THE RISE OF SCIENTIFIC MEDICINE

COURSE DESCRIPTION

This course explores the historical development of cultural beliefs and institutions in Western Europe and the United States during the nineteenth and early twentieth centuries which led to the establishment of the modern system of medicine. The focus of the course is primarily upon the role of natural science in the transformation of medical theory, medical training, and medical practice. We will explore the factors that enabled academically trained physicians, schooled in the elements of experimental physiology, physiological chemistry, the germ theory of disease, and pharmacologically based chemical therapeutics, to displace other types of healers and emerge by the early twentieth century as the sole providers of health care. In part our focus will be on the professionalization of medicine and the role of scientific knowledge and expertise in the making of the modern physician. No less crucial for our consideration, however, is the creation of the modern patient; a major thesis explored in the course is that the professionalization of medicine required at the same time the medicalization of society. We will examine the transformation of values and beliefs which enabled scientifically trained professional physicians to be invested with cultural authority in matters of sickness and health, and we will examine the ways in which this medical authority was institutionalized in standardized training, evaluation, and licensing, supported by a vast armamentarium of technology, centered in clinics and hospitals. Beginning with the reform of medical institutions during the French Revolution and the concomitant developments of pathological anatomy and the Paris clinical tradition, the course will trace the development of scientific and laboratory medicine throughout the nineteenth and early twentieth centuries, culminating with the promised therapeutic revolution to be effected by improved knowledge of biochemistry on the eve of the discovery and commercial development of antibiotics in 1945. Among other topics we will consider are gender in medicine and the development of fields such as medical genetics.
 

COURSE FORMAT AND REQUIREMENTS:

The course will be conducted in lecture-discussion format. Each student is required to make a class presentation with a group of students in the class on one of the sets of assigned readings. You will be expected to work with members of your group in preparing a stimulating and informative presentation. Each student is also required to complete writing assignments totalling 10-15 pages (see explanation below for writing requirement). Course grades will be assigned on the basis of performance on 1) the writing assignment(s) (45%), 2) the class presentation (30%), and 3) quality of regular class participation (25%).

Suggestions for Writing Requirement
The writing requirement for this class is 10-15 typed double-spaced pages. You may fulfill this requirement in a number of different ways.

Option 1. You may write a) one longer or b) two shorter traditional argumentative papers focused on some aspect of the history of medicine and using one or more of the authors we are reading as a starting point for your work; OR

You may combine any writing assignments for a total of 10-15 pages: e.g., two review essays and one short research paper. You might use the materials of your class presentation as the basis for writing a review essay, and complete the remainder of the writing requirement with other reviews and/or a research paper.

Option 2. You may construct a multimedia essay on some medical development, such as penicillin, organ transplantation, or reconstructive surgery.

Due Dates: If you elect to write only one long argumentative paper, then the latest date it can be turned in is June 1. If you decide to write two shorter argumentative papers or a combination of argumentative papers, you need to turn in one completed component of your written work by April 29; the remainder will be due on the last day of class, June 3. (This requirement imposes some discipline so that you won't find yourself swamped with work for this course at the end of the quarter.) If you choose to construct a multimedia essay on some medical development, you have until June 10 to complete your project.

April 1: The Social Construction of Concepts of Sickness and Health
Arthur Kleinman, "Concepts and a Model for the Comparison of Medical Systems as Cultural Systems," in Course Reader.
Arthur Kleinman, Patients and Healers in the Context of Culture, pp. 146-178 in Course Reader.

April 6: Medicine in the Ancien Regime
Roy Porter, "The Eighteenth Century," in Course Reader.
Jean-Pierre Goubert, "The Medicalization of French Society at the End of the Old Regime," in Course Reader.
Michel Foucault, "The Politics of Health in the Eighteenth Century," in Course Reader.

April 8:. The Medical Gaze: French Revolution and Medical Reform
Toby Gelfand, "The Gestation of the Clinic," in Course Reader
Erwin Ackerknecht, "Elisha Bartlett and the Philosophy of the Paris Clinical School,"in Course Reader

April 13: Public Health and Moral Contagion
Charles E. Rosenberg, The Cholera Years: 1-98; 175-234.
William Bynum, Science and the Practice of Medicine in the Nineteenth Century, pp. 25-91.

April 15: The Development of Experimental Medicine
Stanley Joel Reiser, Medicine and the Reign of Technology, pp. 23-43; 69-143; 197-225; 235-259.
John Harley Warner, "The Fall and Rise of Professional Mystery: Epistemology, Authority, and the Emergence of Laboratory Medicine in Nineteenth Century America," in Course Reader.
William Bynum, Science and the Practice of Medicine in the Nineteenth Century, pp. 92-117.

Selections from Primary Texts:

Xavier Bichat, Physiological Researches on Life and Death

Theodor Schwann, Microscopical Researches

Claude Bernard, An Introduction to the Study of Experimental Medicine, pp. 59-65; 99-112; 196-226.

