Triangulating Clinical and Basic Research: British Localizationists,1870–1906

I am grateful to Becker Howard S. Charmaz Kathy Chico Nan Clarke Adele Fujimura Joan Gerson Elihu M. Gregory Kathleen Griesmer James Hewitt Carl Hornstein Gail Law John Little Marilyn Ruzek Sheryl Schaffner Ken Strauss Anselm Volberg Rachel Wellman Barry and Wimsatt William C. for comments and criticism on earlier versions of this material. I would also like to acknowledge the National Hospital for Nervous Diseases, the Thame Library of University College Hospital, the Royal College of Physicians, and the Royal Society, London, for access to unpublished laboratory notebooks, reports, and hospital records, some of which are quoted herein. Portions of this research were part of a collaborative effort between Tremont Research Institute and Carl Hewitt of the Message Passing Semantics Group, Artificial Intelligence Laboratory, Massachusetts Institute of Technology.

In a previous paper, I discussed the transformation of evidence from local uncertainty to global certainty, focusing on the contingencies faced in local situations by researchers and the pressures and mechanisms by which they transformed local uncertainties into general models. See Star S. L. , “Scientific work and uncertainty”. Social studies of science, xv (1985), 391–427.

Campbell D. T. and Fiske D. W. , “Convergent and discriminant validation by the multitraitmultimethod matrix”, Psychological bulletin, lvi (1959), 81–105, and Wimsatt W. , “Robustness, reliability and overdetermination”, in Brewer M. B. and Collins B. E. (eds), Scientific inquiry and the social sciences (San Francisco, 1981), 124–62. I am grateful to Gerson E. M. for a discussion on the several aspects of triangulation and to Wimsatt W. C. for a discussion of triangulation biases.

Whewell W. , The philosophy of the inductive sciences, ii (2nd edn, London, 1847), 65–85. See also discussion in Laudan L. , “William Whewell on the consiliance of inductions”, in Science and hypothesis (Dordrecht, 1981), 163–80.

Campbell and Fiske , op. cit. (ref. 3).

See also Lasagna L. , “The nature of evidence”, in Cooper J. D. (ed.), The philosophy of evidence, iii: Philosophy and technology of drug assessment (Washington, D.C., 1972), 5–24 for a comparable example of this in measuring the efficacy of pharmaceutical drug trials.

See e.g. Clarke A. E. , “Material, constraints, opportunities and resources in reproductive biology: 1880–1940”, paper presented to the American Association for the History of Medicine, San Francisco, 1984; Gerson E. M. , “Scientific work and social worlds”, Knowledge, iv (1983), 357–77 and “Styles of scientific work and the population realignment in biology, 1880–1925”, presented to the conference on history and philosophy of biology, Granville, Ohio, 1983; Wimsatt , op. cit. (ref. 3); Griesemer J. , “Communication and scientific change: An analysis of conceptual maps in the macroevolution controversy” (Ph.D. dissertation, University of Chicago, 1983); Star S. L. , “Simplification in scientific work: An example from neuroscience research”, Social studies of science, xiii (1983), 205–28; idem, “Tactics in the debate about cerebral localization”, paper presented at the Society for the Social Studies of Science, Philadelphia, 1982; Pauly P. J. , “The appearance of academic biology in late nineteenth century America”, Journal of the history of biology, xvii (1984), 369–97; Todes D. P. , “From radicalism to scientific convention: Biological psychology in Russia from Sechenov to Pavlov” (Ph.D. dissertation, University of Pennsylvania, 1981); Latour B. , Guerre et paix, suivi de Irreductions (Paris, 1984); Law J. , “Technology, closure and heterogeneous engineering: The case of the Portuguese expansion” (unpublished manuscript, University of Keele, 1984); Woolgar S. , “Interests and explanations in the social study of science”, Social studies of science, xi (1981), 365–94. Obviously this is not an exhaustive list.

Benton A. , “The interplay of experimental and clinical approaches in brain lesion research”, in Finger S. (ed.), Recovery from brain damage: Research and theory (New York, 1978), 49–68.

