THE SHARED VISION OF METCHNIKOFF AND NIETZSCHE

In a profound sense the success of immunology has rested upon the ascendency of its epistemology, and in this view it has been highly successful. The appropriation of the self must be regarded as an important element of that project. But beneath this triumph we can discern a metaphysical issue that we must further explore to truly discern the theoretical underpinnings of this science. The self metaphor depends on its metaphysical moorings to articulate its meaning; thus, despite ample Wittgensteinian warnings to the contrary, I remain committed to exploring these foundations. If epistemology enunciates how we know what we know, metaphysics (in a Whiteheadian [1925] tradition) proposes what there is for us to know. This is the underlying Metchnikovian challenge. Thus far, the inquiry has been oriented around the self, constructed by metaphor and analyzed in epistemological terms. There remain in fact underlying issues that require attention, and it is to these that we now direct our inquiry. Not surprisingly, considering the logic of my argument, we again turn to Metchnikoff. The fundamental basis of Metchnikoff's thinking consists in an understanding of the indeterminateness of organismal integrity, maintained and perpetuated through an ongoing process of self-definition. The self could no longer be clearly delineated as a given entity. The “boundaries ” of the organism are constantly being reestablished under the assault of temporal change and environmental challenge. A comparable pictorial image would be the cubist or fauvist vision of the object fusing into its contextual surroundings and thus blurred in its identity.

ELIE METCHNIKOFF

Fin-de-siècle Europe was difficult for its citizens to define: “Fin-desiecle! Everywhere it stands for all that you might care to name ” (quoted by Weber 1986, p. 9; see also Schorske 1979; Kern 1983; Dowling 1986). In the midst of social and cultural upheaval, the subject of Man was being redefined. This period witnessed the publication of William James's Principles of Psychology (1890), Ernst Mach's Contribution to the Analysis of the Sensations (1886), Freud's Interpretation of Dreams (1900), and Nietzsche's Beyond Good and Evil (1886). Ibsen produced Hedda Gabler (1890), and Cezanne and van Gogh were radicalizing the visual arts. New artistic freedom, in what Oscar Wilde epitomized as the full expression of personality (with a curious brand of individualism, antibourgeois socialism, and exploration - or better, exposure - of forbidden areas of thought and behavior), has been dubbed an era of decadence or, more kindly, la belle époque (Shattuck 1969; Ellman 1987, p. 305) It was a period of rapid imperialistic colonization of Africa and Asia and of French-German rivalry in Europe, while America was quietly looming as the economic giant, already the source of nearly a third of the world's production by 1888. Around that same year, the first beauty contest was held in Spa, Belgium, Barnum and Bailey's circus opened, cocaine began to be used regularly as an anesthetic, fructose was synthesized, and the term chromosome was first used. The Tenth International Congress of Medicine opened on August 4, 1890, in Berlin's Circus Renz, the only hall large enough to hold the seven thousand participants.

The first lecture I give my undergraduates in courses in philosophy of science or philosophy of medicine is designed to jolt them into recognizing how profoundly what we know determines what we see. The case I use is Leonardo da Vinci's anatomic drawings, which were the unpublished product of his autopsy studies. Shortly after Pope Sixtus IV (in 1482) granted “permission to take the bodies of legally executed criminals from the place of execution, and dissect them according to medical rules and practice, ” Leonardo began a series of studies in which his Galenic prejudice distorted the accuracy of some of his drawings (Clayton 1992). A striking example is the manner in which Leonardo depicted the cerebral ventricles. As taught by Aristotle and faithfully transmitted to European anatomists and philosophers, the mind was supposed to be composed of sensory, cognitive, and memory functions; thus, Leonardo's cerebral ventricles were drawn in 1489 as three connected in-line bullous structures (ibid., pp. 26-9). When he innovatively made a wax cast of the ventricular system twenty years later, he configured it correctly (ibid., p. 74); the circulatory system, however, he never got right (nor did anyone else prior to Harvey), and when my incredulous students demand why Leonardo did not simply “draw what was there, ” I show them his exquisite and accurate rendition of the musculoskeletal system and thus demonstrate that persuasive preconceptions, suffered even by a Leonardo, can guide cognition.

