15 - Laboratory and Clinic: The Epistemic and Social Context

Summary

Types of Medicine

It was no coincidence that organ transplantation was invented in the late nineteenth century. Its underlying disease concept and its therapeutic approach are representative of a contemporary type of medicine that was trying to base its practice on knowledge derived from experimental physiology. This type of medicine arose in the research universities of the second half of the nineteenth century and remained predominant until the first half of the twentieth. The importance of this context becomes evident in the fact that the first attempts at isolating specific organ functions—Berthold’s transplantation experiments in 1849, Brown-Séquard’s ablation experiments with adrenal glands in 1856, Schiff’s extirpations of adrenal glands and thyroids in 1856–57, for example—remained without consequences. Brown- Séquard elaborated his concepts only in the 1880s and 1890s, Schiff did not resume his organ studies until 1883, and Berthold’s experiments were not rediscovered until the twentieth century. Evidently the development of the new concept depended not only on the existence of certain ideas and observations but also on the meaning that contemporary practitioners attached to them. This meaning, in turn, depended on what type of medicine was dominant at the time. John Pickstone suggested distinguishing between several different types of medicine and science that emerged at different times and can each be associated with specific social and institutional contexts. They each exhibit characteristic features in their practical and epistemological approach and are each linked to a specific understanding of what constitutes the scientific method.

From antiquity to the nineteenth century, the dominant type of medicine was what Pickstone calls “biographical medicine.” It took place in the context of private practice and was characterized by the doctor’s social and economic dependence on the patient. The patient’s relationship to the doctor was one of “patronage,” to use the term coined by the sociologist Nicholas Jewson. For the “biographical” medicine of the eighteenth century, the patient’s narrative provided the basis for the doctor’s diagnosis and therapy. The scientific research methods associated with this type of medicine consisted of the observation and classification of phenomena according to their surface features.