Body Counts: Medical Quantification in Historical and Sociological Perspectives (review)

This volume of essays, twelve in English and five in French, had its origin in a conference sponsored by the Fondation Mérieux in 2002 on the history of quantification in medicine and public health since the eighteenth century. These papers, whose authors include scholars who have previously made important contributions to that history, are rich and complex. Many underscore the problematic and contentious nature of quantification as it was introduced into contemporary structures of public and private medicine. Essays in the book's first section on "medical arithmetic" trace the development in the eighteenth century of studies describing, analyzing, and publicizing high infant mortality rates in England and France, leading, as Andrea Rusnock holds, to humanitarian demands for intervention on behalf of infants' welfare; and the development in Britain of an empirically based approach to greater medical certainty in therapeutics and nosology by what Ulrich Tröhler calls "marginal men"—military surgeons and provincial doctors—seeking medical and social reform.

For both Harry Marks and Ann La Berge, the famous quarrels, respectively, between Bernoulli and d'Alembert in 1760 over the calculus of submitting to smallpox inoculation, and between supporters and critics of numeric medicine in the Paris Academy of Medicine in the 1830s, raised a more explosive issue: that of the relationship between the statistical treatment of individuals and the rationalizing and dehumanizing potential of the French state. La Berge, whose essay falls in the book's second section, "Quantification and Instrumentation," writes of quantification as a transformational technology, presumably one that could destroy the individuality and autonomy of citizens, doctors, and patients. However, as writers like Volker Hess and Christiane Sinding argue in that same section, when quantitative technology could be appropriated by patients (in the form of the thermometer, for example) it could offer them a new basis for communication with physicians and assure them greater agency in the clinical relationship. In France, according to Nicolas Dodier, the successful introduction of evidence-based medicine (la médecine des preuves) over the past twenty-five years has not only created the conditions for a significant shift in power relationships within medicine, it has, much as Stephen Epstein has described previously for the United States, created the space for AIDS activists/study subjects to forcefully negotiate the scientific parameters of clinical trials.

Quantification is a powerful descriptive tool, but it has limited intellectual heft in moving beyond correlations to elucidating causality. William Farr, working in the English tradition of medical arithmetic, sought to find explanatory certainty in statistics by mining them for underlying lawful regularities. But, as Michael Donnelly demonstrates (and John Eyler before him), Farr's attempts were often swamped by uncontrolled variables. As a consequence, statistical relationships were open to competing interpretations (characterized by Gérard Jorland, in his essay, as the "underdetermination of medical theories by statistics"). Jorland illustrates that point using Semmelweis's exposition of the etiology of puerperal fever, which was accepted in principle in Edinburgh, where it was bolstered by new theories of disease causation, but rejected in France where such a corroboratory ontological theory was absent. The possibility of confounding variables and alternative etiological hypotheses also roiled the conflict between statisticians/epidemiologists in the United States over whether smoking causes lung cancer. Mark Parascandola, revisiting the scientific arguments of the 1950s, found that the debate helped to develop criteria for making judgments about causality that provided the Advisory Committee to the U.S. Surgeon General the means to institutionally resolve the conflict.

The success of epidemiology (featured in a section entitled "Reducing Uncertainty and the Politics of Health") in establishing risk...