Body Counts

Body Counts: Medical Quantification in Historical and Sociological Perspectives//Perspectives historiques et sociologiques sur la quantification médicale

Copyright Date: 2005
Pages: 416
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  • Book Info
    Body Counts
    Book Description:

    Contributors include Luc Berlivet (INSERM, CNRS, EHESS, Paris), Alberto Cambrosio (McGill University), Sir Iain Chalmers (James Lind Library, Oxford), Nicholas Dodier (INSERM, CNRS, EHESS, Paris), Michael Donnelly (Bard College), Volker Hess (Humboldt-University), Peter Keating (University of Quebec at Montreal), Ann La Berge (Virginia Tech University), Ilana Löwy (INSERM, CNRS, EHESS, Paris), Harry M. Marks (Johns Hopkins University), Lion Murard (INSERM, CNRS, Paris), Mark Parascandola (National Cancer Institute, Bethesda, Maryland), Theodore M. Porter (University of California at Los Angeles), Andrea Rusnock (University of Rhode Island), Christiane Sinding (INSERM, CNRS, EHESS, Paris), and Ulrich Tröhler (Institut für Geschichte der Medizin der Albert-Ludwigs-Universität).

    eISBN: 978-0-7735-7247-8
    Subjects: Health Sciences

Table of Contents

  1. Front Matter
    (pp. i-iv)
  2. Table of Contents
    (pp. v-viii)
  3. Contributors
    (pp. ix-2)
    • 2 Quantifying Experience and Beating Biases: A New Culture in Eighteenth-Century British Clinical Medicine
      (pp. 19-50)

      The last half of the eighteenth century transformed aspects of British medicine. Several practitioners built on the earlier clinical research methods of Francis Clifton (see part I), and the emergent empiricism these marginal physicians challenged the traditional rationalist approach to medicine (part II). An empirical approach began to transform therapeutics and nosography (part III), culminating in the medical arithmetic of William Black (part IV). The result was a new culture knowledge-making within British clinical medicine (conclusion).¹

      Some eighteenth-century British doctors openly admitted doubts and ignorance about the diagnosis and treatment of disease. Francis Clifton’s bookTabular Observations Recommended as the...

    • 3 When the State Counts Lives: Eighteenth-Century Quarrels over Inoculation
      (pp. 51-64)

      “S.F. rates best for infant mortality rate,” reads a recent headline.¹ At the start of the twenty-first century, governments the world over accept mortality indices as a measure of the health of populations and as transparent evidence of medical progress (when they go down). This use of mortality data is relatively recent, dating back to the mid-seventeenth century.² In this paper, I discuss an early and contested use of mortality indices – Daniel Bernoulli’s effort in 1760 to measure the usefulness of smallpox inoculation. Bernoulli’s analysis was challenged by his fellow mathematician Jean D’Alembert in a celebrated controversy over the value...

    • 4 Quantifying Infant Mortality in England and France, 1750—1800
      (pp. 65-86)

      The earliest sustained calculations of infant mortality were made during the latter half of the eighteenth century in England and France as part of larger efforts to quantify mortality and to examine changes in mortality patterns. Government officials and physicians played leading roles within this new area of inquiry, often referred to as medical or political arithmetic. They introduced numerical methods for establishing how many infants died of those born within a given year and thus created a measure of infant mortality. Their calculations revealed not only high numbers of infant deaths, but also variations in infant mortality linked to...

    • 5 Medical Statistics at the Paris School: What Was at Stake?
      (pp. 89-108)

      Classic stories, such as the well-known controversy over medical statistics in Paris in the 1830s, function as points of reference, part of a common academic tradition to which everyone can refer. This is convenient and comforting, as a consensus of recognition emerges. But such stories can also function as black boxes, so well known that they become part of an agreed-on narrative. It is important to reconsider these classic stories in light of changing historiographical concerns and new ways of thinking about quantification historically and in present-day medical science and public health.

      This article focuses on one of these classic...

    • 6 Standardizing Body Temperature: Quantification in Hospitals and Daily Life, 1850—1900
      (pp. 109-126)

      One of the first quantifying techniques in medicine, the thermometer, entered hospitals only in the mid-nineteenth century and found its way from there into everyday life at the end of the century.¹ Fever measurement was thus the first instrumental technique to incorporate the principles of modern medicine in three respects. First, the measurement translated traditional modes of judgment based on assessing the tactual heat or the patient’s feelings into an abstract number. Second, by defining the normal ranges of a physiological function, the data distinguished between the healthy and the sick in a way that became characteristic of the quantifying...

