Reforming American Medicine part 1: making medicine

scientific HI31LWeek 7

Medicine & the ‘rise of science’

I. Overview: late 19th c. as a turning point in American medicine

II. Lay and professional reactions to ‘medical science’What role for science in medicine?What role for medical science in society?

III. Science and specialism

From Natural

History …

‘Science’ in medicine, 1860 vs 1890:

‘Science’ in medicine, 1860 vs 1890:

To experimentation

Resistance

“The domain of therapeutics is, at the present day, continually trespassed upon by pathology, physiology and chemistry. Not content with their legitimate province of revealing the changes produced by disease and by medicinal substances in the organism, they presume to dictate what remedies shall be applied, and in what doses and combinations . Their theories are brilliant, attractive and specious ... When submitted to the touchstone of experience, they prove to be only counterfeits, They will neither secure the safety of the patient nor afford satisfaction to the physicians.”

Alfred Stille 1874

Support“Modern physiology has rendered

experimental therapeutics possible, and has opened an almost boundless field which is being diligently cultivated... It is obvious that no science of therapeutics can be created out of empirical facts. We are not yet in a condition to reject all the contributions to therapeutics made by the empirical method, but a thorough examination of the must be undertaken by the help of the physiological method.”

Roberts Bartholow, 1876

How were patients and doctors converted?

Medical innovations from the lab: From prevention to therapies

• Anaesthesia• Antisepsis/asepsis• Diptheria antitoxin• Rabies vaccination

• ‘the introduction of the hypodermic syringe, of the bromides, of chloral, of nitro-gylcerine, of cocaine and antiseptics’ J.M DaCosta, 1887

How were patients and doctors converted?

Visible social impacts of science (via technology)

• Outcome of Civil War; • Mass industrialization; • rail networks; steamships;

communications technologies• Municipal hygiene: sanitation,

water purification, etc

So were the opponents of the

physiological method just

medical Luddites?

• ‘Clinical experience is the only true and safe test of the virtues of medicine’ Stille, 1874

Thalidomide baby, c1957-61

Which doctor would you rather go to?

Readings: names, concepts and debates

• Alfred Stille vs Roberts Bartholow• Specialism vs general practice• Public health vs private charity• ‘Old Code’ vs ‘New Code’• filth vs germs (etiology)• ‘the physiological method’ [‘physiological

therapeutics’] vs. ‘the empirical method’ [‘clinical empiricism’]

• Medical and therapeutic individualism vs medical and therapeutic standardization and universalism

• Sanitation vs. quarantine• Scientific commercialism vs idealismQuestions:• What was the relationship between ‘basic science’ and

‘clinical practice’ in the last third of the 19th century?• Who was skeptical of ‘scientific medicine’ and why?