Fluent Essays

I need 5 pages of answers, all questions should be answered fully completed. 1.What’s the main point in Laennec’s “On the Diagnosis of Disease of the Chest”? What was Laennec’s pathological view of chest diseases? What do you think the purpose of which Laennec wrote this? Who would be the target reader? 2.How did Laennec associate with his innovation with his predecessors who inspired him? How (what steps did he take) did he improve the diagnostic technique? What medical and non-medical consideration facilitated him for the improvement? What is the significance of his improvement in the field of anatomy? How do you connect Laennec’s medical practices and the invention of stethoscope with his pathological view of chest diseases?3.What were the three classes of application of the invented stethoscope, according to Laennec? What remained limited for Laennec to examine the chest cavity with his new instrument? Within these applications, what were the examples that Laennec could achieve but his predecessors could not?4.In the preface of Virchow’s Cellular Pathology, could you tell who was the target audience of this work/lecture series? What was the purpose of this work/lecture? What was Virchow’s view on medical reform/revolution? How would you associate his view on science/ medicine with his political view?5.What was Virchow’s pathological view of diseases? What was Virchow’s method of conveying his pathological view? How did Virchow prove (what were the evidences) that “cells as the ultimate active elements of the living body”? How did Virchow compare with and contrast to the humoral and solidistic views of pathology?6.According to Hsu, what was Jean Baptiste Du Halde’s foundational understanding of medicine? Compare Du Halde’s remark on Chinese pulse diagnostics in a basis on a conception of the body as a kind of lute with René Laennec’s mediate auscultation in diagnosing of a living body. What are the similarities? How did Du Halde seem to impose the Galenic understanding of pulsation on the Chinese pulse patterns? 7.According to Hsu, how does Chinese tacit perception/experience of pulse taking achieve a diagnosis in a detached and descriptive way? How does a Chinese physician “calibrate” himself or herself when taking a patient’s pulse? What are the differences between “active touch” in Chinese pulse taking and “passive touch” in psychophysical practice? hsu_towards_a_science_of_touch_part_i_chinese_pulse_diagnostics_in_early_modern_europe_2000.pdf laennec_auscultation_1821.pdf virchow_cellular_pathlogy_1860.pdf Unformatted Attachment Preview Anthropology & Medicine ISSN: 1364-8470 (Print) 1469-2910 (Online) Journal homepage: http://www.tandfonline.com/loi/canm20 Towards a science of touch, part I: Chinese pulse diagnostics in early modern Europe Elisabeth Hsu To cite this article: Elisabeth Hsu (2000) Towards a science of touch, part I: Chinese pulse diagnostics in early modern Europe, Anthropology & Medicine, 7:2, 251-268, DOI: 10.1080/713650587 To link to this article: http://dx.doi.org/10.1080/713650587 Published online: 09 Jun 2010. Submit your article to this journal Article views: 107 View related articles Citing articles: 9 View citing articles Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=canm20 Download by: [University of California, Los Angeles (UCLA)] Date: 13 September 2016, At: 14:05 Anthropology & Medicine, Vol. 7, No. 2, 2000 Towards a science of touch, part I: Chinese pulse diagnostics in early modern Europe (Accepted date: 15 April 2000) ELISABETH HSU Faculty of Oriental Studies, University of Cambridge, UK ABSTRACT This paper is about a pre-modern `science of touch’ Ð Chinese pulse diagnosticsÐ which was the aspect of Chinese medicine most admired by physicians in early modern Europe. The paper ® rst provides some historical information on Chinese pulse diagnostics in Europe and then details how it was presented to an 18th-century readership. At last, it points out that Chinese physicians had developed an elaborate system for distinguishing between various experiences of touch. From an outsider’ s viewpoint, one could say that they already had an idea of calibration and made measurements in respect of a calibrated condition. Since they put their ® ngertips on the wrist of their patients and actively palpated it, one can say that their `science of touch’ was developed in respect of `active touch’ . This in contrast to the `science of touch’ developed by psychophysicists of the modern West, who have been interested primarily in `passive touch’ . Introduction Science is, in common parlance, a phenomenon of modernity and accordingly one would trace the beginnings of a `science of touch’ to 19th-century experiments on the psychophysics of touch. This now well-established ® eld has set the trend for 20th-century research on touch in the West, and a section at the end of the paper will summarise what this modern science knows about touch and what it tends to neglect. However, `science’ also designates practices that are pre-modern and not necessarily occidental, and the aspects of the `science of touch’ at the core of this article concern a pre-modern attempt to assess in a descriptive way the tactile sensations, perceptions, and experiences that a physician makes with the sense organ of the skin (more precisely, the glabrous skin of the hand and the ® nger-tips), when he or she engages in pulse diagnostics. Correspondence to: Elisabeth Hsu, Faculty of Oriental Studies, University of Cambridge, Cambridge CB3 9DA, UK. E-mail: elh25@cus.cam.ac.uk ISSN 1364-8470 (print) ISSN 1469-2910 (online)/00/020251-18 Ó 2000 Taylor & Francis Ltd 252 E. Hsu The Paradox of a `Science of Touch’ Touch differs in important ways from other modalities of perception: I can see you without you seeing me; I can hear you without being heard. Likewise in order to smell or taste one need not be tasted or smeltÐ but whatever you touch, touches you too. ª In touch, the distinction between touching subject and touched object blursº (Mazis, 1971). This aspect of touch may explain its prominence both in love relationships and aggression, where it has the emotionally highly laden positive or negative attributes of pleasure or pain. And in turn it may partly explain its prohibition in social behaviour when boundaries between individuals are emphasised. Yet precisely this involvement between subject and object makes it dif® cult to account for touch in a detached and descriptive way, and because of this it appears paradoxical for pulse diagnostics and, for that matter, any descriptive science to rely on differentiations between sensations of touch. I am not the ® rst to point to this peculiarity of touch. Merleau-Ponty (1992, p. 316) states that ª tactile experience ¼ adheres to the surface of our body; we cannot unfold it before us and it never quite becomes an objectº and he opposes this to visual experience, which ª pushes objecti® cation further than does tactile experienceº . But Merleau-Ponty has in fact little to say about touch in his over four hundred page oeuvre on the Phenomenology of Perception. This melding of subject and object makes touch an excellent non-verbal means for communicating one’ s own, and recognising the other’ s, temper and disposition, not only because the social contact is governed by what Hall (1966) called ª intimate proxemicsº , but also because ª there is a feeling of control in verbal discourse that is absent with physical intimacyº (Young cited in Autton, 1989, p. 8). Even in situations other than those governed by intimacy, touch has been shown to have great signi® cance in both social interaction (e.g. Montagu, 1971) and therapeutics (e.g. Older, 1982). While these aspects of touch certainly deserve to be more extensively explored, this paper focuses on another aspect, which appears as a paradox of any `science of touch’ : one would expect that the experience of touch, marked by melding of subject and object, poses dif® culties for its representation in a descriptive and detached, generalising and `objectifying’ way.a Pulse diagnostics is here treated as a form of scienti® c inquiry that identi® es and describes different tactile experiences. In many pre-modern societies it was highly elaborate. Thus, ª sphygmology was perhaps the single most important diagnostic aid in Galen’ s repertoire and the technique to which he devoted most space in his theoretical expositions of medical practice ¼ a whole series of sixteen books on the pulseº (Nutton, 1993, p. 12). Galen related the tactile experience of the doctor during pulse diagnostics to anatomical and physiological speculation: the pulsations at the wrist were attributed to the movement of the arteries, which in turn had been put into motion by the life-force that came from the heart. His understanding of the pulses was different from our own, and also different from