Searching for Medical Certainty: Medical Chemistry to Molecular Medicine

Abstract

Kline's 1897 analysis1 ofmedicine as an exact science inter¬ ests us forwhat it says aswell as forwhat it does not say.Why, for example, did Kline ignore microbiology and aseptic sur¬ gery but include acid-base relationships in the stomach? Kline's omission of the germ theory from his paean, while extreme, represents the ambivalence many late-19th-century physicians felt concerning claims for the specific etiology of infectious disease. Even as the laboratorywork ofPasteur and Koch continued to be celebrated, some physicians wondered how its truths translated into practice. For example, accord¬ ing to one skeptical physician in 1900, Bacteriological find¬ ings, like those of physical diagnosis, in obscure cases, are difficult and uncertain many times... .2 In contrast, medical chemistry seemed to offer a clearer path to diagnosis and treatment. Medical chemists, investigators from diverse disciplines that included the forerunners of today's bio¬ chemistry, physiology, clinical pathology, and pharmacology, saw themselves as extending earlier 19th-century discoveries about organs, tissues, and cells that interpreted the body as a living machine.According to 1898 remarksbyRudolfVirchow,MD, the preeminentGermanpathologist, theories about cellswere asmall conceptual step from theories about physiological chemistry: The cells are composed of organic chemical substances, which