THE EARLY PHENOMENOLOGISTS

There is an extraordinary parallelism in fin-de-siecle concepts of the self in psychology, art, philosophy, and our subject, immunology. Such a sweeping claim may not be judicious to make, and it could be contested by arguments concerning the artificial construction of a Zeitgeist or the inadmissibility of extending analogical cases from one discipline or activity to another. But attempting that claim largely structures the remainder of this essay. In this chapter the phenomenological critique is used to explore further the basis of the immune self concept as understood from this position. The last chapters deal with metaphysical issues that, I believe, underlie our understanding of selfhood. To reach well beyond the confines of immunology is obviously risky, but aware of these dangers, I am still committed to sketch what I perceive to be a widely pervasive understanding of how the world was viewed (and what the nature of the perceiver was) during the same formative period that witnessed the birth of modern immunology. New conceptions of the knowing subject in his or her personal cosmos were evoked by a startling reassessment of the self. This is the same mission identified for immunology, but in a different scientific domain. My exercise is pointed toward a critique of immunology as a discipline that has as its basis the self metaphor. This fundamental concept has the same philosophical construction of personal identity as that formed from novel late nineteenth-century psychological concepts.

CONCERNING IMMUNITY AND COGNITION

Self, in its generic sense, is a complex metaphor used in immunology to signify those attempts to discern the source, the underlying root, of immunity. In scientific discourse self becomes the source from which immune activity arises to defend the organism against pathogens or endogenous deleterious or senile elements. But the self is not easily bounded and defined as an entity. As discussed in Chapter 4,1 refer to one usage as ontological, to suggest the essential quality of the inquiry, not to define an entity. By the very nature of the question of selfhood and the evasive nature of the referred subject we are situated at the elusive pole of the self metaphor. It is in the self-seeking, or selfdefining, process that the organism must emerge, and I use ontological broadly to refer to the admittedly nebulous quality of self-referential behavior. In this sense ontological refers not only to our view of the issue, but assumes the added dimension of the organism's own behavior. This usage, moreover, surreptitiously sets self outside reductionist discourse, fulfilling yet another aspect of my agenda. The transformation of self to a more experimentally fruitful and theoretically concrete usage (discussed in detail in this chapter) never completely absolves us from dealing with the elusive meaning of identity. In any case, as an articulated issue this is a relatively recent formulation. With respect to the organismic source, that is, the origin of immune identity, immunology was confronted with a novel problem.

FRANK MACFARLANE BURNET, PROTOIMMUNOLOGIST

The concern with arriving at a science of immunology that addresses both the pathogen challenge and the surveillance of normal /abnormal body economy expanded immunology into the science of self /not-self discrimination. In this narrative I have so far scrupulously avoided using the term self as noun, but now we are prepared to evaluate critically how it entered the language of immunology and consider what its conceptual utility has been. The concept of the self was formally inaugurated into immunology by Sir Frank Macfarlane Burnet (Figure 2). In the second edition of,The Production of Antibodies (1949), Burnet and Frank Fenner introduced the “self-marker ” hypothesis, which eventually evolved into the theory that tolerance is a result of the elimination of lymphocytes reactive to autologous constituents:

THE IMMUNE SYSTEM

The preceding three chapters have traced the conceptual and scientific history of immunology. There has been limited reference to the broader cultural setting and underlying philosophical orientations in conflict during the discipline's development. In a sense, I have attempted to set the stage for the ensuing discussion, which seeks to explore the interface between the science and its governing philosophy. To do so, the self concept will be carefully delineated, both as theory and as metaphor. So, first, let us briefly review the prevailing theory of immunology a century after the humoral-cellular debate was at its peak. As already summarized, by 1908, when Metchnikoff and Ehrlich shared the Nobel Prize, the basic character of immune reactions were known. There are basically two forms of immune recognition: natural and acquired immunity. Natural immunity is characterized by effector cells and soluble factors that do not require specific or prolonged induction for their functions and more specifically do not require opsonization (coating) of their target. Such coating of the pathogen with antibody and other serum proteins offers “handles ” for attachment and engulfment by specialized “eating cells ” - phagocytes. The encounter with a phagocyte serves as the host's initial cellular defense action. This can result in the destruction of the microorganism by a blood or tissue phagocyte, and if the encounter is with an antigen-presenting cell (APC), a more complex interaction occurs, whereby the antigen (that constituent which elicits an immune response) is “processed,” initiating the immune recognition (i.e., lymphocyte network) process.