Additional Secondary Material:

Hugh La Follette and Niall Shanks, " Animal Experimentation: The Legacy of Claude Bernard," International Studies in the Philosophy of Science, (1994), pp. 195-210.

April 20: The Germ Theory of Disease
Christopher Lawrence, and Richard Dixey, "Practicing On Principle: Joseph Lister and the Germ Theories of Disease," in Course Reader.
Lindsay Granshaw, "`Upon This Principle I Have Based a Practice': The Development and Reception of Antisepsis in Britain, 1867-90," in Course Reader
William Bynum, Science and the Practice of Medicine in the Nineteenth Century, pp. 118-141.
Bruno Latour, " Give Me A Laboratory, And I Will Raise the World."

Selections from Primary Texts:

Joseph Lister, "On the Antiseptic Principle in the Practice of Surgery."

Louis Pasteur, "Infusorian Animalcules Living Without Free Oxygen."

Louis Pasteur, "Experiments Related to Spontaneous Generation."

Additional Resource:

Arthur M. Silverstein, A History of Immunology, Ch. 3 pp 38-58; Ch. 4 pp 59-86; Ch. 5 pp 87-123.

April 22: The Microbe Hunters and the Medical Industry
Jonathan Liebenau, Medical Science and Medical Industry, pp. 30-56; 98-134, in Course Reader.
Timothy Lenoir, "A Magic Bullet: Research for Profit and the Growth of Knowledge in Germany around 1900," in Course Reader.
Nicholas Rasmussen, "The Moral Economy of the Drug Company-Medical Scientist Collaboration in Interwar America," (preprint used with permission of the author)

Additional Resources on the History of Drug Discovery:

Jurgen Drews, "Drug Discovery: A Historical Perspective," Science, Volume 287, Number 5460 (17 Mar 2000): pp. 1960-1964.

April 27: Therapeutic Revolution?
Christopher Lawrence, "Incommunicable Knowledge: Science, Technology and the Clinical Art in Britain, 1850-1914," in Course Reader.
Charles Rosenberg, "The Therapeutic Revolution: Medicine, Meaning, and Social Change in Nineteenth-Century America," in Course Reader.
Gerald Geison, "Divided We Stand: Physiologists and Clinicians in the American Context," in Course Reader.
William Bynum, Science and the Practice of Medicine in the Nineteenth Century, pp. 218-226.

April 29: Professionalization of Medicine
Paul Starr, The Social Transformation of American Medicine: 60-144.

May 4: Gender, Science, Medicine
Ludmilla Jordanova, Sexual Visions: Images of Gender in Science and Medicine between the Eighteenth and Twentieth Centuries, pp. 1-65; 87-159.
Charles Rosenberg and Carroll Smith-Rosenberg, "The Female Animal: Medical and Biological Views of Women," in Course Reader.
Regina Morantz-Sanchez, Sympathy and Science: pp. 203-231.

May 6: Social Construction of Medical Practice: The Case of Venereal Disease
Allan Brandt, No Magic Bullet, pp. 3-51; 122-160.

May 11: Science at the Bedside
Rosemary Stevens, In Sickness and in Wealth: American Hospitals in the Twentieth Century, pp. 3-16; 52-79; 105-131; 200-207; 226-240. In Course Reader.
Joel Howell, Technology in the Hospital: Transforming Patient Care in the Early Twentieth Century, pp. 30-68; 227-249. In Course Reader.

May 13: Fundamental and Applied Science: The Case of Eugenics
Daniel J. Kevles, In the Name of Eugenics: Genetics and the Uses of Human Heredity, pp. 3-56; 85-147.

Resources and Selections from Primary Texts:

Sir Francis Galton, Hereditary Genius: An Inquiry into its Laws and Consequences

The American Eugenics Archive

May 18: Technomedicine
Perrin H. Long, "Medical Progress and Medical Education During the War," in Course Reader.
D.W. Hill, "Progress in Medical Instrumentation over the Past Fifty Years (1938-68)," in Course Reader.
Joel D. Howell, "Diagnostic Technologies: X-Rays, Electrocardograms, and Cat Scans,"in Course Reader.
Stanley Joel Reiser, Medicine and the Reign of Technology, pp. 196-226.
Timothy Lenoir, "The Virtual Surgeon," in Robert Mitchell and Phillip Thurtle, eds., Data Made Flesh: Embodying Information, New York; Routledge, 2004, pp. 137-152.
Timothy Lenoir, “Shaping Biomedicine as an Information Science,” Proceedings of the 1998 Conference on the History and Heritage of Science Information Systems, edited by Mary Ellen Bowden, Trudi Bellardo Hahn, and Robert V. Williams. ASIS Monograph Series. (Medford, NJ: Information Today, Inc., 1999), pp. 27-45.
Suhail Kanchwala, Ectogenesis
David J. Mooney and Antonios G. Mikos, Scientific American, April, 1999. Growing New Organs

May 20: The Human Genome Initiative and Medicine
Daniel J. Kevles, "Out of Eugenics: The Historical Politics of the Human Genome," in Course Reader.
Walter Gilbert, "A Vision of the Grail," in Course Reader.
Leroy Hood, Biology and Medicine in the Twenty-First Century," in Course Reader.
C. Thomas Caskey, "DNA-Based Medicine: Prevention and Therapy," in Course Reader.
Evelyn Fox Keller, "Nature, Nurture, and the Human Genome Project," in Course Reader.
Symposium on Engineering the Human Germline
Arthur L. Caplan, "If Gene Therapy is the Cure, What is the Disease?", G. Annas and S. Elias, eds., Gene Mapping, Oxford University Press, 1992, pp. 128-141.

