THE ROLE OF SCIENCE: Medical Sciences

 

THE ROLE OF SCIENCE

The traditional historical reconstructions of the development of the modern medical profession have considered the role of biomedical science within this process as essentially unproblematic. Medicine advanced as it became more scientific. In this way historians have passively accepted the affirmations of the protagonists of the 19th century; in Über die Standpunkte in der wissenschaftlichen Medicin (On Opinions in Scientific Medicine, 1847) Virchow argued: "The future belongs to science. It will increasingly control the destinies of nations. It already has them in its crucible and on its scales". Scientia est potentia , he liked to say, quoting Francis Bacon.

More recently, however, historians have challenged the idea that medicine became powerful simply because it was permeated by science. Some have argued that the improvement in life expectancy in the 19th century and at the beginning of the 20th century it was due much more to social, economic and above all nutritional factors than to curative or preventive medicine. Others, while recognizing the ideological value of science for medicine, have underlined that overall it did not have much influence on effective therapeutic assistance to patients and, even less, on healing. It was also shown how, within the framework of the well-known divergence of nineteenth-century medicine between science and art, a certain eliteand highly successful physicians continued to see it rather as 'art', insisting on the uniqueness of each individual and their disease and emphasizing that the practice of medicine was based on an incommunicable knowledge that could only be acquired through experience.

These and other readings related to the question of 'science in medicine' at the end of the 19th century. suggest an even more complex debate. They should be integrated with an analysis of the various meanings that the term 'science' had for the doctors of the time. Among other things, it has been demonstrated that the doctors who provided care at the bedside of the sick had developed their own scientific procedures and methods, and that equating 'science' to laboratory practice alone would historically be reductive; this would mean, in fact, ignoring the important changes that took place in hospital practice, which the French strenuously promoted and which transformed Paris into one of the most advanced centers of medical disciplines during the first half of the century.post mortem aimed at highlighting the clinical-pathological correlations, this medicine was defined as 'scientific' by its exponents. One of the American physicians trained in the French school, Elisha Bartlett, provided a coherent exposition of Baconian philosophy as the foundation of medicine in An essay on the philosophy of medical science (1844). According to Bartlett, medicine could have become scientific only with the patient and systematic collection of data relating to the disease, its manifestations and its treatment, and then with the gradual transition towards inductive generalizations based on recorded observations.

In German-speaking countries there were also calls for a more scientific clinical practice, above all by the Naturhistorische Schule of Johann Lucas Schönlein and his disciples, including Nikolaus Friedrich, Carl Wunderlich and Virchow himself. It is sometimes forgotten that Virchow remained actively involved in the clinical field, and that academic clinical medicine developed in German universities alongside the more specialized and ultimately more influential medical sciences. The history of the cases ( Kasuistik) was the hallmark of the historical-naturalistic approach, thanks also to the increase in medical journals in which diagnoses and treatments of individual well-studied cases were reported and discussed. German clinicians combined microscopic examination and chemical analysis of body fluids and tissues, above all blood and urine, with direct diagnostic capabilities on the patient, and Wunderlich spread the use of the thermometer.

DISEASE PREVENTION

Around 1900, public health in Western countries was by then linked to scientific research in the medical and bacteriological fields, with its insistence on the specificity of diseases caused by 'germs' and with its ever more refined knowledge of the way in which each of they spread. The modern development of public health, however, had established itself much earlier during the 19th century, even if it was based on a different conception of the causes of epidemic diseases and had been determined more by the need to respond to the social consequences of industrialization and urbanization than from the simple imperative to apply medical knowledge. In Great Britain and the United States this is particularly evident, for the public health movement was joined in the first phase by a large number of professionals and other middle-class categories: lawyers, clergymen, teachers and wealthy landowners, as well as doctors. By the end of the century, however, most of these partnerships had ceased and public health care had become firmly concentrated in the hands of medical professionals.

