Archive for October, 2012

Nineteenth Century Physicians, the Rhetoric of “Science” and the Professionalization of Medicine

I just finished reading SED Shortt’s brilliant review essay on the relationship between nineteenth century medicine and science, and more specifically, about how the medical profession employed the rhetoric of science to fulfill professional aspirations in advance of any real evidence of efficacy or therapeutic benefit. I have too many good things to say about this piece, and will recommend it as a must read for anyone interested in how language and “agenda framing” can be used to advance sectarian interests in the context of medicine, biomedical innovation and public health.  A few choice excerpts:

On the relationship between medicine and science in the 19th century: “It would appear from…recent historiography, then, that science made little impact on medicine until the end of the nineteenth century.” (p. 58)

On prevailing historical and revisionist accounts of the link between science and medical professionalization: “Science is construed as a linear series of truths, each in turn awaiting inevitable recognition by a succession of astute investigators. In retrospect, a particular theory or innovation becomes “scientific” only when it is demonstrably a step on the path towards what is at present recognized as “true”. Contrary opinions or viewpoints that eventually withered, regardless of their contemporary reception, are rejected as “pseudo-science” and their adherents scrutinized to explain either deceit or gullibility. Only recently have historians of medicine indicated that they are willing to transcend this paradigm and accept the fact that each age has a unique body of knowledge considered scientific.” (p. 59)

And finally, on the co-option of scientific language to advance professional interests in advance of evidence of efficacy or therapeutic benefit: “Sub-groups within [medical practice] employed the rhetoric of science, often at the expense of colleagues, in their individual efforts to secure status and recognition. After the Civil War, for example, young neurologists attacked established alienists for their failure to rid nosology of antiquated terms such as “moral insanity” in light of developments in cerebral localization, cellular pathology, or hereditarian theory. That these new currents of thought made no significant contribution to institutional psychiatry was of less importance than the scientific terms in which they appeared to be couched. In a similar manner, armed with a vocabulary signifying scientific expertise, physicians in general hospitals displaced lay governors as the locus of decision-making… Yet the important shift in institutional power took place well before medicine could demonstrate the efficacy of its science.” (p 65)

My own work on legal developments surrounding legal adoption of smallpox vaccination in 19th century Canada suggests that medical professionals employed legal narratives and tried to enlist judicial intervention in this quest for professional status. Statutory rules rewarded the “faith” that doctors had created around the value of their own definition of science (aided by remedies such as vaccination that worked in spite of poor “scientific” understanding regarding its therapeutic value) by allowing them some control over health care and public health affairs, but never enough (at least until the end of the 19th century) to fully displace the orthodox system of health governance, managed by local /municipal officials, or the orthodox system of health care, characterized by a medical marketplace in which all sorts of practitioners provided health care services.

I will post some examples in a subsequent post.

October 2, 2012 at 4:22 pm Leave a comment

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Reflections on health law and policy in early Canadian history


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