Introduction Author(s): By JohnV. Pickstone and Michael Worboys Source: Isis, Vol. 102, No. 1 (March 2011), pp.

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FOCUS: BETWEEN AND BEYOND HISTORIES OF SCIENCE AND HISTORIES OF MEDICINE

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Introduction
By John V. Pickstone* and Michael Worboys**

ABSTRACT

Historians tend to treat science and medicine as having developed in parallel, and we maintain separate societies and journals, often giving primacy to science, at least for intellectual history. Yet much of science before circa 1800 was dependent on the organizations of medicine, and much of science now is promoted for the improvement of medical diagnoses and therapies. This Focus section unpicks some of the historical and historiographical relationships, recognizing the present prominence of biomedicine and the diminishing utility of distinctions between science, medicine, and technology.

ISTORY OF SCIENCE AND HISTORY OF MEDICINE (and history of technology) are mostly organized separately at the national level, though there has been a degree of integration at the level of university departments. We still tend to treat these subdisciplines as running in parallel. We rarely map the relations of science, medicine, and technology over time or systematically probe the relevance of these categories and their mutual dynamics for the organization of our historical studies. This Focus section seeks to problematize the issues, in the hope of historiographical fertilization. The essays variously explore both the historical and the historiographical relations of science and medicine, while not excluding technology. We focus on three related ques-

* Centre for the History of Science, Technology, and Medicine (CHSTM), Simon Building, University of Manchester, Oxford Road, Manchester M13 9PL, United Kingdom; John.Pickstone@manchester.ac.uk. ** Centre for the History of Science, Technology, and Medicine (CHSTM), Simon Building, University of Manchester, Oxford Road, Manchester M13 9PL, United Kingdom; Michael.Worboys@manchester.ac.uk. This Focus section was organized by John V. Pickstone and Michael Worboys. Isis, 2011, 102:97101 2011 by The History of Science Society. All rights reserved. 0021-1753/2011/10201-0004$10.00 97

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tions. First, how have historians seen the relations between science and medicine for various periods since the Renaissance? Second, what have been the relations between historical writings on science and on medicine, how have they changed, and why? And, nally, how might we conceive histories of knowledge and practice that transcend, where appropriate, the boundaries between these historiographical traditions? In other words and acronymswhat might broad histories of science, technology, and medicine look like, if taken together as STM? We use this common abbreviation aware that it symbolizes distinctions that we wish to challenge, and we reject any implied sequence or hierarchy in which T and M necessarily build upon S. The essays draw on previous debates but also reect the shifts in the world since the 1960s that have increased the salience of medicine and biomedical sciences compared to physicochemical sciences and industry. These include the revolutionary expansion of biomedicine, together with feminism, ecological concerns, and the rise of consumers and service users. We focus here on biomedical sciences and medicine, rather than physicochemical sciences and technology. All of us have published in history of science journals and history of medicine journals; we argue here that history of medicine has much to teach the wider eld, while also acknowledging that it has much to learn. This is partly because the historiography of medicine is relatively strong on social and cultural dimensions, including the analysis of normative issues and of complex sociotechnical ensembles such as hospitals. It is also because medicine includes much of science and much of technology, as is more obviously the case with the recent rise of biomedical sciences and the simultaneous burgeoning of high-tech medical industries. Medicine can thereby provide a useful framework for analyzing sciencetechnologysociety relations more generally. For example, if we are interested in issues of professionalization and the public standing of technical practitioners of various kinds, then studies of medicine have much to teach, in part because physicians were a profession long before engineers, chemists, or physicists, for whom they provided models. From the sixteenth century, at least, medicine was a prominent feature of universities, and graduate physicians were organized in civic colleges or guilds. If we want to extend the remit of the history of STM so as to include informal and vernacular knowledges and practices, then medicine is again encouraging for patients have been harder to exclude from history than were the users of, say, chemical technology. Vernacular medicine is a key to common understandings across the whole geographical and historical range of cultures. And across the world today, the ramications of scientic medicine need to be understood through interactions with vernacular formationsand vice versa. The increasing legitimacy afforded to patients wishes in Western medicine and the increasing acceptance of some alternative practices, both deriving in part from feminism and from health consumerism, underline the cultural embedding of medicine and may serve to encourage a more democratic approach to STM generally. Similarly, recent public and scholarly concerns with global warming, planetary health, and biodiversity resonate with normative considerations intrinsic to medicine. Questions about high-tech solutions versus social action, for example, echo older public health debates about vitamins, vaccines, or malarial eradication. But there is also a deeper point at issue, which has yet to receive proper attention among historians of STM. When we speak about science we usually refer to cutting edges, even when we go on to speak about public understandings. The same tendency is strong in history of technology and some kinds of history of medicine, especially of recent biomedicine. But in history of medicine and history of technology there are also alterna-