that of the Chinese (Kuriyama, 1986, pp. 40± 57, 1999). Science of touch, part I 253 I. The Historical Cadre Attitudes to Chinese Pulse diagnostics The 17th century saw the ® rst translations of treatises on Chinese Pulse diagnostics into Latin and French, and even if the attitude towards them was not uniformly positive (e.g. Winau, 1978), we ® nd that they were often praised as superior to those of scholastic medicine (e.g. Lu & Needham, 1980, pp. 36± 37). Thus Jean Baptiste Du Halde ([1735] 1941) in his Description of the Chinese Empire ¼ begins a chapter on `The Art of Medicine among the Chinese’ b with a mixture of admiration and condescension: It cannot be said that Medicine has been neglected by the Chinese, for they have a great Number of ancient Authors who treat of it, having applied themselves thereto from the Foundation of the Empire. But as they were very little versed in Natural Philosophy, and not at all in Anatomy, so that they scarce knew the Uses of the Parts of the Human Body, and consequently were unacquainted with the Causes of Distempers, depending on a doubtful System of the Structure of the human Frame, it is no wonder they have not made the same Progress in this Science as our Physicians in Europe. (p. 183)c Yet the introduction to this chapter ends with an eulogy of Chinese Pulse diagnostics: They [the Chinese] pretend, by the Beating of the Pulse only, to discover the Cause of the Disease, and in what Part of the Body it resides: In effect, their able physicians predict pretty exactly all the Symptoms of a Disease; and it is chie¯ y this, that has rendered Chinese Physicians so famous in the World. (p. 184) Chinese Pulse diagnostics was certainly the aspect of Chinese medicine that attracted the main interest of the Jesuit missionaries who had travelled to China and were knowledgeable in both medicine and the Chinese language, for several works of 17th-century Europe provide detailed and systematic accounts of it (Grmek, 1962; Despeux & Obringer, 1997, pp. 10± 11). In this context, it is worth mentioning that there possibly were precursors: Avicenna (Arabic: Ibn Sina) (AD 980± 1037) used vocabulary in his Canon of Medicine strikingly similar to that in the later Persian treatise by Rashid ad-Din Fadlallah’ s (1247± 1318) on Chinese Pulse lore, and a chapter in his Canon as well as his Treatise on the Pulses (ar-Risala ® n Nabad) are considered to enumerate pulse qualities which resemble the Chinese ones in the Rhymed Pulse Lore (Maijue) of the 10th century. Although Avicenna nowhere explicitly acknowledges Chinese writings as source material, it is possible that his works testify to knowledge transfer of Chinese Pulse diagnostics into Europe, predating those of the 17th and 18th centuries by more than half a millennium.d Was it the case that Avicenna and some of the later physicians of scholastic medicine considered Chinese Pulse diagnostics superior to Galenic sphygmology? If this was so, what was it that made Chinese Pulse diagnostics so highly 254 E. Hsu respected? From an empiricist viewpoint, one could argue that the doctrine of Chinese Pulse diagnostics was closely linked with empirical knowledge derived from medical practice, and that the doctors who applied it were therefore therapeutically more successful. However, if one hesitates to attribute much empirical value to either the Galenic or the Chinese form of sphygmology, one has to investigate the social conditions that facilitated its transmission from East to West. This paper does not seek to answer the above question of why Chinese Pulse diagnostics was so highly regarded in the West, even though it is concerned with Pulse diagnostics as represented in some of the many editions of the Maijue (Rhymed Pulse Lore) just mentioned. Du Halde renders it in translation as ª The Secret of the Pulseº and presents it in three instead of the usual four parts (pp. 184± 207).e The treatise discusses a whole variety of different Pulses, but in this paper we will discuss only a few sections and focus, in particular, on the editor’ s introduction to it. To be sure, this paper is not primarily concerned with the problem of how Chinese Pulse diagnostics were translated into the vocabulary of the scholastic Galenic medicine that was then prevalent nor does it address the equally important question of the history of the reception of Chinese Pulse diagnostics in Europe. Rather, it intends to contribute to an anthropology