    • 7 Les multiples usages de la quantification en médecine: Le cas du diabète surcé
      (pp. 127-144)

      Si le terme de quantification en médecine évoque souvent les essais cliniques et les statistiques, il ne faut pas oublier qu’il y a bien d’autres usages de la mesure et des nombres dans le domaine médical, qu’il s’agisse de la recherche ou de la pratique clinique. Dès le XIXesiècle, par exemple, Claude Bernard (après Broussais) fut un défenseur de la conception quantitative de la maladie, qui seule selon lui permettait de donner à la médecine des fondements scientifiques. Plus généralement, on retrouve l’opposition entre quantitatif et qualitatif tout au long de l’histoire de la médecine. Cette opposition est par...

    • 8 “Measures, Instruments, Methods, and Results”: Jozefa Joteyko on Social Reforms and Physiological Measures
      (pp. 145-172)

      In August 1910, Jozefa Joteyko – a physiologist, a psychologist, a teacher of experimental psychology at the provincialécoles normalesof Hainanut (Mons and Charleroi), and a pioneer and zealous advocate of pedology (the scientific study of childhood) – spoke to the Third International Congress for Family Education, held in Belgium. She called her talk “Measures, Instruments, Methods, Results.”¹ The unification of measures and tests in pedology, Joteyko argued, is the precondition for the transformation of this domain into a scientific discipline.² She developed this idea in the opening speech of the First International Congress of Pedology, in Brussels, in 1911. Thanks...

    • 9 The Production of Biomedical Measures: Three Platforms for Quantifying Cancer Pathology
      (pp. 173-202)

      In his analysis of medicine as an “evolving synthesis of applied sciences,” Georges Canguilhem described three processes that have transformed medicine in the modern era. First, the signs produced through medical intervention have replaced the symptoms presented by patients; second, the emergence of laboratory medicine has displaced the anthropocentrism embodied in bedside medicine; and, third, political demands have resulted in the rise of epidemiology as a social and economic science. The last in turn has entailed a shift of emphasis from health to safety and increasing reliance of clinical and public health authorities on biological monitoring techniques.¹ The quantitative analysis...

    • 10 La sous–détermination des théories médicales par les statistiques: Le cas Semmelweis
      (pp. 205-225)

      L’historiographie du débat académique de 1836 sur la méthode numérique en médecine conclut à un refus des statistiques médicales qui se serait maintenu pendant plus d’un siècle. George Weisz a mis en pièces ce consensus et montré que des arguments statistiques n’ont jamais cessé d’être êchangés dans les controverses académiques – concernant les techniques chirurgicales beaucoup plus que les traitements de médecine interne, pour lesquels on ne disposait pas toujours d’un indice de létalité.¹

      Mais 1’ambition du docteur Louis excédait largement la seule utilisation des nombres en thérapeutique. II voulait constituer unemedecine statistiqueau sens où 1’on parle aujourd’hui de...

    • 11 Epidemiology in Transition: Tobacco and Lung Cancer in the 1950s
      (pp. 226-248)

      By the 1950s, epidemiologic methods and thinking had expanded beyond the mere study of epidemics to human experiments testing preventive interventions, case-control observations in hospital patients, and the long-term study of large, generally healthy cohorts. Yet there existed no single, shared vision of where epidemiology was headed. There was disagreement about who could practise epidemiology and whether the field was a proper discipline or simply an aggregation of methods.¹ The study of cancer posed unique methodological challenges, and some observers urged development of new rules of inference. Biostatisticians, clinicians, pathologists, and public health officers were conducting case-control studies of varying...

    • 12 William Farr and Quantification in Nineteenth-Century English Public Health
      (pp. 251-265)

      This paper draws on the career of Dr William Farr (1807–1883) to illustrate several uses of quantification in mid-nineteenth century public health in Britain.² Farr served as compiler of abstracts, and later as superintendent of statistics, at the General Register Office of England and Wales, from 1839 until his retirement in 1879. From that position he and his coworkers had unprecedented opportunities to compile, diffuse, and analyse vital statistics. Many of the practices and techniques that Farr adopted left a lasting imprint on public health medicine in England and elsewhere.

      After outlining the context of Farr’s innovations, this essay...

