Pathology in the 19th and 20th Centuries: The Relationship between Theory and Practice (review)

Pathology in the 19th and 20th Centuries: The Relationship between Theory and Practice. Edited by Cay-Rüdiger Prüll in collaboration with John Woodward (Sheffield, European Association for the History of Medicine and Health Publications, 1998) 142 pp. £18.95.

The editor of this collected work introduces the volume by discussing the problems faced by historians of pathology, depending on their concept ("notion") of pathology, as proposed by Maulitz. ¹ For example, "pathology as the science of disease . . . seems to be the oldest approach" (1). In the past, this approach has overlooked the fact that diseases are not independent entities but are influenced by the society and the medicine of the time. Another view considers "pathology as a cognitive notion, i.e., historical analysis of the change of ideas about illness" (2). This one tends to focus on the intellectual history of medicine more broadly and may neglect "all the questions of applying the knowledge about disease in practice within the different periods" (2). A third option considers "pathology as a professional notion, i.e., the description and analysis of the history of pathology as a specific discipline within the canon of the different medical fields" (2). Its disadvantage relates to the difficulty in pinpointing the origins of a discipline and the presence in the twentieth century of many sub-disciplines, such as experimental pathology, chemical pathology, and histopathology.

Recognizing these different notions and the associated pitfalls, the authors of these essays use new research methods to encourage a better appreciation of the relationship between pathology theory and medical practice (4). The first paper, by Volker Hess, reviews the history of the early nineteenth-century concept of disease as a "a parasite living in the ill person" (12). He argues that this trope "functioned as a hinge joining" the static concepts of signs and symptoms of the eighteenth century "with the [dynamic] concept of specific diseases and of causation of the nineteenth century" (11). Although the concept of "parasitism" was dismissed by mid-century, Hess makes the point that it provided an essential temporal component to the notion that diseases were not static but developed in the course of time. He convincingly argues that parasitism "brought with it a new clinical approach by situating disease at the cross-roads of the theoretical construction of pathology and the empirical knowledge of bedside practice" (23).

The second paper, by Christian Bonah, compares and contrasts a leading French medical journal and a corresponding one in Germany, both founded in the mid-1800s. Through this linguistic and nationalistic analysis, he shows how pathology and physiology developed differently in the two countries, particularly in relationship to the practice of medicine.

Thomas Schlich looks at the relationship of pathology and surgery through the example of the early history of organ transplants (mainly thyroid and kidney) from the 1880s to the 1920s. In contrast to the essential role of pathology in radical cancer surgery, he sees only a supplemental role for pathology in the early transplantation efforts.

Prüll does a comparative cultural analysis of surgery and pathology by looking at their functions in London and Berlin in the late nineteenth and early twentieth centuries. British practice was similar to the French model in that it resulted in close cooperation between surgeons and pathologists. The German model tended toward the institutional separation of pathology and surgery, thus impeding the cooperation of surgeons and pathologists. (When this reviewer was serving as a pathologist in a U.S. army hospital in West Germany during the 1960s, he was surprised to notice that physical compartmentalization was still present in many German academic medical centers, symbolized by separate buildings for the institutes of Pathology, Surgery, Medicine, etc.) This strategy was in contrast to most American medical centers, which were more likely to have joint clinical, research, and teaching activities across specialty lines in the same or...