John Harley Warner

Ideals of Science and Their Discontents in Late Nineteenth-Century American Medicine

H ISTORIANS AND SOCIOLOGISTS OF MEDICINE have engaged during the past two decades in a thoroughgoing reevaluation of the historical relationship between scientific knowledge and medical practice. Beginning in the 1960s, critics of modern biomedical authority drew into question the notion that there is any simple correlation between increased scientific knowledge in medicine and better health care. This challenge was mounted on a number of fronts: by ethicists concerned about the infringement of technology on the relationship between doctor and patient, by practicing physicians worried that the reductionist perspective of the laboratory was devaluing an appreciation of clinical judgment, by scholars who suggested that better hygiene and diet may have been more important than any advances in curative medicine in improving overall health in the past, and by activists in the womens movement troubled by abuses of authority perpetrated in the name of scientific expertise. Spurred by this critique of modern medicine and by the theoretical concerns of the new social history, historians began to challenge an earlier assumption that doctors in the past embraced science primarily because it made them better healers. Revisionists especially focused their attention on the infusion of experimental science into American medicine in the late nineteenth and early twentieth centuries, the period during which the problems of the science-based health-care system we live with today purportedly took shape. What they found suggested that physicians took up science as an ideal before it offered much to help them allay the ills of the sick. The American medical profession chose to march under the banner of science for a variety of reasons that had little to do with its clinical application. An ideal of science was brought to medical dominance, recent scholars have argued,

The humanising power of medical history: responses to biomedicine in the 20th century United States

Most American historians of medicine today would be very hesitant about any claim that medical history humanises doctors, medical students or the larger health care enterprise. Yet, the idea that history can and ought to serve modern medicine as a humanising force has been a persistent refrain in American medicine. This essay explores the emergence of this idea from the end of the 19th century, precisely the moment when modern biomedicine became ascendant. At the same institutions where the new version of scientific medicine was most energetically embraced, some professional leaders warned that the allegiance to science driving the professions technical and cultural success was endangering humanistic values fundamental to professionalism and the art of medicine. They saw in history a means for rehumanising modern medicine and countering the risk of cultural crisis. While some iteration of this vision of history was remarkably durable, the meanings attached to ‘humanism’ were both multiple and changing, and the role envisioned for history in a humanistic intervention was transformed. Starting in the 1960s as part of a larger cultural critique of the putative ‘dehumanisation’ of the medical establishment, some advocates promoted medical history as a tool to help fashion a new kind of humanist physician and to confront social inequities in the health care system. What has persisted across time is the way that the idea of history as a humanising force has almost always functioned as a discourse of deficiency—a response to perceived shortcomings of biomedicine, medical institutions and medical professionalism.

Grand Narrative and Its Discontents: Medical History and the Social Transformation of American Medicine

There can be little doubt that Paul Starr’s The Social Transformation of American Medicine (1982) (referred to in short as TSTAM), a study in the history of medicine, has enjoyed its most prominent success in realms outside the history of medicine (see Howell, this issue, and Jost, this issue). When the book appeared in 1982, reviews written by historians of medicine and health care acknowledged its achievement as a major work of synthesis, but tempered admiration with the repeated refrain that TSTAM— most especially in book one, which covered the period up to 1930 and is the focus of this essay—really said very little that was new. Over the ensuing two decades, moreover, Starr is nowhere to be found among the authors most cited in the medical history journal literature (Amsterdamska and Hiddinga 2004). Even works that have implicitly dealt major blows to the story Starr told have not often paused to register that fact. For example, in 1985 medical historian Ronald L. Numbers deftly pointed out that far from succumbing to a hegemonic “scientific medicine”—as Starr like most other writers had assumed—alternative practitioners in earlytwentieth-century America remained a vigorous competitive presence. Yet, even though Numbers’s praise (1983: 838) from his review in Science appeared on the back of the softcover edition of TSTAM—“If you read

