Dialectical Materialism and Medicine

DIALECTICAL MATERIALISM AND MEDICINE. The question of the application of the D. method in medicine and biology, despite all its enormous principle and practical significance, is by no means sufficiently developed. Only in the most recent years have the first studies in this direction begun to appear. This is explained by the fact that bourgeois scientists to this day are almost unfamiliar with D. materialism, and Marxists before the revolution were engaged almost exclusively in the problems of D. materialism in their application to the study of social development; in its application to natural science, however, these questions were not developed by them—partly because social issues naturally stood at the forefront at that time, and partly because, as some Marxists mistakenly thought, D. m. has no relation to natural science and is only called upon to give answers to questions of social development. Such a point of view is sometimes still encountered today (Adler, Kautsky and others), despite the fact that Engels had already said that "nature is the touchstone of dialectics." The October Revolution raised these problems in their full breadth. Dialectical materialism is the philosophy of Marxism and was basically developed by its founders—Marx and Engels. It received further development in the works mainly of Plekhanov and Lenin. As is evident from the name itself, D. m. includes dialectics and materialism, being their synthesis. By materialism, in opposition to idealism, is meant such a philosophical doctrine which recognizes matter as primary in the process of historical development, and thinking spirit, consciousness, as secondary, derived from it. Depending on what is taken as the primary basis, matter or spirit, philosophical systems are divided into materialistic and idealistic. All intermediate teachings are eclectic in this sense. By matter in the philosophical sense Marxism means that which, existing independently of us and "acting on our sense organs, produces sensation." "Matter is objective reality given to us in sensation" (Lenin). The entire universe consists of matter—and only of it. Matter is eternal, it cannot either disappear or appear again. All phenomena of the world, including thought, consciousness, are nothing other than changes and transformations of one kind of matter into another. Under no circumstances should the philosophical and physical concepts of matter be confused, since the latter is only a specification of the former, reflecting the level of knowledge of a given epoch. The basic attribute (form of existence) of matter is motion, and just as there is no matter without motion, motion without matter is unthinkable. By motion D. m. implies not only movement in space, but any change undergone by matter. In this sense, a chemical reaction, the life process, thinking, and social development are also specific forms of motion of matter. However, such an understanding of motion is not characteristic of every system of materialism, but only of D. m. Dialectics (from Greek dialego—I speak, I reason) in its original meaning means the art of reasoning; later this concept was used in different senses, in particular under dialectics was meant simply logic, as well as speculative philosophy. Dialectics in the modern sense (as opposed to metaphysics) is partially already represented in the philosophers of ancient Greece, especially Heraclitus and Aristotle; it received further development in the works of Spinoza, as well as in classical German philosophy (Kant, Fichte, Schelling). As a system, however, dialectics was developed by Hegel, from whom Marx and Engels borrowed it. The latter, however, did not simply adopt it: in Marx's expression, he put Hegelian dialectics from its head upon its feet, since Hegel's dialectics was based on a generally idealistic foundation, while the founders of Marxism brilliantly synthesized it with philosophical materialism. Engels defines dialectics as "the science of the general laws of motion and development of nature, human society and thinking." He characterizes the difference between the dialectical method of thinking and the metaphysical one as follows ("Anti-Dühring"): the latter is characterized by the habit of "taking things and phenomena of nature in their isolation, outside their great general connection, and therefore—not in motion, but in a state of rest, not as essentially changing, but as eternally unchanging, not living, but dead... For the metaphysician, things and their mental images, i.e., concepts, are separate, unchangeable, petrified, once and for all given subjects, to be studied one after another and one independently of the other. The metaphysician thinks in finished, immediate opposites; his speech consists of: 'yes-yes, no-no; what is beyond that is from the evil one.' For him a thing either exists or does not exist; for him a subject cannot be itself and at the same time something else; positive and negative absolutely exclude each other; cause and effect are also completely opposite to each other. This way of thinking seems to us at first glance quite correct because it is inherent in so-called common sense. But human common sense... experiences the most surprising adventures, as soon as it dares to embark on the long path of research. Similarly, the metaphysical worldview, quite correct and necessary in certain, more or less broad fields, sooner or later reaches those limits beyond which it becomes one-sided, limited, abstract, and gets entangled in insoluble contradictions, because behind objects it does not see their mutual connection, behind their being it does not see their origin and disappearance, behind their rest it does not see their motion, behind the trees it does not see the forest. We, for example, in everyday life can with certainty say whether a given animal exists or not, but upon more precise investigation we are convinced that this is sometimes an extremely complicated question... It is also impossible to precisely determine the