Published quarterly exploring epistemological paradigms, clinical ethics, historical pathology, and the evolution of medical humanism.
16
Peer-Reviewed Papers
Showing all 16 articles across Issue 1 and Issue 2. Click article titles or abstracts to explore.
Vol 8, No 1
Issue 1 (2023)
Published: March 2023 | Articles: 8 | Special Focus: Epistemology of Clinical Judgment
8 articles
Research Articlepp. 1–18•DOI: 10.1234/ahifm.2023.8.1.01
The Ontological Status of Disease in Renaissance Medical Philosophy: Between Galenic Humorism and Paracelsian Chymistry
Eleanor Vance-Vanderbilt1, Julian Thorne2
1Department of History and Philosophy of Science, University of Cambridge, UK; 2Institute for Medical Humanities, Heidelberg University, Germany
GalenismParacelsusOntology of DiseaseRenaissance Medicine
Abstract
The transition from medieval scholastic medicine to early modern philosophy of science was marked by intense ontological debates regarding the fundamental nature of pathological states. This paper examines the fierce theoretical disputes between orthodox Galenic physicians, who championed qualitative imbalance (dyscrasia) of bodily humors, and Paracelsian chymists, who posited specific chemical entities (tria prima) and localized ontological seeds (semina) responsible for distinct maladies. Through textual analysis of sixteenth-century medical treatises and university disputations, we trace how this epistemological shift redefined disease not merely as a subjective physiological imbalance of the individual patient, but as an objective, quasi-autonomous entity invading the corporeal domain. Furthermore, we investigate the philosophical implications of this transition for clinical therapeutics, noting how diagnostic criteria transformed from complex holistic pulse-and-urine semiotics toward targeted pharmacological interventions. Our findings suggest that Renaissance medicine laid the crucial groundwork for modern biomedical ontology long before the advent of cellular pathology and bacteriology, fundamentally altering the physician's epistemic relationship to suffering and corporeal reality.
Keywords: Galenism, Paracelsus, Ontology of Disease, Renaissance Medicine
Accepted: 14 Feb 2023
Medical Humanitiespp. 19–34•DOI: 10.1234/ahifm.2023.8.1.02
Narrative Medicine and the Phenomenology of Pain in Post-WWII Clinical Practice
Marcus L. Aurelius Chen1, Beatrice Moreau2
1Department of Bioethics and Medical Humanities, Johns Hopkins University, USA; 2Faculty of Philosophy, Sorbonne Université, Paris, France
The experience of chronic and acute pain presents a profound epistemological and communicative crisis within modern scientific medicine, which has historically prioritized objective, quantifiable diagnostics over subjective lived testimony. This paper explores the emergence of narrative hermeneutics in post-World War II clinical medicine, examining how existential philosophy and phenomenological psychology influenced the doctor-patient encounter. By analyzing clinical case notes, psychiatric hospital archives, and early patient memoirs from the 1950s and 1960s, we demonstrate how physicians began to grapple with the 'un-shareability' of severe pain as articulated by thinkers like Merleau-Ponty and Elaine Scarry. We argue that the marginalization of patient narrative in high-technology hospital environments generated a therapeutic alienation that prompted the early modern roots of the medical humanities movement. Furthermore, we evaluate how incorporating narrative competencies into clinical training restores the ethical balance between the impersonal scientific gaze (the 'disease') and the intimate human reality of suffering (the 'illness'). Ultimately, this historical inquiry underscores that clinical empathy is not merely a soft adjunct to technical expertise, but an essential epistemological instrument for accurate diagnosis and holistic healing.