Wimsatt , op. cit. (ref. 3). Morgenstern's O. On the accuracy of economic observations (Princeton, 1963) provides an elegant critique of this problem from the point of view of data collection and statistics.

“Clinical science then is, for the clinician, not just basic science applied to the diagnosis and treatment of the pathologies of individual patients. According to the grand tradition of the philosophy of science, science or general systematic knowledge operates to explain and elucidate concrete particulars by making inferences from general principles. In contrast … clinical science does not typically operate that way. Instead, clinical science deploys new powers of observation and direct interpretation made possible by clinical instruments and through them reaches directly and observationally the scientific components and processes of the human body. In clinical science, the intermediacy of knowledge is not basic science, but typically a skillfully designed instrument based on good basic science and good technological principles of design. Basic science then ceases to serve an explanatory role for the clinician. It determines instead a space of possible scientific events in which concrete particulars are made manifest in the clinical experience of the physician or revealed directly to him through the text these concrete particulars write for him with the help of suitable technology. Clinical science is basic science incorporated nonobjectively…”, Heelan P. , “The nature of clinical science”, The journal of medicine and philosophy, ii (1911), 20–32, p. 30.

See King L. S. , Medical thinking: An historical preface (Princeton, 1982), especially pp. 103–4.

Geison G. , “Divided we stand: Physiologists and clinicians in the American context”, in Vogel M. J. and Rosenberg C. E. (eds), The therapeutic revolution: Essays in the social history of American medicine (Philadelphia, 1977), 67–90.

Shortliffe E. H. , Computer-based medical consultations: MYCIN (New York, 1976).

Murphy E. A. , “Classification and its alternatives”, in Engelhardt H. T. Spicker S. F. and Towers B. (eds), Clinical judgement: A critical appraisal (Dordrecht, 1977), 59–85 and “Analysis and interpretation of experiments”, The journal of medicine and philosophy, vii (1982), 307–25. See also Meehl P. E. , “Specific etiology and other forms of strong inference: Some quantitative meanings”, Journal of medicine and philosophy, ii (1977), 33–53.

Toulmin S. , “On the nature of the physician's understanding”, The journal of medicine and philosophy, i (1976), 32–50.

Marks H. M. , “Ideas as social reforms: The legacies of randomized clinical trials” (unpublished manuscript, Harvard Medical School, 1984).

See e.g. Freidson E. , The profession of medicine (New York, 1970); Becker H. S. Geer B. Hughes E. C. and Strauss A. L. , Boys in white: Students culture in medical school (Chicago, 1961); Strauss A. L. Fagerhaugh S. Suczek B. and Wiener C. , The social organization of medical work (Chicago, 1985); Gerson E. M. , “On ‘Quality of life’”, American sociological review, xli (1976), 793–806. Pinch T. J. , “Theoreticians and the production of experimental anomaly: The case of solar neutrinos”, in Knorr K. D. Krohn R. and Whitley R. (eds), The social process of scientific investigation, iv (Dordrecht, 1980), 77–106 provides a sociological analysis of the problem of combining applied and theoretical work in physics.

Brazier M. A. B. , “The historical development of neurophysiology”, in Magoun H. W. (ed.), Handbook of neurophysiology (Washington, D.C., 1959), 1–50; Spillane J. D. , The doctrine of the nerves: Chapters in the history of neurology (Oxford, 1981).

Swazey J. , Reflexes and motor integration: Sherrington's concept of integrative action (Cambridge, Mass., 1969).

Several of the participants were involved in multiple endeavours (for example, Ferrier both did physiological experiments and was a practising neurologist). Since my focus here is on the uses and combination of evidence, I will be using the tasks and lines of work as units of analysis, not individual scientists. See Gerson , op. cit. (ref. 7). Because of this choice of unit of analysis, the participation in multiple domains is significant only in that it made information exchange and administration of work easier; my analysis is applicable to endeavours without overlapping staff as well.

