- Therapeutic Proofs and Medical Truths:The Enduring Legacy of Early Modern Drug Trials
"It would be a fruitless enterprise," Owsei Temkin wrote in 1964, "to enter upon speculations on the origins of drug therapy. Suffice to say that it is very old."1 All the same, modernists like to think of the practice of clinical trials for drug therapy as a relatively new thing in the world. Many of my clinical colleagues consider the randomized controlled trial (RCT) the central element in modern medical epistemology, a "gold standard" that neatly divides the evidence-based medicine of the present from the evidence-free medicine of the premodern past.2 Coming to terms with the clinical trial as an older form of medical evidence, with roots in princely politics and prisoner pardons, is a more challenging task.
Likewise, historians of science often leave medicine out of the broader history of experiment. In spite of the efforts of a number of scholars to locate medicine as a central site for the development of empirical and experimental knowledge in the medieval and early modern period, it has been far too easy for historians to casually refer to the incorporation of experiment into medicine as something that develops only in the nineteenth and twentieth centuries.3 As the editors of this special issue of the Bulletin of the History of Medicine point out, this omission occurs because [End Page 420] drug testing has remained a relatively understudied area among historians of medieval and early modern medicine.
In directly challenging both of these assumptions, the articles of this volume constitute a powerful and important intervention that demonstrates the direct relevance of early modern European history of pharmacy and therapeutics to present-day practitioners as well as historians of science, medicine, and technology. True, the methodology of the trials they document might not pass muster with a twenty-first-century Institutional Review Board, a National Institutes of Health study section, or the editorial board of The Lancet, but the forms traced in these essays bear enough genealogical similarities to present-day therapeutic proofs to be sufficiently unsettling. At the very least, they give the lie to the casual assumption that the modern form of therapeutic proof was simply the intellectual accomplishment of Austin Bradford Hill in his MRC offices in 1948. Rather, the reader of this volume finds that the things we do for proof today have roots that stretch back centuries and are as steeped in the social relations of state power, the role of expert knowledge in the bureaucratic systems, and the marketing strategies of drug manufacturers as they are in any purity of method or philosophical principle. One comes away from this collection of articles with a greater awareness of the cracks in the edifice of therapeutic truth-making that twenty-first-century pharmaceutical manufacturers, physicians, and patients have come to inhabit.
The period, place, actors, and scope of action in these contributions range widely, from Michael McVaugh's opening article on experimental protocols for drug provings among the fourteenth-century medical faculty of Montpellier to the eighteenth-century attempt to understand and replicate the blood miracle of St. Januarius, chronicled in Francesco Paolo de Ceglia's concluding essay. The drugs tested vary from bath waters to the blood of saints, from pancreatic extracts to whole chickens; the sites of analysis range across French and German courts, learned societies, hospitals, pharmacies, and households; and the actors cross in and out of learned societies, academic institutions, state regulators, and orthodox medical professionals. And yet the contributions of all scholars cohere around several points of continued interest to therapeutic practice and experimental proof today: the relation of reason, rationality, and experiment; the problem of designating on whose bodies such proofs should be tested; and the broader social role that methods for designating legitimate from illegitimate cures play in the relation of the medical profession [End Page 421] and the regulatory state in shaping markets and monopolies for medical practice and pharmaceutical manufacture.
For more than two decades, Harry Marks's The Progress of Experiment: Science and Therapeutic Reform in the United States, 1900–1990 has served as a key reference work...