Keywords: Phenomenology, Pain Narrative, Clinical Hermeneutics, Medical Ethics
Eugenics, Biopower, and Psychiatric Classification in Early 20th Century Central Europe
Katarzyna Nowak1, Hans-Dieter Schmidt2
1Institute of History of Science, Polish Academy of Sciences, Warsaw; 2Department of Psychiatry and History of Medicine, University of Vienna, Austria
EugenicsBiopowerPsychiatric NosologyFoucault
Abstract
The institutionalization of eugenic ideology across Central European psychiatric institutions in the decades preceding the Second World War represents one of the most troubling intersections of state biopower and medical taxonomy. This study investigates how psychiatric diagnostic categories—ranging from 'constitutional psychopathy' to 'hereditary feeblemindedness'—were systematically redefined to serve state demographic and racial hygiene agendas. Utilizing newly cataloged asylum records, institutional correspondence, and legislative drafts from universities in Vienna, Breslau, and Kraków, we analyze the micro-politics of clinical classification. We show how diagnostic criteria were expanded not merely through clinical observation, but through socio-political pressures aimed at establishing biological hierarchies among citizen populations. The article traces the role of influential psychiatric leadership in normalizing sterilization and institutional segregation under the guise of preventive public health. By examining the complicity and occasional resistance of medical professionals, this historical critique illuminates the dangers inherent when nosological categories are detached from therapeutic beneficence and weaponized in the service of ideological social engineering. The lessons drawn resonate profoundly with contemporary bioethical debates surrounding genetic screening, neurodiversity, and algorithmic health stratification.
Empiricism and Experiment in Arabic Medicine: Ibn al-Nafis and the Pulmonary Transit
Tariq Al-Mansoor1, Sarah Jenkins2
1Department of History of Islamic Science, Cairo University, Egypt; 2Wellcome Centre for Cultures and Environments of Health, University of Exeter, UK
Ibn al-NafisPulmonary CirculationArabic MedicineEpistemology
Abstract
The discovery of the pulmonary transit of blood has long been a focal point in the historiography of physiology, traditionally attributed to sixteenth-century European anatomists such as Realdo Colombo and William Harvey. However, thirteenth-century Arab physician Ibn al-Nafis provided the earliest known accurate description of pulmonary circulation in his monumental commentary on the anatomical sections of Avicenna's Canon. This paper reassesses Ibn al-Nafis's contribution not merely as an isolated empirical observation, but within the broader epistemological framework of medieval Islamic medical science. We examine how al-Nafis utilized logical critique, anatomical dissection (despite legal and religious constraints), and rigorous skepticism toward authoritative figures like Galen and Avicenna. Through close philological examination of 'Sharh Tashrih al-Qanun', we demonstrate that al-Nafis operated with a sophisticated methodology of empirical verification where logical deduction and observation superseded blind reliance on classical texts. This historical reassessment highlights the continuity of scientific inquiry across cultural and linguistic boundaries, challenging Eurocentric narratives of the scientific revolution and demonstrating how medieval Islamic scholars cultivated proto-scientific experimental attitudes centuries before the European Renaissance.
Keywords: Ibn al-Nafis, Pulmonary Circulation, Arabic Medicine, Epistemology
The Ethics of Medical Experimentation on Vulnerable Populations: A Historical Review from Jenner to Nuremberg
Clara Lindqvist1, Arthur Pendelton2
1Centre for biomedical Ethics, Karolinska Institute, Stockholm; 2Department of Philosophy, McGill University, Montreal
Human ExperimentationResearch EthicsNuremberg CodeInformed Consent
Abstract
The codification of modern research ethics—culminating in the Nuremberg Code of 1947 and subsequent Declaration of Helsinki—did not emerge in an ethical vacuum, but was forged through centuries of contested clinical experimentation involving vulnerable populations. This historical review examines the evolving standards of human subject research from the late eighteenth century through the Second World War. We analyze notable milestones, including Edward Jenner's inoculation trials on children and servants, nineteenth-century yellow fever and cholera trials conducted on prisoners and soldiers in colonial territories, and the catastrophic abuses committed by Nazi medical researchers. By examining these historical episodes through the lens of ethical philosophy, we trace how notions of informed consent, risk-benefit ratio, and institutional oversight gradually developed. The paper highlights the persistent tension between scientific imperatives for clinical progress and the fundamental moral imperative to protect human dignity. We argue that historical analysis of past ethical transgressions remains vital for contemporary bioethicists navigating current dilemmas in global clinical trials, particularly concerning placebo-controlled studies in developing nations and genetic experimentation on vulnerable patient cohorts.