Making the Case for History in Medical Education

Historians of medicine have struggled for centuries to make the case for history in medical education. They have developed many arguments about the value of historical perspective, but their efforts have faced persistent obstacles, from limited resources to curricular time constraints and skepticism about whether history actually is essential for physicians. Recent proposals have suggested that history should ally itself with the other medical humanities and make the case that together they can foster medical professionalism. We articulate a different approach and make the case for history as an essential component of medical knowledge, reasoning, and practice. History offers essential insights about the causes of disease (e.g., the nonreductionistic mechanisms needed to account for changes in the burden of disease over time), the nature of efficacy (e.g., why doctors think that their treatments work, and how have their assessments changed over time), and the contingency of medical knowledge and practice amid the social, economic, and political contexts of medicine. These are all things that physicians must know in order to be effective diagnosticians and caregivers, just as they must learn anatomy or pathophysiology. The specific arguments we make can be fit, as needed, into the prevailing language of competencies in medical education.

The Fielding H. Garrison Lecture: The Aesthetic Grounding of Modern Medicine

This article focuses on visual choices that American physicians made in representing their profession, their work, and themselves during the decades when modern medical culture was set in place, the 1880s through the 1940s. Historians have emphasized the role that image played in the formation of modern medicine, but the visual images they have explored in connection to this process have tended to take a reductionist aesthetic identified with experimental laboratory science as emblematic of medical modernity. Explored here instead are several counterexamples—genres of self-representation in which medical students and physicians did not seek to link their identity with the laboratory and in some ways distanced themselves from the image and ideals of experimental science. The cultivation of these images invites us to see the cultural grounding of modern medicine as vastly more complex than a story scripted around the biomedical embrace of a stripped down, reductionist aesthetic.

Medicine, Media, and the Dramaturgy of Biomedical Research: Historical Perspectives

This chapter offers a historical perspective on relations among medical scientists, the mass media, and public perception and expectation. It also provides a broad context for understanding the publicizing of biomedical research as a cultural enterprise. It sketches in wide strokes changing patterns of media depictions of biomedical research. Stressing the co-development of modern medicine, modern media, and public faith in biomedical progress, it shows how such media as newspapers, magazines, health education pamphlets, radio, film, television, even comic books shaped and nurtured an image of research as a heroic drama punctuated by breakthrough discoveries. The aim is to recount and explain rather than to judge the simplifications and sometimes stylized myth-making that mediated between scientific practice and popular perception, in order to better understand how the researcher–media–public triad became an established feature of biomedical enterprise and the larger place of medicine in modern society.

Medicine, Media, and the Dramaturgy of Biomedical Research

This chapter offers a historical perspective on relations among medical scientists, the mass media, and public perception and expectation. It also provides a broad context for understanding the publicizing of biomedical research as a cultural enterprise. It sketches in wide strokes changing patterns of media depictions of biomedical research. Stressing the co-development of modern medicine, modern media, and public faith in biomedical progress, it shows how such media as newspapers, magazines, health education pamphlets, radio, film, television, even comic books shaped and nurtured an image of research as a heroic drama punctuated by breakthrough discoveries. The aim is to recount and explain rather than to judge the simplifications and sometimes stylized myth-making that mediated between scientific practice and popular perception, in order to better understand how the researcher–media–public triad became an established feature of biomedical enterprise and the larger place of medicine in modern society.

Medicine as performance

Early British modern medicine can be considered as a type of theatre.

