Martin M, Fangerau H
Institut für Geschichte, Theorie und Ethik der Medizin, Universität Ulm, Frauensteige 6, Ulm, Germany.
Urologe A. 2010 Jul;49(7):855-60. doi: 10.1007/s00120-010-2277-9.
During the nineteenth century the analysis of urine was based on technical tools for the quantification of its constituents. The transformation of diagnostic signs into numbers made reference and normal values indispensable for the verification of the transition point between "normal" and "pathological". It needed the reconfiguration of disease concepts to link measured data and values with specific clinical pictures. Ontological disease concepts were replaced by a gradual understanding of health and disease. During this process the "normal value" became the crucial point of discussion.Taking a statement by Claude Bernard (1813-1878) about the nonsense of chemical mean values as a starting point the paper focuses on the contemporary debate about the role and function of quantification in medical diagnostics. The methodological reference points of the analysis are Georges Canguilhem's considerations about the normal and the pathological and Ludwik Fleck's thought collectives. The acceptance or rejection of normal value concepts is bound to specific thought styles. Permanent challenges to traditional qualifying semiotics resulted in a slow transformation of semiotic thought styles into quantifying diagnostics. The "technisation" of medicine during the nineteenth century fostered this process. The clinical laboratory helped to establish a"mathematisation" of medicine.
在19世纪,尿液分析基于对其成分进行量化的技术工具。将诊断体征转化为数字使得参考值和正常值对于验证“正常”与“病理”之间的转变点变得不可或缺。这需要重新构建疾病概念,以便将测量数据和值与特定临床症状联系起来。本体论疾病概念被对健康和疾病的逐步理解所取代。在此过程中,“正常值”成为了讨论的关键点。本文以克洛德·贝尔纳(1813 - 1878)关于化学平均值无意义的陈述为出发点,聚焦于当代关于量化在医学诊断中的作用和功能的辩论。分析的方法论参考点是乔治·康吉莱姆对正常与病理的思考以及路德维克·弗莱克的思想群体。对正常值概念的接受或拒绝与特定的思维方式相关。对传统定性符号学的持续挑战导致符号学思维方式缓慢转变为量化诊断。19世纪医学的“技术化”推动了这一进程。临床实验室有助于建立医学的“数学化”。