Keywords: Human Experimentation, Research Ethics, Nuremberg Code, Informed Consent
Accepted: 12 Mar 2023
Philosophy of Medicinepp. 87–102•DOI: 10.1234/ahifm.2023.8.1.06
Philosophical Foundations of Placebo Responses in Clinical Trials: Meaning, Mind, and Methodology
Matteo Rossi1, Helen Cartwright2
1Department of Philosophy, University of Milan, Italy; 2School of Philosophy and Public Health, Australian National University
Placebo EffectEpistemology of TrialsMind-Body ProblemClinical Methodology
Abstract
The randomized controlled trial (RCT) relies fundamentally on the placebo control as the gold standard for isolating specific pharmacological efficacy from extraneous psychological and contextual influences. However, the philosophical status of the placebo response remains deeply contested within philosophy of science and medical epistemology. Is the placebo merely a confounding statistical nuisance to be subtracted from trial data, or is it a potent, genuine psychobiological healing mechanism rooted in meaning and symbolic interaction? This paper investigates the philosophical foundations of the placebo effect, challenging the Cartesian dualistic separation between inert physical pills and active psychological meaning. We examine how historical conceptualizations of inert substances evolved from nineteenth-century deceptive medical practices into standardized methodological controls. Furthermore, we analyze recent neurobiological and enactive theories of medicine that view the clinical encounter itself as an active therapeutic intervention. We argue that treating the placebo effect as a mere methodological artifact distorts our understanding of therapeutic efficacy and obscures the complex psychosomatic pathways inherent in all healing. Reconceptualizing placebo invites a more integrated, patient-centered philosophy of clinical science.
Keywords: Placebo Effect, Epistemology of Trials, Mind-Body Problem, Clinical Methodology
Accepted: 19 Mar 2023
Visual Medical Humanitiespp. 103–120•DOI: 10.1234/ahifm.2023.8.1.07
Medical Iconography and the Visual Rhetoric of Anatomy in Vesalian and Post-Vesalian Works
Sophie van der Meer1, Dominic Vance2
1Department of Art History and Medical Iconography, Leiden University, Netherlands; 2Faculty of History, University of Oxford, UK
VesaliusAnatomical IllustrationVisual RhetoricRenaissance Art
Abstract
The publication of Andreas Vesalius's 'De humani corporis fabrica' (1543) is universally celebrated as a watershed moment in anatomical science, largely due to its unprecedented precision in woodcut illustration. However, these iconic images were not merely neutral scientific depictions of corporeal structures; they were sophisticated rhetorical instruments designed to persuade the scholarly community of Vesalius's anatomical authority over classical Galenic dogma. This paper analyzes the visual rhetoric embedded in Vesalian and post-Vesalian anatomical iconography, focusing on the dramatic 'muscle men' (musculi) striking melancholic and defiant poses against idealized Italian landscapes. By examining the interplay between Renaissance humanist aesthetics, artistic patronage in Titian’s workshop, and empirical dissection, we demonstrate how visual art actively constructed scientific truth. Anatomical plates functioned simultaneously as pedagogical tools, philosophical allegories of mortal transience (memento mori), and assertions of human mastery over nature. We evaluate how subsequent seventeenth-century anatomists adopted and modified these visual tropes, illustrating that the history of medical science is inextricably intertwined with the history of visual representation and artistic persuasion.
Keywords: Vesalius, Anatomical Illustration, Visual Rhetoric, Renaissance Art
Public Health, Quarantine, and Civil Liberties in Nineteenth-Century European Cholera Epidemics
Jan Kowalski1, Marianna Rossi2
1Department of History of Medicine, Jagiellonian University, Kraków; 2Institute of European History, Università di Bologna, Italy
CholeraQuarantineCivil LibertiesState Power
Abstract
The recurring pandemic waves of Asiatic cholera that swept across Europe during the nineteenth century forced states to balance draconian sanitary containment measures against individual civil liberties and free commerce. This historical study examines the political and medical controversies surrounding sanitary cordons, maritime quarantines, and compulsory isolation hospitals in ports and urban centers such as Hamburg, Marseille, Warsaw, and Naples. We analyze municipal health board records, parliamentary debates, and medical journalism to uncover the fierce ideological battles between contagionists and anti-contagionists. While sanitary interventions frequently succeeded in slowing epidemic spread, they routinely provoked social unrest, working-class riots, and accusations of state tyranny against marginalized urban populations. Furthermore, we explore how sanitary crises accelerated the centralization of state bureaucratic power and laid the institutional foundations for modern international health governance. By drawing parallels with recent twentieth and twenty-first-century pandemic responses, this article demonstrates that infectious disease outbreaks consistently test the delicate equilibrium between collective epidemiological security and liberal democratic rights, revealing deep-seated social anxieties surrounding contagion and alterity.