moment of death, since physiology shows that death is not a sudden, instantaneous act, but a very slowly occurring process. Every organic being at any given moment is the same as it was in the previous moment, and at the same time not the same. At every moment it processes the matter it has received from outside and excretes other matter, some cells of its organism die, others are born, so that after a certain period of time, the matter of this organism is completely renewed...; that is why every organic being is always the same and yet not the same. Similarly, upon more precise investigation we find that both poles of any opposition—positive and negative—are as inseparable from each other as they are opposite, and that they, despite all opposition, mutually penetrate each other... All these phenomena and methods of research do not fit within the framework of metaphysical thinking. For dialectics, which takes things and their mental reflections mainly in their mutual connection, in their concatenation, in their motion, in their origin and disappearance—such phenomena as the above, on the contrary, only confirm its own method." In these words of Engels, the main essence of dialectics, its difference from metaphysics and the principles of its application to natural science are briefly formulated. Dialectics is sometimes incorrectly interpreted as a doctrine simply about development. Such an interpretation does not exclude the idea of development as a simple increase or decrease of properties or qualities already inherent in the object; an example of such views is the old doctrine of preformationists, according to which ontogenesis is nothing other than the simple growth of the homunculus (Einschachtehmgslehre) laid in the sperm or in the egg. Such a vulgar-evolutionary concept has nothing in common with D. m., which considers development as a creative, constructive process, resulting in the formation of new qualitative features of the object. This development occurs through contradictions, always inherent in every phenomenon. As the process develops, its inherent contradictions grow, synthesizing at a certain moment into some higher unity. "Dialectics is the doctrine of how opposites can be and are (become) identical, under what conditions they are identical, turning into each other; why the human mind should not take these opposites as dead, petrified, but as living, conditional, mobile, turning into each other" (Lenin). The principle of mutual penetration of opposites is therefore fundamental in the philosophy of D. m. It by no means can be thought of merely as a sum of examples taken randomly from one or another field of knowledge: the mutual penetration of opposites is a universal law, finding its application in any area of nature and society and therefore in any science dealing with them. Even the modern physical theory of the structure of matter, reducing the latter to the synthesis of two opposite principles—positive and negative electricity (proton and electron)—is a brilliant confirmation of the basic principle of dialectics.

Discontinuity and continuity, chance and necessity, cause and effect, quantity and quality, subject and object, theory and practice, analysis and synthesis, internal and external, part and whole, life and death, assimilation and dissimilation of living substance—the most general opposites, the unity of which is now consciously or unconsciously accepted by modern natural science. And the more science grows, the more similar problems arise, to which formal-logical thinking is powerless to answer, treating them as absolute opposites, unrelated to each other, and which receive a brilliant interpretation when viewed from the standpoint of dialectics. In medicine, a good example in this regard is the concept of disease (see). Pathologists have long struggled to give an exact definition of this concept, but all such attempts prove insufficient when treating disease as something absolutely separated from health. And only the representation of disease and health as two mutually penetrating processes (states), finding their synthesis in the living, concrete person, gives us the possibility to emerge from the difficulties that have existed up to now. Here there is unity of theory and practice: Soviet healthcare, with its broad system of social prevention, has expanded the scope of medicine from the former concern only with the sick person to measures aimed at preserving the health of the entire population. Another extremely important problem for the physician is the relationship of internal and external factors of pathology. Here one can note two equally incorrect tendencies: on the one hand, almost all features of a person (including his behavior as a member of a social collective) are explained exclusively by his hereditary substance, while the role of the external environment (particularly the social environment for humans) in which the genotype is realized is completely ignored. Such a view, in its most ugly, reactionary form, goes so far as to explain the class affiliation of a particular individual by the biological laws of heredity and natural selection. It hardly needs to be proven that such a viewpoint is unscientific and in its social part is an apology for class inequality and oppression. The other, diametrically opposite viewpoint reduces all pathology exclusively to the influence of the external environment, explaining genotypic diseases by the inheritance of traits acquired under the influence of the latter. This concept is in essence equally reactionary, since it stands in sharp contradiction with modern biology, which has rejected the old naive Lamarckian (and in essence vitalistic) views according to which changes in the soma must find an adequate reflection in the germ plasm. The truth lies along the line of synthesis of genotype and paratype, the internal properties of the organism dependent on the germ plasm, and their manifestation in the external (physical and social) environment. Their unity is the acting, living phenotype. There