Labelled Bodies: Classification of Diseases and the Medical Way of Knowing

Galison Peter Stump David , The disunity of sciences: Boundaries, contexts and power (Stanford, 1996); Traweek Sharon , “Unity, dyads, triads, quads, and complexity: Cultural choreographies of science”, Social text, xlvi—xlvii (1996), 129–39.

Pestre Dominique , “Pour une histoire sociale et culturelle des sciences: Nouvelles définitions, nouveaux objets, nouvelles pratiques”, Annales: Histoire, sciences sociales, 1 (1995), 487–522; Daston Lorraine , “Science studies and the history of science”, Critical inquiry, xxxv (2009), 2009–815.

Pickstone John , “Working knowledges before and after circa 1800”, Isis, xcviii (2007), 489–516.

Hacking Ian , “The disunities of the sciences”, in Galison Peter Stump David (eds), The disunity of sciences: Boundaries, contexts and power (Stanford, 1996), 37–74.

Pickstone John , Ways of knowing: A new history of science, technology and medicine (Manchester, 2000), 10–12. Bowker Geoffrey Leigh Susan , Sorting things out: Classification and its consequences (Cambridge, MA, 1999).

Pickstone , “Ways of knowing” (ref. 5); and his Introduction to this collection.

Fleck Ludwik (1935), Genesis and development of scientific fact, transl. by Trenn Thaddeus (Chicago, 1979); see also, Gaudillière Jean Paul , “Genesis and development of a biomedical object: Styles of thought, styles of work and the history of the sex steroids”, Studies in history and philosophy of biological and biomedical sciences, xxxv (2004), 2004–43; Löwy Ilana , “Introduction: Fleck dans son temps, Fleck dans nôtre temps: Genèse et développement d'une pensée”, in Fleck Ludwik , Genèse et développement d'un fait scientifique, transl. by Jas Nathalie (Paris, 2005), pp. ix–xlii.

Star S. Leigh Griesemer James , “Institutionnal ecology, ‘translations’, and boundary objects: Amateurs and professionals in Berkeley's museum of vertrebate zoology”, Social studies of science, xix (1989), 387–420; Löwy Ilana , “The strength of loose concepts: Boundary concepts, federal experimental strategies and disciplinary growth. The case of immunology”, History of science, xxx (1992), 1992–96; Pickstone , “Working knowledges before and after circa 1800” (ref. 4), 515–16.

Rosenberg Charles , “The tyrany of diagnosis: Specifc entities and individual experience”, The Milbank quarterly, lxxx (2002), 237–60.

Weisz George Cambrosio Alberto Keating Peter Knaapen Loes Schlich Thomas Tournay Virginie J. , “The emergence of clinical practice guidelines”, The Milbank quarterly, lxxxv (2007), 691–727.

Amsterdamska Olga Hiddinga Anja , “Classifications and autism”, paper presented at 4S meeting, Paris, September 2004.

Hess Volker Mendelsohn Andrew , “Cases and series: Medical knowledge and paper technologies, 1600–1900”, History of science, xlviii (2010), 287–314; Hess Volker , “Formalisierte Beobachtung: Die Genese de modernen Krankenakte am Beispiel der Berliner und Pariser Medizin (1725–1830)”, Medizinhistorisches Journal, xlv (2010), 2010–340.

On the role of classification in early modern and eighteenth-century medicine see e.g. Faber Knut H. , Nosography in modern internal medicine (New York, 1923); Peter Jean-Pierre , “Malades et maladies à la fin du XVIIIe siècle”, Annales ESC, iv (1976), 1976–51; Siraisi Nancy G. , Medieval and early Renaissance medicine: An introduction to knowledge and practice (Chicago, 1990); Thröler Ulrich Prüll Cay-Rüdiger , “The rise of modern hospital”, in Laudun Irvine (ed.), Western medicine: An illustrated history (Oxford, 1997), 160–75.

Quoted by Temkin Owsei , “The role of surgery in the history of medicine”, Bulletin of the history of medicine, xxv (1951), 248–59.

