Science and the Practice of Medicine in the Nineteenth Century by W. F. Bynum

Abstract

TECHNOLOGY AND CULTURE Book Reviews 351 and Buchhaupt are participating in a larger project that investigates electrification and urbanization in southwest German cities. Two articles provide an orientation somewhat at odds with the others. Ulrich Wengenroth describes the different perspectives from which the concept “industrial revolution” has been evaluated, and Tom Peters investigates the differences among architects and civil engineers (Bauingenieureri) and the benefits of crossing the cultural boundaries between them. Timeless definitions and processes may define a history more interesting to those who focus on the present, and they may find their way into industrial standards and engi­ neering texts, but Wengenroth and Peters demonstrate that some­ thing else can be done. This volume unintentionally makes clear the strengths and weaknesses of an approach that imposes current concepts on the past rather than finding ways to bridge the bound­ aries between present and past. Edmund N. Todd Dr. Todd teaches German history and the history of technology at the University of New Haven. Science and the Practice ofMedicine in the Nineteenth Century. By W. F. Bynum. New York: Cambridge University Press, 1994. Pp. xvi+283; illustrations, bibliography, index. $54.95 (cloth); $15.95 (paper). The central thesis of William Bynum’s elegant book, Science and the Practice of Medicine in the Nineteenth Century, is that, in terms of “concepts, institutions, and professional structures, the medicine of 1900 was closer to us almost a century later than it was to the medi­ cine of 1790” (p. xi). Bynum’s expressed purpose in framing 19thcentury science and medicine in this manner is to balance older approaches to the history ofscience and ideas with the “newer social perspectives of the present generation of historians” (p. xl). This is not a simple scholarly task, and Bynum succeeds at it nobly. Bycoveringawidevariety ofnational contexts (British, French, Ger­ man and, to some extent, the United States), Bynum leads the reader from medicine as it was practiced at the close of the 18th century through the 19th century, with a particular focus on how scientific inquiry influenced and shaped the field and the society around it. As Bynum documents, despite the lack ofdefinitive cures elaborated by the medical scientists of the 19th century, the luster and popular per­ ception of medical science’s therapeutic potential quickly overshad­ owed those who advocated the art of medicine. As the author wryly notes, “proponents ofthe notion that medicine is an art, and not one founded on science, had the second-best tunes” (p. 219). In order to contrast 18th-century medicine with its 19th-century counterpart, Bynum begins his study with an essay on the theory and 352 Book Reviews TECHNOLOGY AND CULTURE practice of medicine as it stood in 1790. He describes the medical profession as a social institution, the education of physicians, their medical knowledge as evidenced in variousmedical texts, and theways 18th-century physicians and lay people understood disease and its ef­ fects. The book then covers medical practice and the insinuation of sci­ entific inquiry into the three major settings—or estates, as Bynum calls them—of 19th-century medicine: the hospital, the community, and the laboratory. Bynum is particularly adept in his discussion of what science did (or did not do) for patients. Indeed, as many social historians have pointed out, the science of the 19th century did “lit­ tle for the nineteenth-century patient and . . . the main beneficiaries were the doctors who used medicine as a tool of collective profes­ sional advancement and as an aid to achieving a virtual monopoly in healthcare” (p. 118). Bynum’s study, however, takes a more eventempered approach, one that examines both these nihilistic perspec­ tives and the various means by which “science, from chemistry to bacteriology, was incorporated into clinical concepts and clinical practice” beginning with the middle decades of the 19th century (p. 118). A particular strength of the study is the description of how technology began to work its way into medical practice, beginning with R. Laënnec’s 1819 description of the value of stethoscopy (De l’auscultation médiate) and including the use of the thermometer and measuring a patient’s fever curve, the use of percussion as a diagnos­ tic tool...