The Changing Face of Modern Medicine

TheChanging Face of Modern Medicine John S.Haller,Jr.American Medicine in Transition, /840-1910. Urbana: University of Illinois Press, 1981. 457pp. Regina MarkellMarantz, Cynthia Stodola Pomerleau, andCarolHansenFenichel, eds. In Her Own Words: Oral Historiesof Women Physicians. Westport, Conn.: Greenwood Press, 1982.284 pp. George Rosen. The Structure of American Medical P,actice, 1875-1941. Edited by Charles Rosenberg. Philadelphia: Universityof Pennsylvania Press, 1983. 152pp. Colin D. Howell Inhis seminal study, The Birth of the Clinic, Michel Foucault has outlined thetransition in medicine from classical metaphysical explanations of the natureof disease to the kind of empirical· investigation that now lies at the heartof modern medical understanding. This epistemological shift, which Foucaultlocates in the latter half of the eighteenth century, involved an abandonmentof systems and untested theory and demanded the creation of arationaland scientifically structured discourse centered upon the individual, thediscrete or the specific. In the clinic, Foucault argues, a way of teaching andsaying(i.e., the demonstration of already known truths) became a wayof learningand seeing. "The clinict he writes, "was probably the first attempt toorder a science on the exercise and decisions of the gaze." In its own fashion, each of the books under review deals with the ways in whichmedical science in the modern period adjusted itself to the intellectual transitionFoucault describes. In addition they chronicle the attempts of the medicalprofession to adjust to the changing character of modern industrial society.In American Medicine in Transition John S. Haller describes a medical profession beset with confusion, divided over therapeutics and medical ethics, distrustful of, yet willing to absorb, sectarian ideas, and uncertainabout its relation to modern science. Haller outlines the extent to whichthe medical profession relied upon an aging materia medica and upon traditionaltherapeutic techniques such as venesection, despite advances in CanadianReview of American Studies, Volume 16, Number 3, Fall 1985, 339-343 340 Colin D. Howell scientific knowledge and the challenge of medical sectarians who criticized the excesses of heroic therapy. To Haller, nineteenth-century medicine represents a curious mixture of innovation and immaturity. The resultsof medical investigation were, in a word, ambiguous. If the impact ofFoucaulfs "gaze" was evident in the researches of Bichat and Virchow with respectto tissues and cellular pathology, for example, another result of their workwas to divert the traditional notion of constitutional pathology toward the less profitable science of phrenology and subsequently to the work of anthropologists such as Lombroso who attempted to identify the physical characteristics of the criminal type. The uncertainties of nineteenth-century medicine documented byHaller bring into question the Whiggish presumption that the history of medicine involves an unbroken record of scientific innovation and progressive advancement. Still, Haller argues, the latter half of the nineteenth century left a rich legacy to the twentieth. Most important was a commitment to establish rigorous standards of scientific investigation. "Though doctors failed to speak with one voice," Haller writes, "they nevertheless agreed that while logic and theory were essential arts of the scientific method, their reliability rested ultimately on relevant methods of observation" (p. 321). Across the profession, this devotion to the ideology and methodology of science operated as a check upon medical individualism. The tendency of nineteenth-century physicians to cultivate an interest in natural history,for example, counteracted the weaknesses of a proprietary medical education system which was guided by the principles of the laissez-faire marketplace. Similarly,Haller argues, medical individualism faced the challenge of progres· sive reformers such as Abraham Flexner who, like so many of his contempor· aries, attacked "free enterprise" institutions and suggested that the power of the state be enlisted to ensure that medicine serve the public interest. But the medical profession's devotion to the ideology of science, responsible though it may have been for the stunning medical innovations that have characterized this century, brought with it problems of its own. The mystification of medical knowledge, that lack of humanity that sometimes accompanies narrow medical specialization, and the bureaucratization of medical decisionsthat should more appropriately fallto individual conscience, Haller argues, reveal the necessity to contemplate critically the role of medicine in the modern liberal state. Haller's treatment of the development of modem medicine provides us with the most comprehensive analysis of medical thought...