Keywords: Cholera, Quarantine, Civil Liberties, State Power
Accepted: 31 Mar 2023
Vol 8, No 2
Issue 2 (2023)
Published: September 2023 | Articles: 8 | Special Focus: Ethics of Technology and Modern Psychiatry
From Asylums to Community Care: The Anti-Psychiatry Movement and the Redefinition of Mental Illness in the 1960s
Liam O'Connor1, Astrid Lindgren2
1Department of History of Medicine, Trinity College Dublin, Ireland; 2Department of Sociology and Psychiatry, Lund University, Sweden
Anti-PsychiatryThomas SzaszDeinstitutionalizationMental Health History
Abstract
The 1960s witnessed a radical intellectual and social upheaval within the mental health sector, famously encapsulated by the 'anti-psychiatry' movement. Thinkers and clinicians such as R.D. Laing, Thomas Szasz, and Franco Basaglia challenged the foundational nosological and institutional premises of traditional psychiatry, arguing that madness was not simply a biological brain disease, but a meaningful response to dysfunctional social and familial environments. This article explores the philosophical and historical trajectories that led to the mass deinstitutionalization movement across Western Europe and North America. By analyzing psychiatric congress proceedings, legislative reforms in Italy and the United Kingdom, and critical literature from the period, we examine how the critique of total institutions redefined psychiatric ethics. We assess the profound tensions between idealistic liberation movements and the subsequent practical challenges of community-based psychiatric care, including homelessness and lack of outpatient support. Ultimately, we evaluate how this turbulent decade reshaped modern understandings of mental suffering, patient agency, and the complex boundary between pathology and societal deviance.
Keywords: Anti-Psychiatry, Thomas Szasz, Deinstitutionalization, Mental Health History
Accepted: 10 Aug 2023
Digital Medical Humanitiespp. 21–38•DOI: 10.1234/ahifm.2023.8.2.02
Artificial Intelligence in Diagnostics: Epistemological Shifts and Ethical Dilemmas in Medical Decision-Making
Siddharth Mehta1, Chloe Dubois2
1Department of Ethics and Technology, Indian Institute of Technology Bombay; 2Center for Philosophy of Science, CNRS, Paris, France
The rapid integration of machine learning algorithms and deep neural networks into clinical diagnostic workflows marks one of the most profound epistemological shifts in the history of medicine. Unlike traditional evidence-based medicine, which relies on transparent pathophysiological mechanisms and statistical population inferences, modern AI diagnostic tools frequently operate as 'black boxes', generating probabilistic outputs without discernible causal pathways. This paper examines the philosophical implications of algorithmic opacity in clinical judgment. We investigate how the replacement of human phenomenological intuition and narrative history-taking with algorithmic pattern recognition alters the physician's epistemic authority and moral responsibility. Furthermore, we analyze issues of algorithmic bias, training data provenance, and the erosion of patient-doctor trust when treatment recommendations stem from opaque computational models. We argue that integrating AI into medical practice requires a robust philosophical framework that preserves clinician accountability, promotes explainable AI (XAI), and safeguards the irreducibly human dimensions of clinical empathy and ethical deliberation.
Keywords: Artificial Intelligence, Clinical Epistemology, Black Box Algorithms, Medical Ethics
Accepted: 18 Aug 2023
History of Sciencepp. 39–56•DOI: 10.1234/ahifm.2023.8.2.03
The Invention of 'Normalcy': Quetelet, Biometrics, and the Statistical Transformation of Human Pathology
Frederic G. Bouchard1, Greta Lindqvist2
1Department of History and Philosophy of Science, McGill University, Montreal; 2Institute of Sociology, Uppsala University, Sweden
In contemporary medicine, the concept of the 'normal range' is so ubiquitous that it feels like an immutable law of nature. Yet, as historian Ian Hacking famously noted, the statistical explosion of probability in the nineteenth century fundamentally transformed how humanity conceptualized health and deviance. This paper investigates how Adolphe Quetelet’s formulation of *l'homme moyen* (the average man) and nineteenth-century biometrics shifted medical thought from a qualitative, individualistic understanding of health to a quantitative, population-based normative standard. By analyzing early medical statistics textbooks, anthropometric surveys of military recruits, and clinical diagnostic charts from the 1840s to the 1890s, we trace how statistical deviation became synonymous with pathological abnormality. We examine the philosophical consequences of this quantification, showing how the average was subtly reified as the ideal, thereby pathologizing physical and mental variations from the demographic norm. This historical inquiry reveals that medical normalcy is not a neutral biological discovery, but a historically contingent statistical construct with profound social and ethical ramifications.