is, for example, much basis for speaking of a genotypic predisposition to tuberculosis. At the same time, however, it is beyond doubt that the realization of this predisposition occurs in the environment surrounding the organism and that unfavorable conditions of the latter can sharply intensify both the quantitative and, apparently, the qualitative aspects of morbidity. Of course, such a relationship between genotypic and paratypic factors does not always exist: in each specific case, the significance of the role of each can vary greatly. Similarly closely connected will probably be two opposite concepts such as humorism and cellularism. Thanks to the work of Virchow, cellularism seemed to have finally triumphed over the former. However, research in recent years has brought a considerable amount of data against the narrowly cellular interpretation of many pathological processes (a number of endocrine disorders, a new interpretation from the standpoint of colloidal and physical chemistry of some problems of inflammation, immunity, etc.). They began to speak in medicine of neohumorism, but it can be stated without error that this neohumorism will only prove fruitful if it does not absolutely oppose the morphological direction in medicine, but in the interaction of cellular substance and the fluids bathing it will seek a resolution of the problems of pathogenesis. No less important from the standpoint of the biologist-physician is the question of the relationship of form and function. Even Engels noted that 'the whole of organic nature is one continuous proof of the identity or inseparability of form and content. Morphological and physiological phenomena, form and function, mutually condition each other.' At the present time, in connection with the progress of our knowledge, this problem should be deepened and differentiated. In the order of ontogenesis, this problem can be solved either in the sense of the primacy of function (for example, thickening of a muscle under the influence of exercise) or in the sense of the primacy of form (for example, change in the function of a group of muscles of a limb with some deformation of the latter). The matter is different in the order of phylogenesis: here idiovariation is primary, while function is secondary. However, once having arisen, the latter can in its turn indirectly influence the former, promoting the survival, resp. the fixation in the species of those further mutations of this organ, as well as others in correlational connection with it, which serve for the better performance of the said function. In general, the problem of interaction, mutual penetration of cause and effect will apparently play an exceptional role in the doctrine of pathogenesis. Having learned from bitter experience, physicians often say 'post hoc non est propter hoc.' But this is only the negative side of the matter. For the active, effective side, it is important to know that cause and effect are by no means absolute opposites and that they can change places. For example, there have been many investigations as to what is primary—arteriosclerosis or hypertension. At present, however, the possibility of interpreting these two phenomena from the standpoint of interaction is becoming clear—in the very sense that hypertension, being apparently primary, promotes the development of arteriosclerosis, which in turn intensifies hypertension, and so on. Similarly, probably, the problem of the relationship between hyperchlorhydria and stomach ulcer and others will be solved. In close connection with the concept of development as the result of the struggle of two opposite principles leading to their sublation, stands another law of dialectical materialism—the transition of quantity into quality and quality into quantity. Every phenomenon, having developed historically from a series of preceding ones, at the same time carries within itself (even in an embryonic form) the elements of its own destruction. These elements, increasing quantitatively up to a certain limit, at a certain nodal point undergo a leap, leading to a break in continuity and having as its consequence the appearance of a new quality, with new, specific for the latter regularities. Development thus proceeds according to the scheme: continuity—discontinuity—continuity, etc. The entire universe develops according to this law, and awareness of it is necessary for understanding the development of any phenomenon. Death, for example, ceases to be something alien, external in relation to life, and becomes the result of the continuously proceeding processes in the living (multicellular) organism, the negation of these processes, occurring by a leap. 'To live is to die' (Engels). Some pathological facts, however, become understandable only from this point of view. For example, this includes the disorder of cardiac compensation in defect of the aortic valves. As is known, it occurs suddenly, 'by a leap,' and without particular physical strain on the organism. The fact of the absence of any harmful agents at the moment of decompensation of the organism becomes understandable only on the assumption of the presence in the heart muscle of a continuous process leading to its hypertrophy (it is known that things are exactly so), and at a certain moment—to decompensation. Similarly, one should apparently interpret the paroxysms in some of those diseases that proceed as if cyclically (Werlhoff's disease, hemolytic jaundice, pernicious anemia, genuine epilepsy, etc.). One can think that in these diseases there occurs a periodic accumulation of some toxic products, which, having reached a certain limit, at a certain moment lead to decompensation of the organism, to a paroxysm. The view of development as the result of the struggle of opposite processes, leading at a certain moment to a leap, a break in continuity, and the negation of the preceding stage of development (the law of the negation of negation—the third law of dialectics), deepens our understanding of matter and of the laws inherent in it.