See e.g. Cushing H. , “The special field of neurological surgery”, Bulletin of the Johns Hopkins Hospital, xvi (1905), 77–87 and “The special field of neurological surgery: Five years later”, Bulletin of the Johns Hopkins Hospital, xxi (1910), 325–39.

Star , op. cit. (ref. 7); Gerson E. M. , Scientific work organization: The population realignment in biology, 1880–1925, in preparation.

MacCormac W , (ed.), Transactions of the international medical congress, 7th Session (4 vols, London, 1881); Star S. L. , “Scientific theories as going concerns: The development of the localizationist perspective in neurophysiology, 1870–1906” (Ph.D. dissertation, University of California, San Francisco, 1983); Star , op. cit. (ref. 7); Swazey J. , “Action propre and action commune: The localization of cerebral function”, Journal of the history of biology, iii (1970), 213–34; Brown-Sequard C. E. , “Preuves de l'insignifiance d'une expérience célèbre de MM. Victor Horsley et Beevor sur les centres appelés moteurs”, Archives de physiologie normale et pathologique, 5ième série, ii (1890), 199–201; Dodds W. J. , “On the localisation of the functions of the brain: Begin an historical and critical analysis of the question”, Journal of anatomy and physiology, xii (1877–78), 340–63, 454–93.

Now the National Hospital for Nervous Diseases, London.

In my examination of the casebooks from the National Hospital for the Paralysed and Epileptic, Queen Square (1860–1910), I came across a sketch that Horsley had made of his incision through the skull of a tumour patient. The drawing showed four separate openings, made successively during the operation as the tumour was repeatedly not found. Ultimately, the hole encompassed nearly 25 per cent of the entire skull area (Ferrier casebook, National Hospital, 1886). Casebook Beevor , 1894, describes a similar case where no tumour was removed but a large amount of bone was removed in the search for it. See also Paget S. , Sir Victor Horsley: A study of his life and work (London, 1919).

Knapp P. C. and Bradford E. H. , “A case of tumour of the brain; removal; death”, Boston medical and surgical journal, cxx (1889), 325–30, 353–9, 378–81, 386–8, 439.

Spillane , op. cit. (ref. 18), 398.

Star , “Scientific work and uncertainty” (ref. 2).

Cushing , op. cit. (ref. 21); Horsley V. , “On the technique of operations on the central nervous system”, British medical journal, iii (1906), 411–23.

Lyons J. B. , Citizen surgeon (London, 1966).

Yeo J. B. , “A case of large tumour of the left cerebral hemisphere, with remarkable remissions in the symptoms”, Brain, i (1878), 273–6, p. 275.

Atkins R. , “A case of right hemiplegia, hemianaesthesia, and aphasia, having for its prominent anatomical lesion softening of the left lateral lobe of the cerebellum”, Brain, i (1878), 410–17.

Bennett A. H. , “Case of cerebral tumour: Symptoms simulating hysteria”, Brain, i (1878), 114–20; Ferrier D. , “Pain in the head in connection with cerebral disease”, Brain, i (1878), 467–83.

Star , op. cit. (ref. 2); Star , op. cit. (ref. 23); Fulton J. F. , Harvey Cushing: A biography (Springfield, Ill., 1946), 198.

Ferrier D. , unpublished laboratory notebooks, 1873–83, Library of the Royal College of Physicians, London, MS 246/1–19, MS 246/5, 5 Jan. 1875.

Paget , op. cit. (ref. 25); Temkin O. , The falling sickness: A history of epilepsy from the Greeks to the beginnings of modern neurology (Baltimore, 1945); Star , op. cit. (ref. 23); Holmes G. , The National Hospital, Queen Square (Edinburgh, 1954); Rawlings B. B. , A hospital in the making (London, 1913).

Freidson , op. cit. (ref. 17), 164.

ibid., 163.

Star S. L. and Gerson E. M. , “The management of anomalies in scientific research” (submitted for publication).

Jackson J. H. , “On the anatomical and physiological localisation of movements in the brain”, Part 1, The (London) Lancet, (April 1873), 197–201; Part 2, ibid., (May 1873), 245–8.

MacEwan W. , “Brain surgery”, British medical journal, ii (1922), 155–65, pp. 164–5.

