Death and the Internal Milieu: Claude Bernard and the Origins of Experimental Medicine

PERSPECTIVES IN BIOLOGY AND MEDICINE Volume 39 ¦ Number 3 ¦ Spring 1996 DEATH AND THE INTERNAL MILIEU: CLAUDE BERNARD AND THE ORIGINS OF EXPERIMENTAL MEDICINE ALAN G. WASSERSTEIN* Claude Bernard (1813-1878), the greatest physiologist of the 19th century , is remembered today for his work on hepatic glucose production, pancreatic exocrine function, the mechanisms of action of curare and carbon monoxide, and discovery of the vasomotor nerves; for his conception of the constant internal milieu; and for his methodology of physiological research, An Introduction to the Study ofExperimental Medicine [I]. In addition to physiological research, the major thrust of his career was to establish physiology as an independent and thriving discipline. The Introduction was the founding manifesto of this new science. Bernard, a playwright in his youth, stages a drama with himself as implicit hero. He must defend experimental medicine from the attacks of older, more established disciplines. The physicianswant to preserve clinical practice as a matter of "touch," not reducible to scientific laws; their turf is threatened by the upstart science. The chemists want to subsume physiology under their own science. Physiology , they say, is nothing but chemistry within the living organism. To deny this is vitalism, postulating different laws for life and for the physical world. But the vitalists do not believe that life can be reduced to mechanistic laws. Life is spontaneous and free; observations cannot be reproduced, the phenomena of life do not obey rigorous laws. And life is a whole that is not reducible to its parts. Cuvier (cited by Bernard) had written: "All parts of Supported by NIH Training Grant DK-07006 and The DCI RED Fund. *Renal-Electrolyte and Hypertension Division, Hospital of the University of Pennsylvania, Philadelphia, PA 19104.© 1996 by The University of Chicago. All rights reserved. 003I-5982/96/3903-0956$01.00 Perspectives in Biology and Medicine, 39, 3 ¦ Spring 1996 | 313 a living body are interrelated; they can act only in so far as they act all together; trying to separate one from the whole means transferring it to the realm of dead substances; it means entirely changing its essence" [1, p. 60]. The Hippocratics, still influential in the 19th century, are passive and non-interventionist. They believe in observation (which makes medicine something like botany or astronomy, Bernard says), expectant care, the healing force ofnature. They don't put much credence in specific diseases. Health depends on harmony with the environment, so they urge modification of diet and regimen. The empiricists have remedies handed down for generations. It isn't necessary to understand how the body or these remedies work. The rationalists have systems built on first principles and preconceived notions. Experiment is superfluous. Biomedical science emerges amid these jealousies and contentions. Bringing it to birth in the Introduction is a heroic task. But the heroic father is politically incorrect, sometimes even brutal, with all his talk of dominating nature and mastering phenomena; his dogmatic and rigid determinism; his indifference to the environment (at least to the external one); and, above all, his readiness to fuse life and death. Life is "dead substances" or inanimate mechanisms, to be acted on and appropriated by the experimenter, Bernard's words are susceptible to the worst that radical critique has to say about science: he turns life into death, an inanimate object to be taken apart and mastered. What was heroic in the 19th century is overbearing in the 20th. In a brilliant essay, Evelyn Fox Keller has compared the development of the atomic bomb with the nearly contemporaneous discovery of the structure of DNA [2] . In both cases male fantasies of appropriating female procreation werejoined with killing or its equivalent. That was the significance of the bullroarer myths of primitive cultures, of the Frankenstein story, of the astonishing sex and birth imagery of nuclear bomb engineers. Translating the secret of the generation of life into a molecule, she says, was turning it into lifeless mechanism, into death. Keller could have found another example in Claude Bernard, father of experimental medicine. "Death," understood either as catabolic processes or as physico-chemical mechanism, made possible life processes and their experimental study. Bernard insisted on this idea in provocative, even defiant phrases. Facing...