Matter ceases to be merely an arithmetical sum of qualitatively elementary particles, the quantitative combinations of which explain all the diversity of the world (as follows from the vulgar-materialist, mechanical conception), but represents the result of a complex historical path of development, on which between the individual ingredients of matter specific forms of connection characteristic of each stage were established, as a result of which qualitatively distinct types of matter were formed (proton and electron, atom, molecule, protein molecule, living protoplasm, man, human society). For the moment of formation, the synthesis of the highest form of matter from the lower (for example, living substance from non-living), the regularities of the latter are still sufficient in explaining this synthesis. But once having arisen, these higher forms acquire special regularities (along with the old ones, which are in a negated form); therefore it is incorrect to seek the explanation for any phenomenon exclusively in reducing, decomposing it into its simpler ingredients (for example, reducing the phenomena of biology and pathology exclusively to physico-chemical regularities). That this is so is already proven by the modern doctrine of protein. The latter is not difficult to decompose into its constituent parts—amino acids. For a long time it seemed that the problem of protein synthesis was reduced to the simple summation of these constituent parts. And the efforts of many scientists were directed toward obtaining a compound containing the largest possible number of amino acids. The limit was reached by Abderhalden, who in 1916 synthesized a polypeptide from 19 amino acids. However, research of recent years has shown that by following this path, it will never be possible to synthesize protein, because along with the bonds usual for a polypeptide, the existence of other forms of bonds (cyclic and possibly others) has been proven in protein, which we are still unable to recreate synthetically. Protein therefore represents not a simple sum of amino acids, but their complex unity, and is therefore subject to study by special, qualitatively unique methods. The necessity of the unity of analysis and synthesis in the process of studying an object is manifested here with particular clarity. 'Each of the higher forms of motion is always necessarily connected with real mechanical (external or molecular) motion, just as the higher forms of motion simultaneously produce other kinds of motion; chemical action is impossible without a change in temperature and electricity, organic life is impossible without mechanical, molecular, chemical, thermal, electrical, and other changes. But the presence of these secondary forms does not exhaust the essence of the principal form in each case' (Engels). What has been said has enormous theoretical and practical significance for every physician. The physician operates on the human organism, i.e., on an object that is simultaneously biological and social, and therefore his task is, along with finding in it simple 'forms of motion' (mechanical and physico-chemical regularities), to seek specific regularities to explain the physiological and pathological processes he observes. Even the so-called 'cardiac edema' cannot be entirely reduced to the insufficiency of a mechanical pump (the heart), because then it would remain unexplained why with the same heart enlargement in two individuals, the quantity and quality (localization) of the edema differs between them, and in some, despite enormous heart enlargement, edema is absent altogether. Here it is therefore necessary, along with studying the size of the heart (which undoubtedly partially approaches an understanding of the mechanism of edema), to take into account the biological peculiarities of the body's tissues, as well as the condition of its other organs (capillaries, kidneys, endocrine-nervous system, etc.); in other words, it is necessary to study the organism as a whole. The same can be said about the role of physico-chemical research on individual ingredients of the organism; undoubtedly, the discovery of nitrogen retention in uremic coma or excessive accumulation of ketone bodies in diabetic coma has significantly advanced the understanding of the pathogenesis of these processes. But even the most precise determination of these and other products is unable to explain the numerous individual peculiarities observed in these processes. The introduction into medical practice of the gastric tube, which made it possible to fairly accurately determine the secretory and evacuatory functions of the stomach, greatly expanded the knowledge of gastrointestinal disorders. However, it hardly needs to be proven now that this method alone cannot achieve exhaustive knowledge of gastric pathology, since it is well known that even adding all other methods of stomach research (X-ray examination, etc.) still cannot completely cover all cases observed in the clinic (for example, reflex disorders of the stomach in diseases of a number of other organs). The same can be said about attempts to reduce human mentality and its pathological disorders to a simple sum of conditioned and unconditioned reflexes. There is no doubt that the work of Sechenov, Pavlov, Bekhterev, and others, who created the objective method in psychology, has clarified much in this field, remaining in agreement with the doctrine of materialism. But it is still incorrect to think that reflexology can exhaust psychology, replace it. Mentality remains a special, specific property of specially organized matter (the brain), and its study requires, along with decomposing it into individual acts of inhibition, excitation, etc., the application of specific research methods (including the method of self-observation), operating with it as a whole. It hardly needs to be proven either that attempts to explain social phenomena with the data of reflexology are doomed to obvious failure. Into the same, essentially erroneous, mistake fall the reactionary eugenicists, who try to reduce social phenomena (for example, class differentiation of society) to biological regularities (heredity, natural selection). The class basis of such a methodology is particularly clear in this case. But, despite