Bittersweet medicine
THE defining feature of modern, Western medical perception is the dominance of the laboratory -- it is the biomedical laboratory which determines whether you are 'sick' or 'healthy', it gives you the drugs, and in the medical profession has the highest prestige attached to it. And, of course, as preventive medicine becomes more and more passe, it gets more grants and recognition.
But the moot questions are: why and how did the laboratory become so dominant in modern medicine? This is the basic theme of this book, which is an outcome of the conference on Medicine and the Laboratory organized by the Cambridge Wellcome Unit. It includes revised versions of some of the papers presented there.
Historians of medicine have divided medical practice into 3 distinct phases -- "bedside medicine" which held sway over western Europe from the Middle Ages to the 18th century; "hospital medicine", especially associated with France between 1794 and 1848; and "laboratory medicine", which predominated thereafter, right upto the present day.
Of these 3, hospital medicine has been studied most extensively. The rise of hospital medicine involved a dramatic transformation of the location and content of medicine. The hospital became the centre for medical teaching and research and the arbiter of medical knowledge. The patients became a resource for medical research, made possible by the extreme increase in power of the doctors and the medicalisation of life. The focus shifted from the sick to the sickness.
However, by identifying modern medicine's rise exclusively with hospital medicine, one tends to obscure and minimise the later changes. It is being appreciated now that medicine based on the laboratory actually involved demoting the importance of the hospital. This was perhaps inevitable because of the influence of the Cartesian paradigm on medical thought and the essentially reductionist nature of Western scientificism. Of course, as historians of business point out, the laboratory has an increasing industrial role -- especially where drugs are concerned -- and rising capitalism has helped the laboratory take centrestage.
Rather than focus on personalities like Claude Bernard, Louis Pasteur and Rober Koch, Laboratory Revolution takes up a wider discussion. Thus, Timothy Lenoir raises the question of why teaching and research laboratories became institutionalised. Was it because of what he calls a "discourse of practical interest" as opposed to Wissenschaft (experiment for the sake of experiment)?
The laboratories themselves are the focus of Richard Kremer and Paul Weindling. Weindling compares the funding of the location and the internal organisation of the Pasteur Institute of Paris and the Institute for Infectious Diseases in Berlin. John Harley Warner, Michael Osborne and Stewart Richards outline the long process needed to convince the ordinary practitioner and the members of the public. Andrew Cunningham and Wai Chen discusses the role of the laboratory in the actual construction of medical knowledge and how it determines the form and authority of such knowledge. In the final section, Bruno Latour, Nicholas Jardine and Hillary Rose offer their reflections on laboratory medicine.
This book brings together historians of laboratory medicine in Europe and America. Together, the authors provide a much-needed account of how medicine in Western industrial societies has invested itself with distinctive power and authority.
Bhanushingh Ghosh is a scholar at the Jawaharlal Nehru University, Delhi