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Medicine in Europe and the United States

The Twentieth Century: Science, State, And Business

Whiggish authors justifiably rave about the "stupendous progress" of medicine in the twentieth century; it was also the century that witnessed the greatest medical crimes in history.

The wish-fulfillment can be detected … easily in … dreams.… A friend of mine … said to me one day: "My wife has asked me to tell you that she had a dream yesterday that she was having her period. You can guess what that means." The fact that this young married woman dreamt that she was having her period meant that she had missed her period. I could well believe that she would have been glad to go on enjoying her freedom a bit longer before shouldering the burden of motherhood. It was a neat way of announcing her pregnancy.

SOURCE: Sigmund Freud, The Interpretation of Dreams, trans. James Strachey (New York: Avon Books, 1965), p. 159.

Medical murder and human experimentation.

Enthusiastically serving scientifically deluded politicians and bureaucrats, a large number of doctors turned medical research into a large-scale immoral and deadly science in the Japanese empire, the United States, and, above all, in Nazi Germany. Adopting eugenic policies, Nazi doctors and their collaborators sterilized hundreds of thousands of mentally handicapped and sick persons, epileptics, and alcoholics. Other countries—Sweden and the United States, for example—also pursued sterilization policies. Patients in mental hospitals were starved and, during World War II, gassed. A racial agenda supported cost-effective medicine. Human experimentation carried out by doctors flourished in certain death camps. Beginning with the postwar Nuremberg Code, international declarations have outlawed such medical horrors. A nonethical medicine has a murderous potential; so it is back to Hippocrates, the phoenix of Western medicine, who was also Heinrich Himmler's medical hero.

Medical progress.

By the end of the twentieth century, European medicine was remarkably similar to but not identical with American medicine in terms of clinical science, medical research, and surgery; it was different in its relations with the market economy, in the state's provision of universal primary medical care as a basic service, and in its cultural values. For considerably less cost, Europeans were just as healthy and, in many groups, enjoyed greater longevity than Americans. "Big medicine," which includes giant hospitals, often including extensive imaging and laboratory facilities, enormous bureaucracies, global drug companies, and large medical schools, was of course just as much a feature of the European as the American scene. Nowhere is this clearer than in the "war on cancer," the most useful of diseases in the promotion of the modernization of medicine; cancerology became the growth model of big medicine. The conceptual basis of medicine has changed radically since the eighteenth century. The changes can all be blamed on discoveries in genetics, immunology, neurology, endocrinology, pharmacology, and, the stepchild of medical education, nutritional science.

Still, science cannot escape being part of culture. Even in the new surgical fields that have opened up in organ transplantation and in cardiology, certain cultural differences distinguish medical practice in different countries. German doctors, loving the heart above all other organs, are much more inclined to use drugs than surgery in treating cardiovascular diseases. The number of coronary bypass operations per 100,000 people in 1998 was 202 for the United States, 90 for Germany, and 35 for the United Kingdom; the last figure probably reflected a generally bad state of cardiovascular care. French doctors seem much more concerned with the functioning of the liver than doctors in other cultures; they are also much more conservative in n recommending hysterectomies. French doctors are too generous with the use of ionizing radiation—825 procedures per 1,000 inhabitants—nearly twice as many procedures as in Britain. Wherever one looks, health is a major European growth industry. There is no shortage of disease, including hypochondria. Every age seems to have its "epidemic"—in the early twenty-first century, it is HIV-AIDS. And with the doctor accepting the modern idea that a well person is only an insufficiently diagnosed patient, and genetic medicine aiming to define genetically determined disease susceptibility in individual patients, the normal may become, as in Jules Roman's famous play Knock, the profitable pathological.

KOCH'S POSTULATES (FORMALIZED IN (1882))

That the organism could be discoverable in every instance of the disease;

That, extracted from the body, the germ could be produced in a pure culture, maintainable over several microbial generations;

That the disease could be reproduced in experimental animals through a pure culture removed by numerous generations from the organisms initially isolated;

That the organism could be retrieved from the inoculated animal and cultured anew.

SOURCE: Roy Porter, The Greatest Benefit to Mankind: A Medical History of Humanity, (New York and London: Harper Collins, 1997), p. 436.