the clarity and indisputability of the above, pathology by no means immediately came to these conclusions. On the contrary, even today mechanistic tendencies are often encountered, consisting either in one-sided fascination with laboratory research and neglect of clinical, anamnestic, and genetic data, or in excessive overestimation of the role and significance of one or another system of tissues, resp. organs (vegetative nervous system, endocrine, mesenchymal, etc.), and in attempts to explain almost all pathological processes by disorders of the latter, or finally in interpreting a particular disease exclusively as a disorder of a local, resp. diseased organ. The latter tendency is essentially also mechanistic, anti-dialectical, because it stems from an unconscious view of the organism as a mechanical sum of organs, ignoring the countless specific connections that exist between them. And dialectics is not without reason called 'the science of connections.' By breaking these connections in the process of analysis, decomposing the organism into its constituent organs, reducing the disease exclusively to the disease of the affected, resp. organ giving subjective pathological sensations—in short, by ignoring the organism as a whole, the physician immediately encounters a mass of contradictions: the presence of the same symptoms from individual organs in diseases that are essentially completely different, and conversely—the extraordinary polymorphism in symptomatology in the same disease. It should be noted, however, the extremely interesting path that medicine has traveled in this respect: starting from a unique and very naive doctrine of the wholeness of the organism with a view of disease as a consequence of the corruption of juices ('krases' and 'dyscrasies'), it subsequently came through the work of Morgagni, and later Virchow, to the negation of this concept, to the doctrine of localizations. And one cannot but admit that at that time the search for 'sedes morbi,' despite the mechanistic views that pushed research in this direction, was in essence very progressive, insofar as it accumulated factual material indicating the actual lesion of one or another organ in a particular disease. The rapid growth of such research, however, soon proved that this path is insufficient, since it leads to the contradictions mentioned above. The period of 'negation of negation' arrived, and correctly they began to speak of the wholeness of the organism. But this development by no means can be imagined as a straight line, without any zigzags. Two incorrect concepts are already emerging at present: on the one hand, the concept of the wholeness of the organism in the course of a pathological process by some authors is reduced to the fact of the spread of this process from one organ to a number of others (metastasis of cancer, dissemination of a boil) or to an interpretation that can already be considered proven of some local infectious processes (hard chancre, dysentery, typhoid fever, etc.) as a particular localization of general bacteremia.

Such a concept, based on entirely correct facts, nevertheless (since it exclusively reduces the problem of the integrity of the pathological process to these facts) remains essentially mechanistic, because integrity here is again conceived merely as the sum of its parts. Another extreme exclusively focuses on the whole, completely ignoring the role of individual parts (organs) and even going so far as to assert the fundamental unknowability of the moment of quality synthesis (Fischer). Here we have a brilliant field for the work of dialectical thought. The truth lies along the line of synthesis of the whole and the part: the features of the local reaction (lesion) are determined by the properties of the entire organism just as the reaction of the entire organism depends on the nature of the local process; the course of furunculosis in a given patient depends on the general genotypic and phenotypic properties of the entire organism; at the same time, the reaction of the entire organism depends on the localization of the process, the nature of the virus, and so on. The generalization of the process presupposes its localization (sedes morbi) just as localization is conditioned by generalization. Therefore, the division of diseases into 'local' and 'general' is only relative and conditional, since in essence every disease is both general and local. Eczema, for example, is a general disease in the sense that it is either a consequence of a genotypic defect or some complex paratypic changes that have occurred throughout the entire organism; but at the same time it is a local, skin disease, as such bothering the patient, giving certain complications precisely in connection with this localization and therefore requiring both general and local therapy. And if the view proves correct regarding the difference between eczema and a number of other anaphylactoid-type conditions (bronchial asthma, colitis membranacea, etc.) as a phenotypic difference (polypheny), conditioned by the same genotypic changes, then even alongside the similarity among all these diseases, it will still be necessary to emphasize the differences between them; the latter, however, comes down primarily to localization. This dialectical current has spontaneously penetrated modern genetics: Morgan's words that every gene can have diverse effects on the organism and that every part of the body or even every specific trait is a derivative of many genes are essentially a dialectical formulation of the question of the relationship between the local and the general. But if the mechanistic concept, which reduces the complex to the simple and does not see the qualitative difference between them, is untenable, then the position of vitalism (see) is even more harmful, which in biology is based mainly on the incorrect interpretation of the phenomena of regeneration and embryogenesis, and in medicine has found its concrete expression in the doctrine of immanent purposefulness ('protective forces of the organism,' vis medicatrix naturae, etc.). But however opposed these two concepts may appear at first glance, their initial position is the same, and one can even assert that modern vitalism feeds on the weakness and one-sidedness