National Hospital for Nervous Diseases, unpublished hospital case records (casebooks), formerly of the National Hospital for the Paralysed and Epileptic, Queen Square, London. Archives of the National Hospital for Nervous Diseases, London, 1870–1901. Jackson casebook, 1887.

Foster M. , A text-book of physiology (London, 1877), 439.

Ferrier D. , The functions of the brain (London, 1876), xiv.

Horsley , op. cit. (ref. 29), 411.

Campbell A. , Historical studies on the localisation of cerebral function (Cambridge, 1905), p. xi.

See Ferrier D. , op. cit. (ref. 44); The localisation of cerebral disease (London, 1878); “Review of Animal magnetism, physiological observations by R. Heidenhain (London, 1880)”, Brain, iii (1888), 385–95; “Cerebral amblyopia and hemiophia”, Brain, iii (1881), 456–77; “The brain of a criminal lunatic”, Brain, v (1882), 62–73; “Cerebral localisation in its practical relations”, Brain, xii (1889), 36–58; The Croonian lectures on cerebral localisation (London, 1890); and especially “The regional diagnosis of cerebral disease”, in Allbutt C. and Rolleston H. D. (eds), A system of medicine, viii: Diseases of the brain and mental diseases (London, 1910), 37–162. See also Horsley V. , The structures and function of the brain and spinal cord (London, 1891); Horsley , op. cit. (ref. 29); Campbell , op. cit, (ref. 46), 222.

See Ferrier D. , “Experimental researches in cerebral physiology and pathology”, West Riding Lunatic Asylum medical reports, iii (1873), 30–96; idem, op. cit. (ref. 44); idem, op. cit. (ref. 47); Fritsch G. and Hitzig E. , “On the electrical excitability of the cerebrum”, [1870] in von Bonin G. (ed.), Some papers on the cerebral cortex (Springfield, Ill., 1950), 73–95.

See Thorwald J. , The triumph of surgery (New York, 1959), for an account of the scene; MacCormac , op. cit. (ref. 23), provides the transcript of proceedings.

MacCormac , op. cit. (ref. 23), i, 218–37; translated in Star , op. cit. (ref. 23), 316–43.

MacCormac , op. cit. (ref. 23); Spillane , op. cit. (ref. 18).

Klein E. Langley J. N. , and Schafer E. A. , “On the cortical areas removed from the brain of a dog, and from the brain of a monkey”, The journal of physiology, iv (1883–84), 231–326.

Campbell , op. cit. (ref. 46), 222.

French R. D. , Antivivisection and medical science in Victorian society (Princeton, 1975).

ibid., 203.

Sharpey-Schafer E. , History of the Physiological Society during its first fifty years, 1876–1926 (London, 1927).

French , op. cit. (ref. 54), 152. Ferrier was elected frs in 1876. An interlinked social world based on vivisection and the fight described above can be traced here. Rolleston was among the referees of the Royal Society who accepted Ferrier's first paper for the Society in 1873–74 (Referee's Report, for the Royal Society, 12 May 1874). Burden-Sanderson hired Ferrier to come to London to do experiments, after his work at West Riding ( Spillane , op. cit. (ref. 18)). Bastian Charlton , physician at Queen Square, was Herbert Spencer's literary trustee, and a friend and coworker of Darwin, Wallace Russel and Huxley T. H. ( Holmes , op. cit. (ref. 36), 39). Jackson Hughlings was heavily and explicitly indebted to Spencer for his theoretical assumptions (see e.g. Jackson J. H. , “Evolution and dissolution of the nervous system”, in Selected Writings, ii (London, 1932), 45–75). Jackson also had complete access to The lancet, and control of what he published there. According to his biographer, James Taylor, he would often write a short fragment and get the staff of The lancet to include it even after they'd done the pasteup for an issue. Jackson J. H. , Neurological fragments, with “Biographical memoir” by Taylor James and “Recollections” by Hutchinson J. and Mercier C. (London, 1925), 19. Horsley , the first brain surgeon at Queen Square, was a student and collaborator of Schafer's at University College; Schafer was on the committee that assessed the findings from the Goltz-Ferrier controversy.

