Science and the Practice of Medicine in the Nineteenth Century (review)

Consciously placing his short volume in the Cambridge series lineage of William Coleman’s Biology in the Nineteenth Century (1971), William Bynum here balances the needs of the research and educational fronts in a user-friendly effort that will serve both as hardy next-door neighbor and as worthy successor to that perennially sturdy and useful work. Coleman was concerned to survey the domains of biology that were institutionalized partly (embryology, cell theory, physiology) or fully (evolution) outside the medical establishment. A generation later, deftly weaving in many of the insights of recent turns toward social history, Bynum looks to the institutions and ideas of clinical medicine and public health that came to rely on the claims of science. He is even-handed about the range of resources that framed Western medicine’s scientific ethos after 1790—first, in the hospital medicine that concentrated patient populations; then, on theoretical grounds, in the sciences of anatomy, pathology, physiology, and microbiology; and finally, in laboratories that again loosed nosology from its necessary moorings in the hospital wards.

It is a vast arena to cover in a little over two hundred pages. Bynum does a surprisingly good job, as Coleman did before him, of acquitting himself of this task. He does so, first, by scanning his horizon with a partial emphasis on the British Isles, as he qualifies his stance in advance in the introduction, while spreading out more broadly to survey the traditional “BFAG” (Britain/France/America/Germany) canon; and second, by skimming above the best secondary literature of the past two generations of medical historians. In seven chapters of roughly equal length, he attempts not to break major new ground (the text is appropriately spare of footnotes), but to provide a new synthesis, beginning with a chapter on the state of Western medicine in 1790. In succeeding chapters he describes the advent of hospital medicine in Paris and elsewhere; mid-nineteenth-century public health (primarily in England); the rise of laboratory medicine both in Britain and on the Continent; the impact of pathology and bacteriology; the institutional and technological implantation of medical physics and chemistry as the nineteenth century matured (this in a grab-bag called “Medical Science Goes Public,” covering divers subjects from the X ray to the pharmaceutical industry); and finally, “Doctors and Patients,” ending somewhere around 1900 in Europe and Flexner in the United States. American examples are more than ample, in my view, to whet New World appetites.

In “Doctors and Patients,” the author finally gives a slightly awkward but obligatory nod to some of the most recent stresses in medical historiography. These include excursuses on women in medicine, professionalization and specialization, and “the literature on medicine ‘from below’”—that is, the experience of the patient. As the sole stand-in for the patient’s view of all that precedes, Alice James (of that family) is a fascinating, if tokenistic and elitist, choice. But no matter: to provide more than such a brief nod to these matters would have produced a very different book. What we have been given instead is the best possible refurbishing of a still-serviceable tradition in the history of medicine, dipping a cogent if high-medicine-oriented narrative out of the time-honored TIL (texts, innovations, and laws). But Prof. Bynum knows and demonstrates amply that behind every text is a career resonant of social context; behind every innovation, an institutional context; and behind every law, a bureaucratic and demographic context. Where there were ideological conflicts and institutional clashes among groups laying claim to the mantle of “science,” he clearly does not wish, in a book of this sort, to belabor the point; but he always points us to the fact that more recent and subtle readings exist in such cases.

Other features of the volume commend it to a wide readership. Some twenty-nine black-and-white illustrations are exceptionally well...