of mechanism, since if the latter denies the qualitative uniqueness of living substance and is therefore forced to dissolve its peculiarities in the properties of the physical-chemical components that produced it, then vitalism, standing essentially on the same principled position as mechanism, resorts to the recognition of a supernatural, irrational principle (entelechy, dominance, etc.) to explain the specific regularities observed in living beings. Dialectical materialism is equally alien to the pallor, narrowness, and one-sidedness of mechanism as well as to the speculative, unscientific nature of vitalism. The above represents an attempt (far from complete) to apply the laws of dialectical materialism to a part of nature—the sick human organism. The concrete application of dialectical materialism in the area of the historical development of society is called historical materialism. The latter Engels defines as 'that view of the course of world history which sees the ultimate cause and the great moving force of all important historical events in the economic development of society, in the changes in the modes of production and exchange, in the resulting division of society into classes and in the struggle of these classes against each other.' The mode of social production and exchange is the same base on which all forms of human relations grow as a superstructure (class struggle, the state with all its attributes as an instrument of the domination of one class over another, law, morality, forms of art, etc.). 'It is not the consciousness of men that determines their being, but, on the contrary, their social being that determines their consciousness' (Marx, 'A Contribution to the Critique of Political Economy'). And here there is a dialectical interaction: once having arisen, the superstructures in turn influence the base, and so on. An understanding of these regularities is of enormous importance for the physician. Only with their help do the paths of development of public health in capitalist countries, as well as the measures in this direction of Soviet legislation (see Public Health), become understandable. Another area of fruitful application of historical materialism for the physician is the history of science in general and of medicine in particular. Usually bourgeois scientists write the history of a particular science in such a way that it appears as a simple chronological registration of scientific discoveries, with an apology for the talent of this or that scientist, without indicating the social relations that gave science its progressive course in this particular direction. And yet it is beyond doubt that it is the material needs of society that are the main lever of scientific progress, that the latter is determined by the development of the productive forces. This is evidenced by the fact that some sciences grew directly from the needs of society (astronomy in antiquity, for example, from the needs of navigation); genetics develops almost exclusively where agriculture and animal husbandry flourish (U.S.S.R., Germany, Austria, England, Scandinavia). The war of 1914-18 also produced many discoveries directly responding to the needs of the war industry (for example, the extraction of nitrogen compounds from atmospheric nitrogen). A number of discoveries directly depend on the level of technical development (for example, the accuracy of the microscope, chemical balances, etc.). It is not accidental, furthermore, that some discoveries are made simultaneously by several researchers (for example, the discovery of differential calculus almost simultaneously by Leibniz and Newton, of the periodic system of elements by Mendeleev and L. Meyer; the same can be said regarding the evolution of organisms for the discovery of Darwin and Wallace, etc.). But not only are scientific discoveries dictated by social needs: even the abstract theories that unite them reflect the interests of one or another social-class formation—it is sufficient, for example, to recall the struggle between religion and materialism in the Renaissance, the great materialist wave that swept through the U.S.S.R. after the October Revolution, etc. It is necessary, however, to remember that first, in many cases the influence of the productive forces and social needs on the character of scientific progress is only indirect, occurring through a series of intermediate links, and therefore not always clearly apparent, and second, that science, having grown from the needs of society, in turn influences the development of the latter (steam engine, electricity, etc.). Dialectical interaction is also evident in this case. What has been said has enormous significance for the physician interested in the history of his science. Here we have an almost completely unexplored field. It is beyond doubt, however, that when it comes to the history of medicine—a science that in the past was concerned almost exclusively with the sick human organism—the application of the principles of historical materialism will prove somewhat more difficult than in other areas of knowledge. It is undeniable, however, that only by following this path will we be able to create from the enormous multitude of disparate facts a truly scientific history of medicine. Already now, for example, it can be said that some scientific discoveries that had enormous significance for medicine were called into being by the economic needs of society. Thus, Pasteur's brilliant discovery was dictated by the needs of the chemical industry. It is also beyond doubt that the progress of medicine directly depends on the state of technology (X-ray, surgical, laboratory instrumentation, etc.). Medicine constantly uses the successes of other sciences, which in turn are conditioned by the needs of society (for example, the role of genetics in the doctrine of the etiology of diseases, of chemistry in the doctrine of pathogenesis, etc.). And finally, we now come to the point where the progress of medicine, in turn, begins to affect certain aspects of social development (the sharp decrease in infant mortality and the related question of population growth, preventive measures in the field of occupational health and the related question of increasing the productivity of labor, etc.).

