Drugs on Trial: Experimental Pharmacology and Therapeutic Innovation in the Eighteenth Century. Vol. 53 of Clio Medica (review)

Andreas-Holger Maehle. Drugs on Trial: Experimental Pharmacology and Therapeutic Innovation in the Eighteenth Century. Vol. 53 of Clio Medica. Wellcome Institute Series in the History of Medicine. Amsterdam: Editions Rodopi, 1999. i + 376 pp. Tables. $110.00 (cloth), $30.50 (paperbound); Hfl. 200.00 (cloth), Hfl. 55.00 (paperbound); £65 (cloth), £18.00 (paperbound).

In our era of scholarship when some claim the experimental scientific method to be a myth, Andreas-Holger Maehle offers a remarkable historical contribution toward contextualizing the experimental foundation of medical therapeutics. Drugs on Trial is historiographically noteworthy in two important areas: (1) its elucidation of what European physicians and natural philosophers deemed as "experimental" evidence a century before historians generally acknowledge experimental pharmacology to have developed, and (2) its explanation of drug efficacy and toxicity from the viewpoint of contemporaries who prescribed and received such treatments. Thereby, Maehle fills a lacuna of knowledge created by generations of medical historians who have evaded objective discussion of drug efficacy as experienced in earlier cultures.

After introducing his readers to a general overview of eighteenth-century "pharmacology," Maehle employs the case-history approach in three equal-length therapeutic case studies: lithontriptics (solvents of kidney and bladder stones), opium, and cinchona (Peruvian bark, or quinine). As substance for his analysis,
he draws primarily upon the medical periodical literature from London and Edinburgh. Importantly, he supplements this literature with other European sources, thereby providing an international comparison of the discourse on drug efficacy.

Regarding lithontriptics, Maehle reviews Stephen Hales's work and analyzes the experimental trials of Johanna Stephens's purported curative remedy, as well as the pharmacological investigations it provoked James Jurin and Robert Whytt to pursue. The veritable analytical chemistry enterprise founded upon determining the composition of the airs and waters thought to be the best stone solvents or preventatives, together with the unflagging experimental attempts to ascertain the composition of the stones themselves, are fully explored. Maehle presents sufficient evidence to support his conviction that "controlled in vitro experiments, tolerance tests on animals, self-experimentation, and clinical trials" (p. 106) actually became routine in eighteenth-century trial-and-error attempts to alleviate what was viewed as one of the most grievous afflictions upon humanity.

In his next case study, Maehle explores opposing theories that emerged throughout the eighteenth century regarding the pharmacological actions of opium. He suggests that the predominant theory changed early in the century from an iatrochemical argument, based on the drug's reputed physical structure, to an iatromechanical argument based on its physiological action. A subsequent belief that opium rarefied the blood was challenged, in mid-century, by claims that it acted primarily upon the nerves. Further experimentation rekindled support for the view that it acted via the circulatory system. The shifting allegiance to particular theories mirrors, as Maehle rightly notes, more general theoretical shifts in eighteenth-century medicine and, relatedly, shifts in the leading European centers of pharmacological research. The experiments that Maehle highlights substantiate his claim that a "remarkable degree of methodological awareness" existed in Enlightenment pharmacology (p. 196): control conditions were often established, results of animal experimentation were extrapolated to the realm of human therapeusis, and ethical concern was expressed regarding the undue suffering of animals within experimental protocols.

In the third case study, an examination of the experiments with cinchona, Maehle corroborates his previous claims of methodological awareness. He also demonstrates how practitioners' increasing reliance upon contemporary pharmacological explanations "eroded" cinchona's status as a "specific" against intermittent fever, leading instead to its recommended use against a broader array of diseases including gangrene, ulcers, and smallpox. Its efficacy in treating both internally and externally manifest diseases allowed cinchona to become a central therapeutic agent for both physicians and surgeons.

Although Maehle details a multitude of experiments throughout Drugs on Trial, this reader hoped that more distinguishable interconnections could...