Phenomenological Psychopathology: Karl Jaspers, Ludwig Binswanger, and the Reconstruction of Lived Experience
Helena S. Vance1, Markus E. Weber2
1Department of Philosophy, University of Heidelberg, Germany; 2Institute for Phenomenological Psychopathology, Zurich, Switzerland
Karl JaspersLudwig BinswangerDaseinsanalysisPsychopathology
Abstract
Early twentieth-century psychiatry experienced a profound methodological revolution with the introduction of phenomenological philosophy into clinical psychopathology. Spearheaded by Karl Jaspers and subsequently expanded by Ludwig Binswanger through Heideggerian Daseinsanalysis, phenomenological psychopathology sought to move beyond mere external behavioral classification and causal neurological explanation. Instead, it aimed to comprehend the internal, lived structure of abnormal subjective experience (Erlebnis). This paper examines how Jaspers' distinction between 'explaining' (Erklären) and 'understanding' (Verstehen) reshaped psychiatric diagnosis, allowing clinicians to empathically grasp delusional states and mood alterations as meaningful structural modifications of human existence. We analyze Binswanger’s clinical case studies to demonstrate how mental disorders such as schizophrenia and melancholia were reconceptualized not as mechanical breakdowns of brain machinery, but as alternative modes of being-in-the-world (In-der-Welt-sein). We argue that in an era dominated by hyper-reductionist neuroimaging and standardized psychopharmacology, returning to the phenomenological tradition provides essential philosophical tools for clinicians striving to honor the subjective reality of psychiatric patients.
Keywords: Karl Jaspers, Ludwig Binswanger, Daseinsanalysis, Psychopathology
Accepted: 02 Sep 2023
Colonial Medical Historypp. 75–92•DOI: 10.1234/ahifm.2023.8.2.05
Colonial Medicine and Tropical Diseases: The Ideology of Imperial Hygiene in Late Nineteenth-Century Africa
Amara Diallo1, Julian Thorne2
1Department of History, University of Dakar, Senegal; 2Institute for Medical Humanities, Heidelberg University, Germany
Colonial MedicineTropical HygieneImperialismPublic Health
Abstract
The institutionalization of tropical medicine as a distinct academic and clinical discipline in the late nineteenth century was deeply intertwined with European imperial expansion across Africa and Asia. Medicine served simultaneously as a humanitarian endeavor, an economic imperative to protect European labor in tropical climates, and a powerful ideological tool justifying colonial domination through the rhetoric of sanitary civilizing missions. This historical study investigates how colonial medical officers and metropolitan scientists constructed the category of the 'tropical disease' and mapped racialized bodies onto geopolitical spaces. Analyzing administrative records, missionary medical reports, and colonial health service journals from British and French West Africa, we examine how quarantine regulations, forced vaccination campaigns, and urban segregation (sanitary cordons separating European quarters from indigenous towns) were enforced under the banner of public hygiene. We argue that tropical medicine functioned as a technology of biopower that facilitated colonial extraction while systematically subordinating indigenous healing traditions. This critical historical examination sheds light on persistent global health inequities and the enduring legacies of colonial medical structures in contemporary international health policy.