See e.g. discussion in notes of Medical Society of University College, where the association voted to support Ferrier. Minutes of the Medical Society, University College Hospital, viii (7 Dec. 1881). See also editorial in the British medical journal, “Dr Ferrier's localisations: For whose advantage?”, British medical journal, ii (1881), 822–4.

French , op. cit. (ref. 54), 202.

One of the founders of the localizationist journal Brain, Browne was former supervisor of West Riding Lunatic Asylum, where Ferrier did his first physiological experiments. He was one of the first publishers of localizationist research in Britain and in Reports of the West Riding Lunatic Asylum. He published Ferrier (op. cit. (ref. 48)) and Jackson J. H. , “Observations on the localisation of movements in the cerebral hemispheres, as revealed by cases of convulsion, chorea and ‘aphasia’”, West Riding Lunatic Asylum Medical Reports, iii (1873), 175–339. See discussion in Spillane , op. cit. (ref. 18), 398.

See e.g. Brown-Sequard C. E. , “Nombreux cas de vivisection pratiquée sur le cerveau de l'homme: Le verdict contre la doctrine des centres psycho-moteurs”, Archives de physiologie normale et pathologique, 5ième serie, ii (1890), 762–73; idem, op. cit. (ref. 23); Panizza M. , La fisologia de sistema nervoso e i fatti psichici (3rd edition, Rome, 1887).

See for example Foster's address to the Physiological section of the 1881 Congress, in MacCormac , op. cit. (ref. 23), or Ferrier's attack on Brown-Sequard in The functions of the brain, op. cit. (ref. 44), 233–5.

See e.g. Beevor C. E. and Horsley V. , “Electrical excitation of the so-called motor cortex and internal capsule in an orang-utang”, Philosophical transactions of the Royal Society, clxxxi (1890), 129–58; idem, “A further minute analysis by electric stimulation of the so-called motor region (facial area) of the cortex cerebri in the monkey (Macacus Sinicus)”, Philosophical transactions of the Royal Society, clxxxv (1894), 39–81; Hobson J. M. , “A case of tumour in the medulla oblongata and pons varolii, with remarkable paralytic symptoms”, Brain, iv (1881), 531–9. Fujimura's Joan examination of contemporary cancer research organization reveals a similar pattern of problem construction via biochemical techniques (dissertation research in progress, Tremont Research Institute and Dept of Sociology, University of California, Berkeley).

Because of the risk of infection, surgeons had developed the habit of operating very quickly — records indicate that Horsley would remove a brain tumour, including making the incision through the skull, in fifteen minutes! Jones C. , “Some founders of British neurològy”, New Zealand medical journal, ii (1946), 143–54. Thus, there was neither time, resources nor methods to deal with the individuality of brain structures.

See, for example, maps in Ferrier , op. cit. (ref. 44) and op. cit. (ref. 47) and in Gowers W. R. , Lectures on the diagnosis of diseases of the brain (London, 1885). A discussion of the atlas as ideal type can be found in Star , op. cit (ref. 2) and op. cit. (ref. 23).

Becker H. S. , “Whose side are we on?”, Social problems, xiv (1967), 239–47.

Gerson E. M. and Star S. L. , “Practical reasoning: Rules and methods for evaluating arguments”, unpublished manuscript, 1984; and “Practical reasoning: The plausibility of arguments”, unpublished manuscript, 1984. I am grateful to Sheryl Ruzek for bringing this important point to my attention.

Pauly , op. cit. (ref. 7); Geison G. , Michael Foster and the Cambridge school of physiology: The scientific enterprise in late Victorian society (Princeton, 1978); Harvey A. M. , Science at the bedside: Clinical research in American medicine, 1905–1945 (Baltimore, 1981); Clarke A. E. , “Emergence of the reproductive research enterprise: A sociology of biological, medical and agricultural science in the U.S., 1910–1940”, Ph.D. dissertation, University of California, San Francisco (1985).