What has been said does not exhaust the role of historical materialism: the correct resolution of questions of medical ethics (see), the behavior of a physician as a citizen, a member of the social collective, a participant in socialist construction - is also conceivable only on the basis of mastering historical materialism. Finally, the specification of D. m. in relation to thinking constitutes the area of dialectical logic and gnoseology (theory of cognition). Here there are no special problems affecting the activity specifically of a physician, but for him, as for every naturalist-biologist, these questions have paramount importance. It is necessary to point out a peculiarity which in the realm of thinking distinguishes the philosophy of D. m. from other systems: 'The dialectical method is characterized primarily and mainly by the fact that it seeks the forces determining the development of a phenomenon in the phenomenon itself, and not in the sympathies of this or that researcher' (Plekhanov). The dialectics of thought is thus a reflection of the dialectics of objective reality. The basic problem of gnoseology is the relation of thinking to being. Dialectical logic insists that 'the dialectic of concepts' is merely 'a conscious reflection of the dialectical movement of the external world.' 'The task is not to invent the connection that exists between phenomena, but to discover it in the phenomena themselves' (Engels, 'Ludwig Feuerbach'). But, accepting the dialectic of consciousness as a reflection of the laws existing in the objective world (in nature and society), D. m. insists on the active role of the subject in the process of consciousness. 'The main defect of materialism--including that up to Feuerbach--has hitherto been that it considers reality, the objective, perceptible world of the senses, only in the form of the object or in the form of contemplation, and not in the form of concrete human activity, not in the form of practice, not subjectively. Therefore, the active side, in opposition to materialism, has hitherto been developed by idealism, but it has been developed abstractly, since idealism naturally does not recognize concrete activity as such' (Marx, 'Theses on Feuerbach'). D. m. has eliminated the insufficiency in this respect of old, metaphysical materialism and insists on the unity in the process of cognition of subject and object: the external world is the source of our sensations, but our brain does not passively reflect them, but actively processes them. Hence the insufficiency of bare sensationalism, and the unity of the latter with rationalism. No less relevant is the question of the reality of cognition and its limits. In these questions, naturalists have repeatedly made major errors (recall only Dubois-Reymond's 'Ignorabimus,' Virchow's 'Restringa-mun,' etc.). D. m. insists on the existence of objective being, independent of our consciousness. There is nothing fundamentally unknowable. The process of cognition itself is infinite, just as objective activity is infinite. Therefore D. m. is equally alien to both the unbelief and despondency of agnosticism, and to the limitations of metaphysical materialism, which rests content with 'eternal' truths. We are proceeding along the path to knowledge of objective, absolute truth, and this path leads through an infinite series of relative truths. In this respect D. m. sharply differs from vulgar relativism, for which the subject is an insurmountable barrier to the cognition of the object. 'The materialist dialectic of Marx and Engels undoubtedly includes relativism, but it is not reducible to it, i.e., it recognizes the relativity of all our knowledge not in the sense of denying objective truth, but in the sense of the historical conditionality of the limits of our approach to this truth' (Lenin, 'Materialism and Empiriocriticism'). The criterion of truth, from the point of view of D. m., is practice. 'The question of whether human thinking is capable of cognizing things as they exist in reality is by no means a theoretical question, but a practical one. Man must prove the truth of his thinking by practice, i.e., prove that it has real force and does not stop short of phenomena' (Marx, 'Theses on Feuerbach'). This criterion of truth enables us to guard against both subjective idealism (Mach, Avenarius, etc.) and the half-measures of Kant, for whom there is a fundamental separation of the 'thing in itself'--the noumenon--from the phenomenon. Of course, the thing in itself is not adequate to our sensations (things for us), since the latter is only a part of the former, but by practice man proves the cognition of the thing itself and thereby turns the 'thing in itself' into a 'thing for us.' Therefore, while subjective idealism criticizes Kant from the right for his admission of the objective reality of the thing in itself, D. m. criticizes him from the left for agnosticism, for the transcendence and otherworldliness of the thing in itself. D. m. is the enemy of all half-measures, incompleteness, eclecticism, and dualism. It is a monistic worldview, consistently and to the end carrying through its point of view in nature, society, and in thinking. And if from all that has been said it follows with certainty the enormous significance which knowledge of D. m. has for the naturalist and physician, it would on the other hand be a mistake to think that the latter in any way replaces the