    • 13 La santé publique et ses instruments de mesure: Des barèmes évaluatifs américains aux indices numériques de la Société des Nations, 1915—1955
      (pp. 266-308)

      “Plus les conditions d’existence sont misérables, plus 1'emploi du savoir médical devient affaire d’organisation¹.” Émis depuis le Peking Union Medical College au milieu des années 1930 par le “bolchevik medical” de la Fondation Rockefeller, John B. Grant, confirmé par le même Grant depuis 1’All-India Institute of Hygiene and Public Health de Calcutta au milieu des années 1940, le propos se recommande à 1’évidence d’une approche comparative, et implicitement politique, de la médecine comme science sociale². Que s’élèvent les niveaux de vie la santé suivra, sous réserve d’une conversion des “faits” scientifiques en termes de politique et d’organisation³. La nouveauté de...

    • 14 Statistical Theory Was Not the Reason That Randomization Was Used in the British Medical Research Council’s Clinical Trial of Streptomycin for Pulmonary Tuberculosis
      (pp. 309-334)

      An understanding of the history of controlled trials is of importance today because their history is still evolving. Although it is possible to identify treatments with dramatic effects – good and bad – without carefully controlled studies, inferences about more typical treatment effects are usually insecure unless based on studies with concurrent comparison groups, assembled in ways that reduce the likelihood that biases or the play of chance will mislead people.

      The principal defining characteristics of controlled clinical trials today are the measures taken to reduce biases and the play of chance. Although several historians have been interested in “the taming of...

    • 15 Exigence scientifique et isolement institutionnel : L’essor contrarié de 1’épidémiologie française dans la seconde moitié du XXe siècle
      (pp. 335-358)

      L’évolution du discours et des pratiques de santé publique, dans la seconde moitié du xxesiécle, aura été marquée par un mouvement de systématisation et d’intensification simultanées du recours à 1’objectivation statistique. Aux entreprises de description quantifiée de 1’état de santé des populations, nées au siécle précédent, vinrent s’ajouter la mobilisation des ressources de la statistique inférentielle au service de la recherche sur 1’étiologie des maladies, ainsi que le recours a des méthodologies analogues -développées dans le cadre des essais thérapeutiques dits “randomisés” – arm d’évaluer 1’efficacité des actions de prévention et 1’organisation des soins¹. Cette transformation de 1’approche étiologique fut...

    • 16 L’infléchissement du travail politique autour des essais contrôlés: L’épidémic de sida à la fin du XXe siècle
      (pp. 359-374)

      Plusieurs chapitres de ce recueil portent sur le raisonnement statistique et la quantification dans 1’évaluation des thérapeutiques, couvrant une large période qui va du XVIIIesiècle au début du XXe. J’aimerais prolonger cette interrogation par une réflexion sur le nouveau contexte qui prévaut à la fin du XXesiècle, et qui amorce sans doute les évolutions que nous vivons aujourd’hui. Une caractéristique essentielle du monde médical depuis le milieu des années 1950 est la victoire progressive des essais contrôlés comme méthode d’évaluation scientifique canonique des médicaments¹. Méthode au fondement de lamédecine des preuves,1’essai contrôlé s’est imposé dans les pays...

    • 17 From Clinical Counting to Evidence–Based Medicine
      (pp. 377-393)

      Several years ago, I gave a talk in Gérard Jorland’s seminar on the quantification debates that stirred the Parisian medical world during the 1830s. During question period, one of my listeners asked whether the “numerical method” advocated by P.C.A. Louis was in fact evidence-based medicine (EBM). The query struck me as historically naïve; but both advocates and opponents of EBM have since made this very same connection; the latter use it to emphasize the historical legitimacy of their enterprise, while the former argue that there is nothing particularly original about EBM – old French wine with a new Canadian label.¹ The...

    • 18 Medical Quantification: Science, Regulation, and the State
      (pp. 394-402)

      B.J.I. Risueno d’Amador spoke for many doctors in 1836 when he told the Académic Royale de Médecine in Paris that statistics is profoundly anti-medical. An ancient tradition of medical practice, backed up by extensive theorizing, insisted on the subtle skills of medical practice and the individuation of patients and conditions. The anti-statistical animus was often expressed as a moral claim about treating the sick. If a course of therapy is indicated by the preponderance of the numbers, wrote Risueňo, this still means that it will work only for some, and a physician who chooses remedies based on statistics will in...

    • Index
      (pp. 403-417)