Ackerknecht Erwin , Medicine at the Paris hospital 1794–1848 (Baltimore, 1967); Foucault Michel , Naissance de la clinique: Une archéologie du régard médical (Paris, 1963); Wilson Adrian , “Porter versus Foucault on the ‘Birth of the clinic’”, in Bivins Roberta Pickstone John V. (eds), Medicine, madness and social history: Essays in honour of Roy Porter (Basingstoke, 2007), 25–35; and, for a dissident view, Keel Othmar , L'Avènement de la médecine clinique moderne en Europe, 1750–1815: Politiques, institutions et savoirs (Montreal, 2001).

The standard historiographies of medicine stress the radical shift in the understanding of diseases in the nineteenth century. Real life transitions are often more complex and gradual: Since the nineteenth century, many patients have continued to think of their diseases in the old ways, many heterodox practices employed older conceptual frameworks, and even in specialized hospital medicine not all diseases have their lesions. Maulitz Russell , Morbid appearances: The anatomy of pathology in the early nineteenth century (Cambridge, 1987); Löwy Ilana , The Polish school of philosophy of medicine: From Tytus Chalubinski (1820–1889) to Ludwik Fleck (1896–1961) (Dordrecht, 1990); Pickstone John , “The biographical and the analytical: Toward a historical model of science and practice in modern medicine”, in Löwy Ilana (ed.), Medicine and change: Historical and sociological studies of medical innovation (Paris 1993), 23–48.

Hess Mendelsohn , “Cases and series” (ref. 12), 296–300. For a different reading of Pierre Louis's practice, see Marks Harry , “Marking time: Typhoid fever in Paris, 1800–1840”, paper presented at the conference Seriality and Scientific Objects in an Age of Revolution, 1780–1848, Cambridge, 16–17 June, 2008. Hess and Mendelssohn argue that “paper technologies” did more to shape the practices of nineteenth-century medicine than the so called “laboratory revolution” later in the century. One may argue, however, that the opposition between “paper technologies” and “laboratory techniques” is more rhetorical than real: Paper technologies were essential to the rise of laboratory methods. Marks Harry , “Medical technologies: Social contexts and consequences”, in Bynum Wiliam Porter Roy (eds), Companion encyclopedia of the history of medicine (London, 1993), 1592–1618; Howell Joel , Technology in the hospital: Transforming patient care in the early twentieth century (Baltimore, 1997), esp. pp. 69–102.

Canguilhem Georges , Le normal et le pathologique (Paris, 1966); Hacking Ian , The taming of chance (Cambridge, 1990).

Contrepois Alain , “The clinician, germs and infectious diseases: The example of Charles Bouchard in Paris”, Medical history, xlvi (2002), 197–220; L'invention des maladies infectieuses: Naissance de la bactériologie clinique et de la pathologie infectieuse en France (Paris, 2003).

Maulitz , Morbid appearances (ref. 16); Warner John Harley , The therapeutic perspective: Medical practice, knowledge, and identity in America, 1820–1885 (Cambridge, MA, 1986); Worboys Michael , Spreading germs: Disease theories and medical practice in Britain, 186–1900 (Cambridge, 2000); Hess Volker , “Standardizing body temperature: Quantification in hospitals and daily life, 1850–1900”, in Jorland Gérard Weisz George Opinel Annick (eds), Body counts: Medical quantification in historical and sociological perspective (Montreal, 2005), 109–28; Weisz George , Divide and conquer: A comparative study of medical specialization (Oxford, 2005).

Foucault , La naissance de la clinique (ref. 12); Canguilhem , Le normal et le pathologique (ref. 18); Hacking , The taming of chance (ref. 18).

Rosenberg Charles , The care of strangers: The rise of America's hospital system (New York, 1992); Howell , Technology in the hospital (ref. 17); Weisz , Conquer and divide (ref. 20).

Leigh Star and Geoffrey Bowker studied the origins and development of classification and their effect on people and organizations, but their important book does not focus on the role of medical classifcations in the clinics. Bowker Geoffrey Star Susan Leigh , Sorting things out: Classification and its consequences (Cambridge, MA, 1999).

