Locating Medical History: The Stories and Their Meanings

11 Trading Zones or Citadels? Professionalization and Intellectual Change in the History of Medicine

C H A P T E R E L E V E N Trading Zones or Citadels? Professionalization and Intellectual Change in the History of Medicine Olga Amsterdamska and Anja Hiddinga Ronald Numbers, a historian of American science and medicine, published an article in 1982 describing changes in the history of medicine during the previous two decades.1 Numbers argued that in the 1960s, medical history in the United States already had begun its transformation from a subfield of medicine to a subfield of history. Linking the emergence of the social history of medicine to the replacement of physician-historians of medicine by general historians who took medicine as their subject, Numbers associated professional change with intellectual development. By the 1970s, ‘‘local, institutional, and biographical studies’’ were being replaced by works that situated ‘‘medical developments within their cultural context’’ and explored ‘‘connections between ideas and institutions.’’2 The intellectual affinity between the history of medicine and other areas of cultural , intellectual, and social history meant that historians of medicine paid increased attention to the professional and economic interests of medical practitioners (not just the elite or the orthodox doctors); examined the broad social and cultural influences on the development of medical institutions such as hospitals and asylums, regarding their evolution as a process of change rather than necessarily progress; and began addressing issues such as gender and race. While applauding the professionalization of his discipline, Numbers also voiced a concern, 238 A Generation Reviewed shared by others he cited, that attention to various ‘‘socio-economic determinants ’’ might obscure the role of medical science and intellectual change in the evolution of medicine. Three years later, reviewing the relations between the history of medicine and the history of science, John Harley Warner also noted that the rise of the new social history of medicine diverted scholars’ attention ‘‘from analysis of the content and internal logic of medicine,’’ so that ‘‘close study of the development of medical science’’ came to be regarded as ‘‘antiquarian and more than likely positivistic .’’3 According to Warner, however, this shift toward social history did not mean that the role of science in medicine was being ignored. Instead, the ‘‘historical study of the cognitive development of medical science’’ was being recon- figured in investigations of the cultural, social, and economic roles of science in medicine. Rather than following the development of scientific ideas, the new historians saw science in medicine as a source of authority and legitimacy or as a means of professional advancement. In his article, Warner analyzed how historians of medicine came to question the progressive role of science in medicine by critically examining the social implications of technological and scientific change in medicine, criticizing the reductionist epistemology of the biomedical sciences, and relativizing the impact of developments in the biomedical sciences on improvements in the health of populations . Studies of the role of science as a means of social control and as a source of professional authority meant, according to Warner, that science in medicine came to be seen more as an ideological or—less polemically—more as ‘‘a cultural than as a technical resource.’’4 Warner, in a sense, shared Numbers’s concern that the new historiography of medicine tends to diminish the historian’s attention to the ‘‘content of science.’’ Warner, however, gave this problem a different twist. He argued that the problem is not so much due to the predisposition of the new historians, who are trained in history rather than medicine, to look at social rather than intellectual processes; instead, he attributed the relative inattention to the content of medical sciences to ‘‘historiographic reductionism.’’ Such reductionism prevents historians from properly historicizing the very meaning of science and makes them hold onto the presentist identification of ‘‘medical science’’ with laboratory biomedical investigations. Warner called for more attention to the multiple meanings of science, which can be found among its practitioners at any given time and in the belief systems of the broader public, and to the historical changes in the notion of medical science espoused in different periods and settings. Warner repeated virtually the same warning in a review paper written ten years Trading Zones or Citadels? 239 later.5 Encouraged that history of medicine was more likely to be considered in the context of social, economic, or cultural history rather than as history of science, Warner worried that historians of medicine were...