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Cui Bonol BETWEEN THE mid-1860S and the mid-1880s, some American physi­ cians began to articulate an expansive program for reconstructingmed­ icine on the foundation of experimental science. The claim of laboratory science to practical relevance in medical therapeutics did much more than challenge the reign of empiricism: it urged a thoroughgoing rear­ rangement of the relationships among therapeutic practice, knowledge, and professional identity. As the proponents of the newly laid basis for treatment teased out theimplications of physiological therapeutics, they portrayed it as an integral part of a new medical ethos gradually taking shape. A few practitioners fully gave their hearts and minds over to the new science and its enticing therapeutic promise. Other intellectually prominent physicians, firm in their commitment to clinical empiri­ cism, vocally opposed the new plan's epistemological heresy. The vast majority of American physicians, though, remained ambivalent—but not indifferent. The proposition that experimental science should gov­ ern therapeutic practicehad fundamental implications for professional identity; the doctor-patient relationship; the professional meanings of the hospital, medical education, and codes of ethics; therapeutic prac­ tice; and the very definition of professional orthodoxy. Hence the no­ tion that medical therapeutics should be grounded upon experimental science unavoidably enteredinto theeveryday concernsof practitioners to whom epistemological disputes might otherwise have seemed ar­ cane if not frivolous. Furthermore, the lingering suspicion that toofirm an allegiance to science could distract the physician from the care of patients, that the"medical speculator"might be bargainingaway moral behavior for expert knowledge, made many practitioners uneasy. Often the epistemological concerns about experimental therapeu­ tics that some elite physicians explicated—concernsabout empiricism Cui Bonoi 259 versus rationalism, specificity versus universalism, and observation versus experimentation—were distilled into blunter questions: Of what use is it in healing? What difference does it make at the bedside? If these questions were plainer, they were also in some ways harder to answer. The simple fact that knowledge generated in the research lab­ oratory failed to revolutionize actual treatment during these decades sustained critics in their skepticism. At the same time it made the question Cui bono? singularly grating to the defenders of experimental science's therapeutic worth, for they were unable to find the compel­ ling evidence they wanted to uphold their bold assertions. However adamantly enthusiasts of experimental physiology and bacteriology foretold the coming revolutionin therapeutics, in this period theirfaith was sustained more by the promise of future relevance than by dem­ onstrated results. That the anticipated therapeutic millennium did not have its advent in their lifetimes was a source of acute disappointment and frustration to them. Despite the ambivalence toward laboratory science that the over­ whelming majority of the profession retained, changes in therapeutic attitude were not confined to a few zealots. The ideals and products of experimental science had a tremendous impact on medical thera­ peutics in America in the postbellum period despite the fact that their influence was not expressed principally in altered prescribing habits. The pervasiveness of certain changes in language demonstrates that physicians widely shared in the transformation. The declining use of the word natural and the rising use of normal in its place was but one semantic signal of the changing outlook. The connotations of terms that described epistemological stances in therapeutics began to change at the same time. Rational and empirical retained their earlier profes­ sional connotations, but the methodological meaning of rational re­ gained a positive connotation after the 1860s, while that of empirical became steadily more negative. Many physicians—not just spokesmen for laboratory science—also began to speak in positive ways about specific treatment. And by the 1870s regular physicians were again talking about a system of practice as something desirable. To display the therapeutic permutations experimental science in­ stigated, this chapter first analyzes the blueprint for reform that the laboratory's enthusiasts delineated. The plan they sketched in pro­ grammatic statementsfor restructuring professional identity and prac­ tice was bolder than most practitioners were willing to fully accept, but elements of their design are evident in the self-image and practice of the profession as a whole. The forceful protest that experimental science did little to make practitioners better healers—the most com­ mon negative expression of physicians' persistent ambivalence—is then 260 THERAPEUTIC RECONSTRUCTION evaluated. Finally, the way American physicians assessed the thera­ peutic implications of early bacteriology is presented as an exemplar of both the promise for therapeutics some physicians saw in laboratory science and the practical, ideological, and emotional objections it elic­ ited...

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Additional Information

ISBN
9781400864638
MARC Record
OCLC
889252597
Pages
380
Launched on MUSE
2015-01-01
Language
English
Open Access
No
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