of sensory or, more precisely, tactile experience. It centres on the problem of how, despite the blurring of subject and object in touch, touch can be described in a detached and `objective’ way. This is done by exploring some examples of how a pre-modern Chinese `science of touch’ Ð Chinese Pulse diagnosticsÐ assessed tactile experience. However, before turning to the representations of touch in Chinese Pulse diagnostics, let us outline its rationale. Du Halde’s introduction to the Chinese ª antick, but erroneousº system of medicine Du Halde gives a summary of the Chinese ª antick, but erroneousº system of medicine in a two-page introduction in small script, without, however, indicating the textual source material on which it is based. Since the information he provides coincides largely with what is currently known from Chinese sources, it is outlined here for the reader unfamiliar with Chinese medical doctrine.f Thus, Du Halde remarks that Chinese Pulse diagnostics are based on a conception of the body as a kind of lute: They ¼ suppose that the Body, on account of the Nerves, Muscles, Veins and Arteries, is a kind of Lute, or musical Instrument whose Parts yield diverse Sounds, or rather have a certain kind of Temperament peculiar to themselves, by reason of their Figure, Situations, and various Uses; and that the different Pulses, which are like the various Tones and Stops of these Instruments, are infallible Signs whereby to judge of their Disposition, in the same manner as a String, which is touch’ d in different Parts either strongly or gently, gives different Sounds, and shews whether it be too slack or too streight. (p. 183) Science of touch, part I 255 This comparison of the body to a lute is not given in any of the Chinese texts known to me, but it captures aptly the kind of tactile perception Chinese physicians were interested in, which, from a bio-physiological viewpoint, was primarily vibration. With regard to yang and yin, Du Halde says that they are the two ª natural Principles of Lifeº ; qi, which is translated as ª Spiritsº , and xue, ª Bloodº , are considered their ª Vehiclesº . Du Halde then proceeds to explain that the Chinese conceive of the body (a) by dividing it into a left and a right part; (b) by dividing it into three parts: an upper, middle, and lower part (ª from the top of the Head as far as the Breastº , ª from the Breast to the Navelº , ª from the Navel to the Sole of the Feetº ); and (c) by dividing it into ª Members and Intestinesº , or ª Entrailsº , elsewhere also referred to as ª Springs of Lifeº (see Table I). With regard to these ª Intestinesº or ª Entrailsº , Du Halde says from a bird’ s-eye view: ª After they had establish’ d these twelve Springs of Life in the Body of Man, they searched after outward Signs, whereby to discover the inward Dispositions of those twelve Parts.º (p. 183) Du Halde mentions the correlations between ª the Tongue and the Heart, the Nostrils and the Lungs, the Mouth and the Spleen, the Ears and the Kidneys, the Eyes and the Liverº (without explicitly indicating that they are characteristic of reasoning in terms of the ª Five Elementsº ), and explains that ª the Colour of the Visage, Eyes, Nostrils, and Earsº , ª the Sound of the Voice, and the Relish which the Tongue either feels or desiresº are such ª outward Signsº ; they are found in the head which, according to Du Halde, ª is the Seat of all the Senses that perform the animal Operationsº .g Diagnostics in those cases are based on visual and auditory perception, or in the case of tongue diagnostics, according to Du Halde, on the patient’ s subjective disposition.h Du Halde speaks of such diagnostics as relating ª outward Signsº to ª inward Dispositionsº . In Pulse diagnostics, one would expect the Pulse patterns to be the ª outward Signsº of the ª Springs of Lifeº Ð they were felt at three positions on the left and right wrist, in analogy to their position in the body (see Table I)Ð but Du Halde does not take the different Pulses as ª outward Signsº : It is Motion, say they [the Chinese], that makes the Pulse, and this Motion is caused by the Flux and Re¯ ux of the Blood and Spirits, which are convey’ d to all Parts of the Body by the twelve Canals [¼ ]. (p. 183) TABLE I. The Twelve ª Springs of Lifeº (Du Halde [1735] 1741, p. 183). Left yang Small Guts or Pericardiuma Gall-bladder Ureters a Right yin Heart Liver Kidneys yang Great Guts Stomach The third part of the Body yin Lungs Spleen Gate of Life 5 Right Kidney The pericardium is mostly considered a yin entrail that corresponds with the sanjiao, here given as ª The third part of the Bodyº . 