Fleck Ludwik , “Some specific features of the medical ways of thinking”, Archiwum historji i filozofji medecyny, vi (1927), 55–64. English translation in Cohen Robert Schnelle Thomas (eds), Cognition and fact: Materials on Ludwik Fleck (Dordrecht, 1986), 39–46, p. 41. Faber's Nosography in modern internal medicine of 1923 (ref. 13), and Canguilhem's first part of Le normal et le pathologique (ref. 18), written in 1943, are additional examples of early interest in medical classification.

Löwy , The Polish school of philosophy of medicine (ref. 16).

Chalubinski Tytus , Method of finding therapeutical indications (Warsaw, 1874), esp. p. 39; Kramsztyk Zygmunt , “On clinical descriptions”, in Kramsztyk Z. , Critical notes on medical subjects (Warsaw, 1899), 46–65; Bieganski Wladyslaw , “Critical remarks on the classification of diseases”, Krytyka Lekarska, xi (1907), 67–76.

Biernacki Edmund , The essence and limits of medical knowledge (Warsaw, 1898), 28.

Fleck , “Some specific features of the medical ways of thinking”, op. cit. (ref. 24), 40.

Canguilhem , Le normal et le pathologique (ref. 18); Rabinow Paul , Essays on the anthropology of reason (Princeton, 1996); Rose Nicolas , The politics of life itself: Biomedicine, power and subjectivity in the twenty-first century (Princeton, 2006): Hacking Ian , Historical ontology (Cambridge, MA, 2002).

E.g., notes of the British surgeon, William Sampson Handley (1862–1962), Wellcome Archives, Series GC/152, Box 1.

Barnes Robert , Medical and surgical diseases of women (London, 1878), 821.

Temkin Owsei , “The role of surgery in the rise of modern medical thought”, Bulletin of the history of medicine, xxv (1951), 248–59; Gelfand Toby , Professionalizing modern medicine: Paris surgeons and medical science and institutions in the 18th century (Westport, CO, 1980).

Jacyna L. Stephan , “The laboratory and the clinic: The impact of pathology on surgical diagnosis in the Glasgow Western Infirmary, 1875–1910”, Bulletin of the history of medicine, lxii (1988), 384–406.

MacNaughton-Jones Henry , Practical manual of diseases of women, 6th edn (London, 1894), 443. Ablation of the cancerous cervix was already proposed in the 1820s, but was abandoned because of extremely high mortality rate. Anne Carol, “Une sanglante audace: Les amputations du col d'utérus au débout de XIXème siècle en France”, Gesnerus, lxv (2008), 2008–95.

Rosen George , “Beginings of surgical biopsy”, The American journal of surgical pathology, i (1977), 361–4. At that time mortality from Schoeder's operation was 20–25%, an acceptable result if the alternative was a certain death from cancer, a much more problematic one if many of the operated women did not need this surgery in the first place.

Winckel Frederich , A handbook of diseases of women (Edinburgh, 1890), 367.

Bloodgood Joseph Colt , “What every one should know about cancer”, leaflet of the American Medical Association, undated (probably circa 1915); Ewing James , “Precancerous diseases and precancerous lesions, especially in the breast”, Fourth report of the Collin P. Huntington fund for cancer research and the Memorial Hospital, 1913–14, vol. iv, pp. 1–32; Aronowitz Robert , “Do not delay: Breast cancer and time, 1900–1970”, The Milbank quarterly, lxxix (2001), 355–86.

Wright James , “The development of the frozen section technique, the evolution of surgical biopsy and the origins of surgical pathology”, Bulletin of the history of medicine, lix (1985), 295–326; Löwy Ilana , Preventive strikes: Women, precancer and preventive surgery (Baltimore, 2010), 19–39.

Archives of British Empire Cancer Campaign, series SA/CRC: Clinics, pathology, research. Minutes of the meeting of Clinical research sub-committee, 1934–1937, box 38, meeting of 4 May 1951: Follow-up reports of case E. 70.

Rather Leland J. , The genesis of cancer: A study in the history of ideas (Baltimore, 1978). The Bellevue classification of tumours, widely employed in the US, exemplifies such histological classification. Committee on clinical records, The revised Bellevue Hospital nomenclature of diseases and conditions (New York, 1929).

