Medizin am Toten oder am Lebenden?: Pathologie in Berlin und in London, 1900-1945 (review)

At the beginning of the twenty-first century, research on the history of science has begun to focus increasingly on the medical aspects of the twentieth century. Cay-Rüdiger Prüll, in his pathological-historical study, contributes importantly to the analysis of the transformation from medicine based on science to a clinical practice centering on therapy that took place in the first half of the twentieth century. He demonstrates the increasing emphasis on physiology in the hospital by comparing the development of the discipline of pathology in Berlin with that in London from 1900 to 1945. His evaluation is grounded in an abundance of archival material, from which few relevant studies have previously been made. The detailed and rich picture he has drawn of the equipment and positions, as well as the themes and processes, in the pathological departments, institutes, and dissection halls of the two European metropolises, points up fundamentally different situations. In Berlin, the influence of Rudolf Virchow, the German grandfather of pathology, dominated the field up until 1945; his morphological paradigm, which placed the dissection hall at the center of pathological anatomy, blocked the integration of clinical pathology. In London, on the other hand, an integrated clinical pathology prevailed that was tied strongly to the interests of the hospital—in particular, to bedside care and medical teaching.

Prüll defines "discipline" as a system that is organized within itself, and he uses this definition as a backdrop for the developments in both cities, starting from within medical science and practice and then moving outward into society and examining the associated and resulting professional and social relations. In Berlin, the discipline of pathology developed under Virchow's aegis, and it was subject to the general trend toward greater specialization that began in German medicine in the middle of the nineteenth century. Under this influence, it had already attained independent status as an academic teaching subject by the beginning of the twentieth century. The dissection centers in early twentieth-century Berlin were all founded as spin-offs from Virchow's central institute and therefore remained ideologically bound to their source. London, however, demonstrates a very different development: there, the discipline remained relatively unhierarchically organized at all teaching hospitals, and was consistently oriented toward the interests of the still-living patient in the hospital. Because the specialists in London understood themselves as clinical pathologists, they were in a much better position to integrate functional aspects into their work and to apply them at the sickbed; in Berlin, by contrast, a practical application of experimental pathology from within the discipline did not take place before 1945. In Berlin, medical education in the field of pathology focused on training physicians in a postgraduate program as specialized pathologists; whereas in London, emphasis was placed on schooling students as physicians at the bedside, developing a command of broad knowledge about healthy and ill human beings.

The differing format of pathology also conditioned the differing presentation and standing of its representatives in the two cities. In Berlin, the director (Ordinarius) ruled with autocratic power over his institute, accepting practically no influence from outside. He was able to preserve morphological ideas in the context of a constitutional pathological approach that fitted well into German nationalist thought in the Weimar Republic and the Third Reich. Very early (1913), a British commentator came to the telling conclusion that "this one man show is really the weak spot in the German system" (p. 420). The London pathologists operated in a more open and transparent system, in which the goals and tasks of pathology were generally agreed upon by the committees of the individual hospitals. In general, Prüll concludes, London pathology shows itself as the more modern development for the period investigated, one that was better equipped with its clinical base...