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tive perspectives that can give a better sense of the synchronic assemblages of practices and hybrid knowledges. Much social history of medicine, for instance, has focused on synchronic relations between various kinds of practitioners and institutions, including lay medicine; and for early modern history, as Hal Cook notes, this approach overlaps with studies of mentalite s. Certain kinds of synoptic economic history, and some feminist studies of domestic technologies, have performed similar services for history of technology; and the work of David Edgerton is notable for its critique of neophilia and repeated emphasis on use.1 Such accounts of ensembles of knowledge and practice also help indicate how mundane activities changewhich is more through contested cumulation than simple successions.2 There seems to be room for more of this perspective in the history of sciencefor example, exploring the time relations of the practices and knowledges used in a given research laboratory, eld station, or graduate program, including synchronous uses. Thinking historically about such ensemble changes, both over short periods and over longer dure es, might help integrations across histories of S, T, and M. It might also help connect up the period limited cases now favored by many historians of science and the cases in science and technology studies (STS) that tend to inhabit a present that is not historicized. Cases may thereby come to illuminate aspects of long-term dynamic structures, not just times, places, or themes.3 For a vision of STM that includes both mundane practices across long time and a historicized present, medicine may be doubly useful because its cultural prominence not only postdates the high period of chemical and then physical sciences in the nineteenth and twentieth centuries but also predates them. From the European Renaissance through the eighteenth century, graduates in medicine were relatively common, at least in cities, when science in the modern sense barely existed and no one was called a scientist. If, historiographically, we still tend to make medicine secondary to science, perhaps it is because canonical postWorld War II histories of science, and of technology and medicine, were constructed in intellectual worlds (mostly universities) that were focused on cutting edges, dominated by physical sciences, and ready to see medicine as the application of rather lowly sciences. Indeed, historians of science continue to focus on pure natural sciences, largely ignoring applied sciences, hybrid knowledges, anda major growth area of the last centurythe social sciences, including economics. If that preeminence of the physical and conceptual now begins to appear as a period phenomenon, it is partly because our world is again becoming more biomedical (as opposed to physical) and perhaps also more technological (as opposed to scientic). We seem now to be more fascinated with biopolitics and forms of life than with visible machinesand arguably more oriented to the uses of knowledge than to its principles or methods.4 That rebalancing of S with T and M, as also the widening of public discussion,

F O C U S

1 See, e.g., Harry Braverman, Labour and Monopoly Capitalism: The Degradation of Work in the Twentieth Century (New York/London: Monthly Review Press, 1974); Ruth Schwartz Cowan, More Work for Mother: The Ironies of Household Technology from the Open Hearth to the Microwave (New York: Basic, 1983); and David Edgerton, The Shock of the Old: Technology and Global History since 1900 (London: Prole, 2006). 2 John V. Pickstone, Ways of Knowing: A New History of Science, Technology, and Medicine (Manchester: Manchester Univ. Press, 2000; Chicago: Univ. Chicago Press, 2001). 3 See Lorraine Daston, Science Studies and the History of Science, Critical Inquiry, 2009, 35:798 813; and Mario Biagioli, Postdisciplinary Liaisons: Science Studies and the Humanities, ibid., pp. 816 833. 4 See John V. Pickstone, Sketching Together the Modern Histories of Science, Technology, and Medicine, in this Focus section. Also noteworthy is a new concern with impact in research policy and funding. See Julia Lane, Assessing the Impact of Science Funding, Science, 2009, 324:12731275.

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would seem to suggest a need for wider perspectives in and across the history of STM and for research that systematically explores the historical relations of knowledge and action through broad denitions of the subject matter and as aspects of social and cultural change. In the essays that follow, Hal Cook explores the scientic revolution as a modernist historiographical construction, which marginalized medicine by focusing on new concepts in physical science. He then shows how new social histories of medicine converged with historical critiques of medicine, and with wider histories of occupations and consumption, to produce a new history of the long seventeenth century. Natural philosophy and its conicts now appear as a key aspect of medical education and practice, and vice versa; but they also seem to have been less important at the time than were the various emergent means of cumulating facts. Michael Worboys, for the nineteenth century, takes off from previous reviews of science and medicine by John Harley Warner and argues that we have yet to engage seriously with medical practice. Rhetorics for and against science in medicine have been well explored by historians, but in spite of the practice turn in history of science we still have few studies that look at performance in any medical setting clinic, laboratory, or eld. Worboys argues that we need, along with explorations of the language and meaning of case notes and journal articles, studies that reimagine and reconstruct the performative aspects of practice, including how things were put together and made to work. Physicalities have been more to the fore in historical and sociological studies of more recent periods, and the practices of biomedicine since World War II are the main focus of the essay by Ilana Lwy. The range and interdisciplinarity of such studies has been commendable, including the engagement with patients and the links with studies of other sciences and technologies. For Lwy, the remaining desiderata include a wider view of medicine that encompasses the clinic and population concerns. The corresponding resources, she suggests, still include the kinds of medical history pioneered by the 1930s e migre s from Germany, who stressed the art of medicine, rejected the applied sciences model, and saw medicine as fundamentally social. In the last essay, John Pickstone offers a birds-eye history of STM across this whole time span, asking about the dynamic relations between medicine and the wider congurations of natural knowledge and suggesting modes of analysis and historiographical formulations that may work across the whole domain. For successive periods of modernity, he explores the shifts in hegemonic relations between sciences and arts, including those of our neoliberal, postindustrial, or postmodern society. Like Worboys and Lwy, he stresses the layered complexities of synchronic practices and knowledges, seeing them as contested cumulations that need to be analyzed historically through to a historicized present. All the authors are energized, in part, by developments in our world and, especially, by the changes in the academic, industrial, and political realms to which medicine and biological sciences are now central. We would like to see more historians of STM rising to these challenges, talking about larger issues and putting their periods in dialogue with the present. We recognize that the reference points of such debates need to be far wider than we have managed here, not least geographically. The essays that follow are brief and provisional, but we hope they will be of assistance to historians in at least three ways: rst, by improving historical characterizations of science, medicine, and technology and their relations; and second, by facilitating mutual learning across the histories of STM and

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science studies, so that we may all draw on the themes and methods that are strongest within each historiographical tradition. Third, and nally, we look forward to the mobilization of that common range of concerns and methods across the increasing range of topics not easily categorized as history of science or technology or medicine, thus fostering more integrated histories of STM.

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