A BIOLOGY BASED ON THE WHOLE

The conflict between Metchnikoff and the humoralists must be regarded as a particular case of a more general struggle surrounding the ascendency of reductionism, defining both the research strategies and the metaphysical foundations of biology and medicine in general. Reductionism was declared as the program of German physiology in the 1840s to combat vitalism and establish the exclusive domain of physics and chemistry as the sciences to describe the living realm (Galaty 1974' Gregory 1977' Lenoir 1982' Kremer 1990). The application of physicochemical theory and methods to biology has a clear history dating from the end of the eighteenth century in the maturation of combution theory (Lavoisier), the application of atomic proportions (Jeremias Richter and Dalton), and the extension of inorganic chemistry to organic matter. More broadly the reductionist program in physiology arose from the growing appreciation that energy was interconvertible from one form to another and was conserved. As fundamental laws governing physical forces were defined for electrical, chemical, and mechanical energies, biologists would seek to place organic functions within the same scientific construct. Thus, the initial efforts to formalize the research agenda of physiology to chemistry focused on the problem of accounting for animal heat. In the process teleology and holism (the latter we would describe as organismic biology) were assaulted as allied, if not intimately linked, with the vitalistic doctrine. In the twenty-five-year period of 1883-1908 (the years of Metchnikoff's active immunology career), the emergence of new standards and expectations can be discerned in almost all biological disciplines, molded by what might well be regarded as a modern-age scientific ethos.

FROM NIETZSCHE TO FOUCAULT

Those who argue that we are now in a postmodernist age often cite Nietzsche's attack on the Enlightenment (a critique profoundly and disturbingly extended by Heidegger) as the origin of a new vision of the self. As already discussed, Nietzsche's mature position corresponds closely to the presentation of Metchnikoff's theory of immunity and the midpoint of James's writings of Principles. Thus Spoke Zarathustra (composed between 1883 and 1885) and The Will to Power (edited selections from his last notebooks, 1883-8) were written during this period. If Metchnikoff offered a biological formulation of the self, and James an epistemological definition, then Nietzsche is the metaphysician who proclaims self-affirmation and self-assertion as the process of returning to the self's essence and origins, as the process, that is, of becoming. Nietzsche makes no attempt to re-create a Kantian enlightenment ideal of critical self-consciousness based on assumed “values ” or an assumed epistemological foundation (Behler 1991, pp. 20ff). There is no traditional appeal to nature or any transcendental subject as a source of value:

One of the many distinctive features of nineteenth-century Scottish medical education was the unique system of teaching forensic medicine and public health together under the heading of medical jurisprudence and medical police. Within the British Isles, Scotland was alone not only in teaching these subjects in tandem, but in doing so throughout the nineteenth century, and at some institutions well into the twentieth century. To the present-day observer, there would seem to be little in common between forensic medicine and public health, but throughout the nineteenth century these two subjects were intimately connected both at the level of academic teaching and in everyday practice. The link between them was their common concern with meeting certain requirements of the law. They did not train doctors to become more proficient in the healing arts, but equipped them to provide the courts and local magistrates with informed advice on the material facts of crime and squalor and the best means of dealing with them. This chapter focuses on two main aspects of this system. The first is the European origins of medical jurisprudence, sometimes referred to as state medicine or medical police, and the reasons why it was more attractive to Scotland than to England. It examines the circumstances surrounding the establishment of the first British chair of medical jurisprudence at Edinburgh in 1807, and the perceived radical implications of the subject. Secondly, the paper traces the progress of Scottish medical jurisprudence teaching, explaining why a formal system of medico-legal education was deemed necessary, who taught it and what its effects were.

On 27 April 1938 a fourteen-year-old girl, Miss H, was assaulted and brutally raped by a number of guardsmen in a barracks on Horse Guards Parade, Whitehall. Popularly known as ‘the case of the horse with the green tail’ after the enticement which lured the young victim into the barrack's stables, the assault was widely reported and sensationalized by the press. Miss H was subsequently admitted to St Thomas's Hospital for a pregnancy test, which proved to be positive. Her doctor at St Thomas's was not sympathetic to her predicament. He reportedly took the position that ‘he would not interfere with life because the child may be the future Prime Minister of England’ and that in any case, ‘girls always lead men on’. The police surgeon, the doctor at her work, and her school doctor, however, were all of the opinion that Miss H ought not to be left to carry the pregnancy to term. Miss H's parents were desperate to have the pregnancy terminated, but were said to be ‘so respectable that they did not know the address of any abortionist’.

Abortion was a disreputable practice in part because it was illegal. The offence of unlawfully procuring an abortion was laid down in Section 58 of the Offences Against the Person Act 1861, the relevant terms of which provided that: