History and Health Science: Medical Advances across the Disciplines

Historians and benchscientists have viewed each other's work witha mixture of envy and suspicion. Historians have longed for the precision and replicability of scientific experimentation. Medical scientists and microbiologists have, in turn, admired history's ability to capture the broad sweep of human society and the motivations of individuals. Most scholars have despaired of bridging the gap between the highly technical and incremental enterprise of science and the careful evaluation of sources and syntheses. Nonetheless, the process has begun. As Rotberg put it in the introduction to a collection of essays which appeared in The Journal of Interdisciplinary History between 1975 and 1996, scholars are exploring "the deployment of medical information and insight to solve historical questions previously presumed to be solely political, social, or economic."¹

This essay surveys a number of books by life scientists who have written historical narratives and historians whose work has incorporated insights from the life sciences. Part of this discussion examines the distortions and anachronisms that inevitably arise when practitioners of one discipline arrogate the methods and findings of another. Indeed, differences of emphasis even arise in citation conventions: Bothh istorians and benchs cientists list authors for short citations, but the former often stress a publication's title and the latter its date. Notwithstanding such formal discrepancies, however, historians and scientists-who, at first glance, would appear to have widely different orientations-ultimately represent the interactions between people and other inhabitants of the biosphere in surprisingly similar ways.

Unfortunately, some of the pioneering monographs in medical history, by historians and scientists alike, stand in need of reevaluation in the light of modern microbiology. These works fall into two categories: those that rely on symptoms and clinical signs, rather than molecular structure or properties of the organisms, to identify pathogens and those that use terminology and explanations based on outmoded notions of immunology. The hypotheses founded on their questionable assumptions and methodologies can no longer be considered the state of the art in medical writing.

Archaisms in the Classics

During the last 130 years, bench scientists have made enormous progress in understanding the causes of disease. Previously, diseases could be understood only through their symptoms and clinical signs. As William Coleman, Yellow Fever in the North (Madison, 1987), and James C. Riley, The Eighteenth-Century Campaign to Avoid Disease (New York, 1987), have shown, clinicians gave their utmost attention to external conditions-physical changes and the links between these pathological phenomena and particular environments and behaviors. Of the microbiologists, Robert Koch, in particular, developed relatively rigid criteria for proving that a specific organism caused a specific disease. Not all subsequent identifications, however, stood the test of time. Before the 1930s, microscopes were not strong enoughto detect individual viruses, and even closely related bacteria could be confounded. At the turn of the twentieth century, typhoid and paratyphoid infections, for example, were lumped together as enteric fever.

In the twentieth century, however, microbiologists and clinicians increasingly confirmed their diagnoses through microscopic analysis and microbiological methods, including the ability to culture and characterize organisms serologically. By the 1950s, led by the work of the geneticists James Dewey Watson and Francis Harry Compton Crick, and parallel advances by immunologists, the bench scientists achieved a higher level of precision-the identification of the molecules and their structure within cells, and of the specific genomes that contained the unique instructions...