The concept of 'hygiene', the set of advice on how the individual could preserve their health and avoid disease, has a long history and public health concern, especially in terms of epidemic control and prevention , dates back to Antiquity. From around the twenties of the century. However, some important factors determined by the changed social conditions began to emerge: the situation of the workers (including women and children) in the factories had changed; the rapidly expanding metropolises and towns presented environmental problems that were qualitatively different from those of the rural suburbs; class awareness and the gap between rich and poor gradually increased. Both secular and religious motivations induced the reformers, coming above all from the middle class, to seek and propose remedies to the many problems created by the new social, demographic and economic situations. The development of statistical studies at the beginning of the 19th century it put at the disposal of activists a set of powerful analytical tools to evaluate in an 'objective' way a wide range of social phenomena. The menace of cholera in Europe throughout the 1920s and then its dramatic impact in the 1930s showed that unfortunately the era of epidemics was not over. it put at the disposal of activists a set of powerful analytical tools to evaluate in an 'objective' way a wide range of social phenomena. The menace of cholera in Europe throughout the 1920s and then its dramatic impact in the 1930s showed that unfortunately the era of epidemics was not over. it put at the disposal of activists a set of powerful analytical tools to evaluate in an 'objective' way a wide range of social phenomena. The menace of cholera in Europe throughout the 1920s and then its dramatic impact in the 1930s showed that unfortunately the era of epidemics was not over.

In Britain the key figure in the early public health movement was Edwin Chadwick, a lawyer who, as Jeremy Bentham's last secretary, had inherited his commitment to reform society along utilitarian principles. According to Bentham, goodness and happiness coincide, so society should be organized in such a way as to ensure maximum happiness for as many people as possible. After Bentham's death in 1832 - a year of political turmoil in France, the first Reform Bill in Great Britain and the drama of the cholera epidemic throughout Europe - Chadwick became secretary of the Poor Law Commission, charged with reforming the system of public assistance, then still operating on the basis of the laws enacted in 1597 and 1601. The New Poor Law of 1834 established uniform guidelines for the whole country on how to provide assistance to the poor, based on the assumption that, by applying the principle of 'less preferability' (the subsidies foreseen by the Poor Law had to be less generous than the minimum obtainable with work), individuals would have felt encouraged to be personally enterprising and to take action to fend for themselves on their own. At the same time, Chadwick and his colleagues recognized that the state of need that put them in the position of having to take advantage of social assistance could be determined by illnesses and accidents, which is why every begging shelter had to be equipped with an infirmary, supervised by a Poor Law medical officer. assistance to the poor, based on the assumption that, by applying the principle of 'less preferability' (the subsidies provided for by the Poor Law had to be less generous than the minimum obtainable with work), individuals would feel encouraged to be personally enterprising and give themselves do to fend for themselves. At the same time, Chadwick and his colleagues recognized that the state of need that put them in the position of having to take advantage of social assistance could be determined by illnesses and accidents, which is why every begging shelter had to be equipped with an infirmary, supervised by a Poor Law medical officer. assistance to the poor, based on the assumption that, by applying the principle of 'less preferability' (the subsidies provided for by the Poor Law had to be less generous than the minimum obtainable with work), individuals would feel encouraged to be personally enterprising and give themselves do to fend for themselves. At the same time, Chadwick and his colleagues recognized that the state of need that put them in the position of having to take advantage of social assistance could be determined by illnesses and accidents, which is why every begging shelter had to be equipped with an infirmary, supervised by a Poor Law medical officer. (Poor Law subsidies had to be less generous than the minimum achievable by work), individuals would feel encouraged to be personally enterprising and to take steps to fend for themselves. At the same time, Chadwick and his colleagues recognized that the state of need that put them in the position of having to take advantage of social assistance could be determined by illnesses and accidents, which is why every begging shelter had to be equipped with an infirmary, supervised by a Poor Law medical officer. (Poor Law subsidies had to be less generous than the minimum achievable by work), individuals would feel encouraged to be personally enterprising and to take steps to fend for themselves. At the same time, Chadwick and his colleagues recognized that the state of need that put them in the position of having to take advantage of social assistance could be determined by illnesses and accidents, which is why every begging shelter had to be equipped with an infirmary, supervised by a Poor Law medical officer.