Managing clinical uncertainty

How do we know that a particular drug is effective at the bedside, as well as in the marketplace? What reliable guides do we have for the clinical investigations of an academic medical élite and for the daily prescribing habits of general practitioners? Which intellectual and social tools are most dependable for defining therapeutic merit in theory, practice and law? The shifting ways in which twentiethcentury therapeutic reformers in the United States have grappled with such questions is the focus of Harry M. Marks’s bold, nuanced account. In a century flooded with pharmaceutical marvels (and some notorious iatrogenic tragedies), reformers have seen in experimentalism the most promising foundation for creating a rational therapeutics. Marks is not chiefly concerned with the ways in which new therapeutic possibilities were developed, or with recounting successes and failures. Rather, the story he tells is about how the methods and ideals of science were brought to bear on the management of clinical uncertainty. The nature and meanings of experimentalism have changed over time, Marks convincingly shows, but its place in the larger programme of therapeutic reformers to bring scientific order to clinical practice remained remarkably durable. Their task was to create reliable criteria for therapeutic evaluation, and to inculcate their conception of a scientific attitude towards therapeutics among the medical rank and file. Today, the randomized, controlled clinical trial, although not without its critics, is the gold standard of clinical research. Yet even as recently as 1950, therapeutic evaluation relied little on statistics. Early in this century, progressive therapeutic reformers distrustful of commercialism looked on the integrity of experienced researchers consecrated to the ideals of experimental science as the most dependable leaven for clinical practice. In 1906 the American Medical Association founded its Council on Pharmacy and Chemistry to judge independently the claims made by drug companies for their products. Reformers went on to promote cooperative investigations as a means of pooling expert experience, but it was the character of individual clinicians that was believed to best guarantee the integrity of their therapeutic observations. During the 1930s and 1940s, officials at the US Food and Drug Administration largely adopted the council’s approaches to therapeutic assessment in their efforts to regulate drug safety. After the Second World War, however, therapeutic reformers increasingly sought to purge clinical evaluation of subjectivity, and began to embrace the double-blind, randomized, controlled clinical trial as a more impersonal, scientific standard for assessing and improving therapeutic knowledge and practice. Building on the statistician R. A. Fisher’s conception of experimental design, experiments by the British Medical Research Council and the US Public Health Service to use streptomycin to treat tuberculosis during the war introduced the randomized clinical trial. From the 1950s onwards, Marks observes, therapeutic reformers insisted that trust in numbers — in an experimental method regulated by statistics — should supplant the trust an earlier era had placed in the judgement of experienced researchers. Investigations at the bedside, newly governed by the reign of statistics, could be every bit as scientific as research conducted in the experimental laboratory. Marks anchors his overarching account of change over time in a series of richly textured case studies, offered, as he rightly insists, not as typical but as powerful exemplars of larger patterns. Prominent nodal points include, from the period between the two world wars, the Cooperative Clinical Group’s study of syphilis treatments and the Commonwealth Fund’s experiments with serum treatment of pneumonia; the National Research Council’s investigations of penicillin during the Second World War and the streptomycin studies conducted by the Veterans Administration and the Public Health Service immediately after the war; and, in the 1960s, the Diet-Heart study and the University Group Diabetes Program study of tolbutamide. It is through these case studies that we are drawn into the world of therapeutic investigation, including conflicts between the aspirations of researchers and the day-to-day demands on general practitioners; between the purity of experimental design and the realities of patient compliance; and — in the book’s most contemporary example, which is invoked but not thoroughly explored — between the political and clinical demands of patient activists and the protocols of therapeutic research on HIV and AIDS. Readers might well feel uneasy, as I did initially, about Marks’s use of the omnibus category “therapeutic reformers”, which encompasses a motley assemblage of pharmacologists, physiologists, statisticians, epidemiologists, journal editors, government physicians and clinical specialists. I would also have liked to learn more about how the American medical profession at large perceived the movement for therapeutic reform and its products; the strategies enlisted to persuade general practitioners of the virtues of randomized, controlled clinical trials; and how what Marks calls a “quintessentially an American story” compares with patterns in other national contexts. What more than warrants his use of the aggregate term “therapeutic reformers”,

”Hydropathic Highway to Health”: women and water-cure in antebellum America

Well, someone can decide by themselves what they want to do and need to do but sometimes, that kind of person will need some hydropathic highway to health women and water cure in antebellum america references. People with open minded will always try to seek for the new things and information from many sources. On the contrary, people with closed mind will always think that they can do it by their principals. So, what kind of person are you?