256 E. Hsu Each of these ª Canalsº or ª Passagesº or ª Ductsº or ª Waysº , as Du Halde refers to them, have been established because ª it is necessary to explain in what Manner they [the Chinese] think this radical Moisture [yin] and vital Heat [yang] are communicated to other Parts of the Bodyº (p. 183).i Soulier de Morant (1934) called them `meridians’ and this is how they are generally referred to among medical practitioners in Europe. Porkert (1974) speaks of `sinarteries’ ; Unschuld (1986) of `conduits’ ; Lu and Needham (1980) of `tracts’ ; and Sivin (1987) of `circulation tracts’ . One of the reasons why historians and anthropologists of Chinese medicine hesitate to call them `meridians’ Ð which invokes the metaphor of meridians that are `lines of orientation’ projected onto the body of the globeÐ is that Pulse diagnostics, unlike the other diagnostic methods mentioned above, is supposed to be based on the investigation of a postulated reality, and not imagined lines of orientation: it detects the motions of the ª Bloodº and ª Spiritsº in those Canals or Passages: By a thorough Knowledge of these Beatings and Percussions, the Dispositions of the Body, and the Affections which they receive from the Elements are discovered. By these Beatings, one may know the Nature of the Blood and Spirits, with the Defects and Excesses that may happen therein; ¼ (p. 184) The ª Elementsº are not the elements of early Greek philosophers nor of modern chemistry but rather spatio-temporal `rubrics’ (Granet, 1934) according to which the dynamics and changes in the universe are assessed, today generally referred to as ª Five Phasesº (Porkert, 1974): Wood,j Fire, Earth, Metal, Water (see Table II). Du Halde explains that they are ª the exterior Bodies, which may cause Alterations in the Body of Manº and that ª all these Elements unite in composing the Human Body, which is disposed in such a manner, that one Element prevails more in some Parts than othersº (p. 183). Such were the foundations of Chinese medicine in Du Halde’ s view. At the time, he could say: ª They reason much in the same manner as we do, concerning the Agreement and Disagreement of these Elements with the Body of Man, to account for the Alterations and Diseases incident theretoº . He obviously had a different foundation for understanding Chinese medical doctrine, but none the less his outline contained surprisingly similar contents as those currently taught to students of Traditional Chinese Medicine (Hsu, 1999). In one aspect, however, Du Halde’ s understanding differs from that of present-day interpreters of canonical medicine. This concerns Pulse diagnostics. The Tactile Experience Touch and the melding of subject and object Du Halde stresses that Pulse diagnostics is not based on identifying ª outward Signsº Ð beatings and percussionsÐ and linking them to ª inward Dispositionsº Ð the disposition of the body. In this respect Pulse diagnostics differs from Science of touch, part I 257 TABLE II. The Five ª Elementsº (Du Halde [1735] 1741, p. 183). Thus Fire predominates in the Heart, and the chief Viscera, which lie near it; and the South is the Point of the Heavens that principally hath respect to these Parts, because Heat resides there: They also observe the Affections of the Heart in Summer. The Liver and the Gall-bladder are referred to the Element of Air, and both have a Relation to the East, which is the Place from whence the Winds and Vegetation proceed; and the Disposition of those Parts ought to be observ’d in Spring. The Kidneys and Ureters belong to the Water, and correspond to the North; whence Winter is the most proper Time to observe their Indications. The Lungs and Great Intestines are govern’ d by the Metals as well as by the West, and the Autumn, which is the Time of their Indications. Lastly,a the Spleen and Stomach participate of the Nature of the Earth, and are referr’ d to the middle of the Heavens, between the four Cardinal Points; and the third Month of every Season is the particular Time of their Indications. a Despite this adverb, Du Halde (p. 183) thereafter includes one more paragraph on Fire and Water: ª The Gate of Life and the third part of the Body are subject to Fire a ... Purchase answer to see full attachment