Pathology in the 19th and 20th Centuries: The Relationship Between Theory and Practice

It is doubly welcome to find a volume containing five authors using up-to-date historiographic perspectives to write about the history of pathology. Were this a book on a familiar social historical topic, such an introductory comment would scarcely be necessary; however, the history of pathology insofar as it relates to the history of the medical profession, rather than the populations from which the pathologist’s material is taken, is rather neglected nowadays. The “doubly” in the welcome, then, refers to the fact that the authors are very much alive to the wider determinants of pathological theory, yet they choose to use recent insights to investigate a domain usually the prerogative of rather more triumphalist approaches. A third welcome perhaps attends the fact that all the authors are based on the mainland of Europe.

The hint of new approaches is of course indicated in the subtitle: “The Relationship between Theory and Practice.” More specifically, what is the relation of pathological theory to (medical) practice? Put brutally, who gets the final say in whether a disease is present, and what it is, may be questions with different answers depending on whether the clinician and the pathologist are (or can be) the same person. All of the essays address the subtitle except the first, in which Volker Hess examines the “disease as parasite” theory, the ontologische Krankheitsauffassung spawned by German romanticism. This essay in the history of medical semiotics is hard going, although at its core is the interesting, revisionist, and therefore almost ipso facto Whiggish claim that parasite theory was some sort of bridge between ancient and modern views.

The other four papers address the theory-and-practice issue with rather more, albeit varying, directness. First Christian Bonah compares the perceptions of pathology and its place in mid-nineteenth-century German and French medicine. His broad conclusions are familiar, but there is much wealth in the paper’s detail. There was a great deal of integration of experimental physiology and pathophysiology within German medical faculties, and a more independent view of a science of life in France. Of all the authors, Thomas Schlich takes the theory-and-practice problem most seriously, examining how, conceptually (and at the time, to some extent practically), surgeons created organ transplant by using a functional surgical pathology in the period 1880–1920. The debt to Owsei Temkin in this important piece is not hidden—surgeons invaded the body in theory long before they did so successfully in practice.

Cay-Rüdiger Prüll, who also contributes an introduction, compares pathology and surgery in London and Berlin, 1800–1930. His piece is rich in empirical detail and hints at huge political generalizations that demand further investigation. The ease of correspondence of surgeon and pathologist in Britain compared to Germany, he suggests, related “somehow” to British democratic culture (p. 90). Incidentally, Prüll’s work might draw attention to the richness of some of the lesser-known London hospital archives. In the final essay, Lazare Benaroyo does make the overt political point about pathology, which he recognizes had been explicitly done for him by his subject, Ludwig Ascoff, whose teleological biology was quite in accord with his holist, crisis-ridden perceptions of contemporary Germany.

There is lots of good material in this volume, but that may not save it from having a limited readership. There is unfortunately too much density of expression, circumlocution, alien grammar, and at times downright incomprehensibility, which may consign the book to the older world of progress-ridden histories of pathology to which it undoubtedly does not belong.