Classifications within the autistic spectrum, Hacking has noted, are very important for researchers, play some role in the attribution of resources, and may be relatively unimportant when the main issue is solving practical problems of people. Hacking Ian , “What is Tom saying to Maureen”, London review of books, xxviii (ix) (2006), 3–7.

Lane Claypon published four volumes in the series “Reports on public health and medical subjects” of the UK Ministry of Health, two on breast cancer (report 28 (1924) and report 51 (1928)); and two on cancer of the uterus (report 40 (1927) and report 47 (1927)).

“Raport de la comission du cancer de la Societé des Nations sur le traitement radiothérapique du col d'utérus”, La lutte contre le cancer, xxvii (1930), 507–36.

Disseminated cervical cancer could be treated only by X-rays and/or radium — And the treatment rarely led to a cure.

WHO's expert committee on health statistics, “Statistical code for human tumors”, WHO document WHO/HS/CANC/24.1, 15 August 1956.

Hill Gerry B. , “Editorial: Counting cancers”, Canadian Medical Association journal, xxix (1983), 1262–3.

Letter from Stebbinng to Scarff, 3 May 1946. BECC archive, Wellcome Archives of Modern Medicine, London, Box 38 file A.30: Consultant Panel in Morbid Histology, 194–1970; Scarff to Stebbing, 19 July 1946. BECC archive, Box 38, file A.30: Consultant Panel in Morbid Histology, 1946–1970.

Ménoret Marie , “The genesis of the notion of stages in oncology: The French permanent cancer survey, 1943–1952”, Social history of medicine, xv (2002), 291–302.

http://seer.cancer.gov/studies/index.html (accessed 15 September 2010).

On the role of laboratory tests in medical diagnosis see e.g., Amsterdamska Olga Hiddinga Anja , “The analyzed body”, in Cooter Roger Pickstone John (eds), Medicine in the 20th Century (Amsterdam, 2000), 417–34, and on growing entaglement of analysis and diagnosis, Löwy Ilana ” The experimental body”, ibid., 435–50, and Rosenberg , “The tyrany of diagnosis” (ref. 9).

Medical files dept. Curie Institute, file of Mlle C.A. first examined at the Foundation, 6 March 1934.

Bud Robert , “Strategy in American cancer research after World War II: A case study”, Social studies of science, viii (1978), 425–59; Löwy Ilana , Between bench and bedside: Science, healing, and interleukin-2 in a cancer ward (Cambridge, MA, 1996), 36–83.

Keating Peter Cambrosio Alberto , “Cancer clinical trials: The emergence and development of a new style of practice”, Bulletin of the history of medicine, lxxxi (2007), 197–223; Keating Peter Cambrosio Alberto , “Who's minding the data? Data managers and data monitoring committees in clinical trials”, Sociology of health & illness, xxxi (2009), 2009–42.

Epstein Richard J. , “TNM: Therapeutically not mandatory” European jounal of cancer, xlv (2009), 1111–16.

Hess Mendelsohn , “Cases and series” (ref. 12).

These developments, one should add, take place in cutting edge cancer hospitals in Western countries. In developing and middle-income countries, cancer patients (with the exception of the narrow strata of truly privileged ones) are often given a “one size fits all” Therapy. E.g., Gregg Jessica , Virtually virgins: Sexual strategies and cervical cancer in Recife, Brazil (Stanford, 2003), 143–6.

Epstein , “TNM: Therapeuticaly non mandatory” (ref. 54), 1114.

Löwy , The Polish school of philosophy of medicine (ref. 16).

Hamlin Christopher , this issue.

Keating Cambrosio , “Cancer clinical trials” (ref. 52).

Epstein , “TNM: Therapeuticaly non mandatory” (ref. 54), 1115.

Porter Theodore , Trust in numbers: The pursuit of objectivity in science and public life (Princeton, 1996), 217–29.

Löwy , Between bench and bedside (ref. 52); Porter , Trust in numbers (ref. 62).