Keywords: Colonial Medicine, Tropical Hygiene, Imperialism, Public Health
Accepted: 09 Sep 2023
Philosophy of Sciencepp. 93–110•DOI: 10.1234/ahifm.2023.8.2.06
The Philosophy of Medical Causation: From Koch's Postulates to Probabilistic Causality in Molecular Biomedicine
Jeremy P. Watson1, Katerina Vlahos2
1Department of Philosophy, London School of Economics, UK; 2Center for Philosophy of Biology, University of Vienna, Austria
Medical CausationKoch's PostulatesMolecular BiologyEpistemology
Abstract
Determining what constitutes a 'cause' of disease is a central epistemological challenge in medical science. In the late nineteenth century, Robert Koch’s bacteriological postulates established a deterministic, mono-causal framework: one specific microorganism causes one specific disease. While immensely successful for infectious pathologies, the rise of chronic, multi-factorial diseases (such as cancer, cardiovascular disorders, and psychiatric illnesses) in the twentieth and twenty-first centuries rendered Koch’s deterministic model obsolete. This paper explores the philosophical evolution of medical causation, tracing the transition from nineteenth-century germ theory determinism through Bradford Hill’s epidemiological criteria for causality to contemporary multi-factorial, probabilistic, and network-based models in molecular biomedicine. We examine how genetic pleiotropy, epigenetic interactions, and environmental determinants challenge traditional reductionist notions of biomedical causality. We argue that modern molecular biomedicine requires a pluralistic philosophy of causation that abandons strict mono-causal determinism in favor of complex causal webs, thereby providing a more robust theoretical foundation for personalized and precision medicine.
Keywords: Medical Causation, Koch's Postulates, Molecular Biology, Epistemology
Accepted: 14 Sep 2023
Gender & Medical Historypp. 111–128•DOI: 10.1234/ahifm.2023.8.2.07
Gender, Hysteria, and the Wandering Womb: A Historiographical Critique of Medical Misogyny from Antiquity to Freud
Evelyn Vance1, Nkechi Okoye2
1Department of Gender Studies and Medical History, Columbia University, USA; 2Faculty of Humanities, University of Lagos, Nigeria
HysteriaGender BiasCharcotMedical Misogyny
Abstract
For over two millennia, the diagnosis of 'hysteria' served as a convenient medical catch-all for female emotional distress, social nonconformity, and physiological unexplained symptoms. Rooted in ancient Greek gynecological theories of the 'wandering womb' (hystera), the diagnosis persisted through centuries of medical literature, culminating in Jean-Martin Charcot’s theatrical neurological demonstrations at the Salpêtrière hospital in Paris and Sigmund Freud’s early psychoanalytic formulations. This historiographical critique examines how medical authorities systematically pathologized female bodily expression and autonomy. By analyzing classical medical texts, nineteenth-century asylum patient records, and feminist philosophical critiques, we demonstrate how hysteria functioned as a powerful instrument of social control, reinforcing patriarchal norms by framing female emotional suffering as an inherent biological defect of the female nervous system. Furthermore, we trace the conceptual erasure of hysteria from official nosology in the late twentieth century and evaluate the enduring legacy of gender bias in contemporary clinical diagnostics, particularly regarding chronic pain syndromes, autoimmune disorders, and mental health evaluations in women.
Keywords: Hysteria, Gender Bias, Charcot, Medical Misogyny
Accepted: 21 Sep 2023
Medical Humanities & Ethicspp. 129–146•DOI: 10.1234/ahifm.2023.8.2.08
Palliative Care and the Philosophy of the Good Death: Cicely Saunders and the Hospice Movement
Margaret M. Sullivan1, Jean-Paul Sartre2
1Department of Bioethics, University of Edinburgh, UK; 2Institute of Philosophy and Human Sciences, Paris, France
Palliative CareCicely SaundersHospice MovementEthics of Dying
Abstract
The institutionalization of high-technology hospital medicine in the mid-twentieth century frequently reduced the dying patient to a biological failure, prioritizing aggressive life-prolonging interventions over comfort, dignity, and existential peace. In response to this medicalization of mortality, Dr. Cicely Saunders founded the modern hospice movement with the establishment of St. Christopher’s Hospice in London in 1967, introducing the revolutionary concept of 'total pain'—encompassing physical, psychological, social, and spiritual suffering. This paper explores the philosophical and historical foundations of palliative care, examining how Saunders and her contemporaries redefined the 'good death' in opposition to the clinical imperative of cure-at-all-costs. By analyzing hospice archives, foundational nursing lectures, and existential ethics, we investigate how palliative care reintroduced holistic humanism into end-of-life care. We analyze the ethical implications of shifting clinical goals from therapeutic eradication of disease to compassionate accompaniment and symptom palliation. Finally, we evaluate how the philosophy of palliative care challenges contemporary debates surrounding physician-assisted dying, autonomy, and the ultimate meaning of human mortality in advanced technological societies.
Keywords: Palliative Care, Cicely Saunders, Hospice Movement, Ethics of Dying