BIBLIOGRAPHY

Ackerknecht, Erwin H. A Short History of Medicine. Baltimore, Md.: Johns Hopkins University Press, 1982. Whiggish and opinionated; students like its brevity.

Bonner, Thomas Neville. Becoming a Physician: Medical Education in Britain, France, Germany, and the United States, 1750–1945. New York: Oxford University Press, 1995.

Bynum, W. F. Science and the Practice of Medicine in the Nineteenth Century. Cambridge, U.K.: Cambridge University Press, 1994. An essential book on the nineteenth century.

Canguilhem, Georges. The Normal and the Pathological. Translated by Carolyn R. Fawcett. New York: Zone Books, 1991. Published in French, 1996.

Cantor, David, ed. Reinventing Hippocrates. Aldershot, U.K.: Ashgate, 2002.

Conrad, Lawrence I., et al. The Western Medical Tradition, 800 B.C. to 1800 A.D. Cambridge, U.K.: Cambridge University Press, 1995.

Dally, Ann. Women under the Knife: A History of Surgery. New York: Routledge, 1992.

Debus, Allen. The French Paracelsians: The Chemical Challenge to Medical and Scientific Tradition in Early Modern France. Cambridge, U.K.: Cambridge University Press, 1991.

Evans, Richard J. Death in Hamburg: Society and Politics in the Cholera Years, 1830–1910. Oxford: Clarendon, 1987.

Foucault, Michel. The Birth of the Clinic: An Archeology of Medical Perception. Translated by A. M. Sheridan Smith. London: Tavistock, 1973. Published in French, 1963.

Gay, Peter. Freud: A Life for Our Time. New York: Norton, 1988.

Geison, Gerald L. The Private Science of Louis Pasteur. Princeton, N.J.: Princeton University Press, 1995.

Gelfand, Toby. Professionalizing Modern Medicine: Paris Surgeons and Medical Science and Institutions in the Eighteenth Century. Westport, Conn.: Greenwood, 1980.

Goldstein, Jan E. Console and Classify: The French Psychiatric Profession in the Nineteenth Century. 2nd ed. Chicago: University of Chicago Press, 2001.

Hannaway, Caroline, and Ann La Berge, eds. Constructing Paris Medicine. Atlanta: Rodopi, 1999.

Kevles, Bettyann Holtzmann. Naked to the Bone: Medical Imaging in the Twentieth Century. New Brunswick, N.J.: Rutgers University Press, 1997.

Kiple, Kenneth F., ed. The Cambridge World History of Human Disease. Cambridge, U.K.: Cambridge University Press, 1993.

Lesky, Erna. The Vienna Medical School of the Nineteenth Century. Translated by L. Williams and I. S. Levij. Baltimore, Md.: The Johns Hopkins University Press, 1976.

Nutton, Vivian. "Roman Medicine, 250 BC to AD 200." In The Western Medical Tradition, 800 BC to AD 1800, by Lawrence I. Conrad et al., 39–70. Cambridge, U.K.: Cambridge University Press.

Payer, Lynn. Medicine and Culture: Varieties of Treatment in the United States, England, West Germany, and France. New York: Holt, 1996. Amusing and incisive analysis of the cultural foibles of medicine.

Porter, Roy. The Greatest Benefit to Mankind: A Medical History of Humanity. New York: W. W. Norton, 1998. For a survey of the field.

Ramsey, Matthew. Professional and Popular Medicine in France, 1770–1830: The Social World of Medical Practice. Cambridge, U.K.: Cambridge University Press, 1988.

Risse, Guenter B. Mending Bodies, Saving Souls: A History of Hospitals. New York: Oxford University Press, 1999.

Romain, Jules. Knock ou la triomphe de la médecine. Paris: n.p., 1924. This play (1923), made famous by Louis Jouvet in the role of Knock, enjoyed a revival on the Paris stage in the early 2000s with Fabrice Lucchini as Knock.

Weiner, Dora B. The Citizen-Patient in Revolutionary and Imperial Paris. Baltimore: Johns Hopkins University Press, 1993.

Harry W. Paul

Additional topics

Science EncyclopediaScience & Philosophy: Mathematics to Methanal trimerMedicine in Europe and the United States - Ancient Greece And Rome, The Medieval World, Renaissance Medicine, The Harveian Revolution (seventeenth Century)