Sources and Perspectives on Human Cloning:

Margaret Talbot, "Clone of Silence," New York Times Magazine(16 April 2000), pp. 21-22.

The Wellcome Trust, Public Perspectives on Cloning (Spring 1998)

American Association for the Advancement of Science Resources on Cloning and Stem Cell Research

May 25: Biomedical Platforms: The Rise of Biomedicine
W. Bruce Fye, "Fueling the Growth of Cardiology: Patients, Procedures, and Profits," in Course Reader.
Joel D. Howell, "The Changing Face of Twentieth Century American Cardiology," in Course Reader.
Timothy Lenoir and Marguerite Hayes, "The Manhattan Project for Biomedicine," in Phillip R. Sloan, Controlling Our Destinies, South Bend, In, University of Notre Dame Press, 200, pp. 19-46.
Alberto Cambrosio and Peter Keating, "A Matter of FACS: Constituting Novel Entities in Immunology," Medical Anthropology Quarterly, Vol 6(1992), pp. 362-384.
Joan Fujimura, “Crafting Science: Standardized Packages, Boundary Objects, and 'Translations'," in Andrew Pickering , ed., Science as Practice and Culture, Chicago, University of Chicago Press, 1992, pp. 169-211.

Additional Resources:

Annetine Geljins and Samuel Thier, "Medical Innovation and Institutional Interdependence: Rethinking University-Industry Connections," Journal of the American Medical Association, Vol 287, No. 1, Jan. 2, 2002, pp. 72-77.

May 27: Molecular Medicine
Robert A. Weinberg, "Molecular Mechanisms of Carcinogenesis," Chapter 10 in Scientific American Introdtuction to Molecular Medicine, Philip Leder, David A. Clayton, Edward Rubenstein, eds., New York; Scientific American, 1994.
Curtis L. Scribner, et al., " Bioengineered Agents in Clinical Medicine," Chapter 11 in Scientific American Introdtuction to Molecular Medicine, Philip Leder, David A. Clayton, Edward Rubenstein, eds., New York; Scientific American, 1994.
Curtis L. Scribner and Paul Aebersold, "Gene Therapy," Chapter 12 in Scientific American Introdtuction to Molecular Medicine, Philip Leder, David A. Clayton, Edward Rubenstein, eds., New York; Scientific American, 1994.

Additional Resources:

Chris Sander, "Genomic Medicine and the Future of Health Care," Science, Vol 287, 17 March 2000, pp. 1977-1978.

Jason Gibbs, "Mechanism-Based Target Identificaton and Drug Discovery in Cancer Research," Science, Vol 287, 17 March 2000, pp. 1969-1973.

John Rosamond and Aileen Allsop, "Harnessing the Power of the Genome in the Search for New Antibiotics," Science, Vol 287, 17 March 2000, pp. 1973-1976.

June 3 : Prevention versus Cure: The Politics of Disease
Robert Proctor, Cancer Wars: How Politics Shapes What We Know and Don't Know About Cancer, pp. 1-9; pp. 35-53;pp. 101-132; pp. 216-247; pp. 249-271.
Michelle Murphy, "The 'Elsewhere within Here' and Environmental Illness; or, How to Build Yourself a Body in a Safe Space," Configurations, Vol. 8 no. 1, Winter, 2000), pp. 87-120.

COURSE TEXTS

• Allan Brandt, No Magic Bullet: A Social History of Venereal Disease in the United States since 1880, Oxford; Oxford University Press, 1985.
• William Bynum, Science and the Practice of Medicine in the Nineteenth Century, Cambridge; Cambridge University Press, 1994.
• Daniel J. Kevles, In the Name of Eugenics: Genetics and the Uses of Human Heredity, Berkeley; University of California Press, 1985.
• Robert Proctor, Cancer Wars: How Politics Shapes What We Know and Don't Know About Cancer, New York; Basic Books, 1995.
• Stanley Joel Reiser, Medicine and the Reign of Technology, Cambridge; Cambridge University Press, 1978.
• Charles E. Rosenberg, The Cholera Years: The United States in 1832, 1849, and 1866, Chicago; University of Chicago Press, 1962.
• Paul Starr, The Social Transformation of American Medicine: The Rise of a Sovereign Profession and the Making of a Vast Industry, New York; Basic Books, 1982.
• Keith Wailoo, Drawing Blood: Technology and Disease Identity, Johns Hopkins Press, 1999.
• COURSE READER.