sixteenth and Seventeenth Centuries

June 1996 saw the death of Professor T S Kuhn, an influential commentator on the history of science. Kuhn maintained that normally scientists think and work within an intellectual framework namely, a paradigm and their research is directed to solving puzzles that serve to clarify and extend the application of the paradigm. Occasionally, in the course of the puzzle-solving that he called 'normal' science, facts incompatible with the framework emerge and as they increase in number a 'crisis' develops. The crisis results in extraordinary investigations being undertaken and these lead to a new paradigm. This is a scientific revolution as described by Kuhnl. I fell to wondering how far these ideas apply to medicine as it progressed in the sixteenth and seventeenth centuries. Kuhn refers to the Copernican revolutions in astronomy and in other sciences in the sixteenth century and later, but there is no mention of the advances in medicine. Where he does refer to medicine it is to include it with crafts such as calendar making and metallurgy. In a later work, however, he acknowledges that anatomy and physiology were highly developed sciences in antiquity and he considers that this development fulfilled a social function namely, the requirements of medicine just as astronomy provided data for horoscopy2. Historians of science have not always confined their attention to anatomy and physiology as examples of medical contributions to science in antiquity. Sambursky has emphasized the importance of the Hippocratic school as a model for the advancement of science and he points out that the physician's clinical observations, his attempts to find a cause for a disease in the environment and predict the course it is likely to follow, are essential features in the scientific approach with its emphasis on cause and effect3. In the opinion of Rupert Hall, most historians do not think that a scientific revolution in the biomedical sciences comparable with that described by Kuhn in astronomy and physics occurred in the seventeenth century4. On the other hand Bernard Cohen in his book Revolutions in Science has no doubt that Harvey brought about a revolution in physiology5. L S King considers that Kuhn's term paradigm does not have any validity in medicine6. I think, however, that a case can be made out for the set of medical dogmas-