knowledge of concrete science, as if it had ready-made recipes for the cognition of the latter. It is called upon only to facilitate scientific research, serving as it were a lantern illuminating the path in scientific quests. It is true that it is an undoubted fact that the progress of the natural sciences has hitherto proceeded spontaneously in general along the path of D. m., without the scientists who made brilliant discoveries consciously applying materialist dialectic (Lyell, Darwin, Pavlov and many others). And medicine knows not a few examples of spontaneous dialectics: the generally accepted teaching, for example, that one must treat the patient, not the disease, that an experiment in vitro cannot without any reservations be transferred to the interpretation of phenomena taking place in vivo, is deeply dialectical, insofar as it emphasizes the concrete peculiarities of the individual phenomenon and does not dissolve the latter in general, abstract regularities. This circumstance seems to many a sufficient basis for denying the active, creative role of consciously applied dialectic (and philosophy in general) in the course of scientific research. It is not difficult, however, to prove that such a judgment is deeply erroneous, since first, along with the brilliant examples of spontaneous dialectic cited above, it is necessary to point out that not all the constructions of these scientists are correct; the latter can be explained only by the absence of a correct general theoretical orientation (for example, Lyell's denial for a long time of the evolution of the organic world, despite his own introduction of the historical method into geology; Darwin's denial, at least in some places, of jumps in nature; attempts by Pavlov and Bekhterev to explain social phenomena by moments of reflexology and many others.). All these grossest errors could easily have been avoided by the conscious application of materialist dialectic. Furthermore, one can cite not a few cases where scientists, standing on an incorrect general theoretical position or altogether ignoring theoretical thinking, arrived at obviously erroneous conclusions in their special researches. For example, Virchov's hostile attitude (in the second half of his life) to Darwinism and the associated skepticism in the question of the origin of man from primates led him to deny the kinship of homo fossilis with modern man, to narrowing the tasks of anthropology in fact to mere anthropometry, which significantly retarded the further progress of this science, in particular the doctrine of anthropogenesis. One can cite no fewer examples of this kind, when neglect of dialectics led scientists who had achieved brilliant results in their field to obviously incorrect, idealistic (Gurvich), and sometimes bordering on occultism, general theoretical conclusions (Driesch and others.)- And finally, the history of science proves that in some cases philosophy preceded natural science in the construction of brilliant scientific hypotheses. Thus, Kant created a cosmogonic theory of the origin of the world before Laplace. It is true that as yet there are no scientific results of the conscious application of materialist dialectic in the natural sciences (not counting the theoretical interpretation of empirical data obtained by bourgeois scientists), but if one recalls that the number of naturalists-Marxists can be counted on the fingers, that in the overwhelming majority of cases they are young scientists, that the movement for Marxism in the natural sciences began too recently--then there can be no doubt that the future holds brilliant prospects in this respect. The examples of achievements in the conscious application of dialectic in the social sciences (Marx, Lenin and others) are particularly encouraging. It is necessary, however, in this connection to remember that the above comparison of D. m. with a lantern by no means should be imagined as if D. m. itself were an unchanging, constant collection of eternal truths. 'Materialism, like idealism, has passed through various stages of development. It has to take on a new form with each new great discovery which constitutes an epoch in natural science' (Engels, 'Ludwig Feuerbach').

We thus have an interaction between the progress of science and the philosophy of dialectical materialism, which is consequently not only a method but also a special scientific discipline, and therefore it is incorrect to think that one can, by 'learning' the basic laws of dialectics, obtain once and for all the correct methodological setting for scientific research. Dialectical materialism insists on the concreteness of truth, and therefore the worst service is rendered to it by those who, formally relying on this or that statement of the classics of Marxism, lose sight of the specific features of the moment (the state of science, etc.) at which these statements were made, since 'Marxism is not a dead dogma, not some finished, ready-made, immutable teaching, but a living guide to action' (Lenin). The problems of medicine from the point of view of dialectical materialism are developed by the Society of Materialist Physicians at the section of natural and exact sciences of the Communist Academy in Moscow (a similar organization exists in Kharkov). This society arose in 1927 from the Circle of Materialist Physicians organized in 1924 at 1st MSU. In 1929, the Society joined the Communist Academy.