Medicine is often thought of as a science of the body, but it is also a science of data. In some contexts, it can even be asserted that data drive health. This article focuses on a key piece of data technology central to contemporary practices of medicine: the medical record. By situating the medical record in the perspective of its history, we inquire into how the kinds of data that are kept at sites of clinical encounter often depend on informational (...) requirements that originate well outside of the clinic, in particular in health insurance records systems. Although this dependency of today's electronic medical records on billing requirements is widely lamented by clinical providers, its history remains little studied. Following the archaeology of medicine developed by Michel Foucault in The Birth of the Clinic and expanding his methodology in light of more recent contributions to the field of media archaeology, this article excavates some of the underexplored technological conditions that help constitute today's electronic medical record. If in some contexts, it is true that data drive health, then an archaeology of medical records helps reveal how health insurance records often impact clinical care and, by extension, health and disease. (shrink)

What was classification as it first took modern form in the eighteenth century, how did it work, and how did it relate to earlier describing and ordering? We offer new answers to these questions by considering an example less well known than that of botany or zoology, namely medicine, and by reconstructing practice on paper. The first and best-known disease classification is the “nosology” of the Montpellier physician François Boissier de Sauvages de Lacroix. Its several editions, we show, were less (...) products than process: published tools for building a classification system. The disorder of a hitherto unstudied notebook that Boissier de Sauvages kept throughout this process provided a way of breaking with the topical order of earlier physicians’ humanistic commonplace books of disease observation while sustaining the paper practices those earlier physicians—and Sauvages himself as a student—had used to order disease. This suggests a different picture of historical change than that of a scholarly world of ordered words giving way to a scientific one of ordered things. Classification, in the case of Sauvages’ nosology, arose through an incomplete break with, and intensified practice of, a past way of ordering the described world. The humanist paper practice that had made observationes, differently applied, now made species. Classification into genera and species by similarity and difference, which Sauvages’ nosology shared with botany, was an algorithm of paper and ink practice—in its operation more machine-like than humanist textual practice yet in its effects more creative and re-creative of categories and questions of relationship. Thus a new empiricism of generalizations arose out of the older, Renaissance empiricism of particulars. (shrink)

This introduction to the following five articles discusses concepts, practices and debates before and after the adoption of the term “questionnaire” in the late nineteenth century. Information gathering by way of itemized questions was established in the early modern period (c. 1500–1700). Developments associated with questionnaires in the modern period (such as mass standardized items) began in the late 1800s; but there was significant scrutiny of the questionnaire itself in the decades between the two World Wars.

This article explores the relationship between medicine’s history and its digital present through the lens of the physician-patient relationship. Today the rhetoric surrounding the introduction of new technologies into medicine tends to emphasize that technologies are disturbing relationships, and that the doctor-patient bond reflects a more ‘human’ era of medicine that should be preserved. Using historical studies of pre-modern and modern Western European medicine, this article shows that patient-physician relationships have always been shaped by material cultures. We discuss three activities (...) – recording, examining, and treating – in the light of their historical antecedents, and suggest that the notion of ‘human medicine’ is ever-changing: it consists of social attributions of skills to physicians that played out very differently over the course of history. (shrink)

This contribution explores how Forrester’s work on cases has opened up an arena that might be called ‘the medical case as a travelling genre’. Although usually focused on the course of disease in an individual patient and authored mostly by one medical author, medical case histories have a social dimension: Once published, they often circulate in networks of scholars. Moreover, scholars of the history of literature have shown that numerous medical cases seem to travel easily beyond the context of medical (...) science into the realm of popular literature and journalism. After tracing the idea of cases travelling in Forrester’s Thinking in Cases, I discuss several contributions by authors who, in the wake of interdisciplinary research on cases in the past two decades, have dealt in different ways with this idea. In the third section, I present my own research on a case of self-crucifixion that was widely discussed in 19th-century Europe. I suggest that understanding the case as a ‘traveling genre’ – an expression borrowed from literary genre theory – highlights the role of readers and publication formats as constitutive for cases, and enables us to see more clearly what cases do for scientists and writers who work with them. (shrink)

Als Vorstellung eines vom Wissen der Medizin abweichenden Behandlungsfalls können Fallberichte darauf Einfluss haben, welche Maßnahmen zukünftig als medizinisch indiziert gelten. Die öffentliche Präsentation der getroffenen Handlungen und Empfehlungen liegt in der Regel ausschließlich in der Hand ärztlicher Autor*innen – Betroffene kommen hingegen kaum zu Wort. Während in der klinischen Patientenversorgung bereits hohes Gewicht auf Patientenperspektiven und -erzählungen gelegt wird, scheinen sich diese Entwicklungen im Fallbericht als Form wissenschaftlicher Kommunikation so nicht widerzuspiegeln. Vor diesem Hintergrund wird im Folgenden aus gattungstheoretischer (...) Perspektive untersucht, welche Rolle Patientenperspektiven und -erzählungen nicht nur – wie in der bisherigen Forschung vor allem untersucht – im Bereich des Klinischen, sondern gerade auch des Kasuistischen und den damit verbundenen Fragen klinischer Indikationsreflexion und -empfehlung zukommen sollten. Dabei wird nicht zuletzt argumentiert, dass Narrationen analog zu Indikationsstellungen gerade ein Moment des Ungesicherten und Singulären betonen, das für die Textsorte des Fallberichts und daraus abgeleiteten Indikationsüberlegungen von spezifischem Wert ist. (shrink)

Als Vorstellung eines vom Wissen der Medizin abweichenden Behandlungsfalls können Fallberichte darauf Einfluss haben, welche Maßnahmen zukünftig als medizinisch indiziert gelten. Die öffentliche Präsentation der getroffenen Handlungen und Empfehlungen liegt in der Regel ausschließlich in der Hand ärztlicher Autor*innen – Betroffene kommen hingegen kaum zu Wort. Während in der klinischen Patientenversorgung bereits hohes Gewicht auf Patientenperspektiven und -erzählungen gelegt wird, scheinen sich diese Entwicklungen im Fallbericht als Form wissenschaftlicher Kommunikation so (noch) nicht widerzuspiegeln. Vor diesem Hintergrund wird im Folgenden aus (...) gattungstheoretischer Perspektive untersucht, welche Rolle Patientenperspektiven und -erzählungen nicht nur – wie in der bisherigen Forschung vor allem untersucht – im Bereich des Klinischen, sondern gerade auch des Kasuistischen und den damit verbundenen Fragen klinischer Indikationsreflexion und -empfehlung zukommen sollten. Dabei wird nicht zuletzt argumentiert, dass (Patienten-)Narrationen analog zu Indikationsstellungen gerade ein Moment des Ungesicherten und Singulären betonen, das für die Textsorte des Fallberichts und daraus abgeleiteten Indikationsüberlegungen von spezifischem Wert ist. (shrink)

ArgumentThe paper argues that epidemic surveillance and state-building were closely interconnected in interwar Poland. Starting from the paper technology of weekly epidemiological reporting it discusses how the reporting scheme of Polish epidemics came into being in the context of a typhus epidemic in 1919–20. It then shows how the statistics regarding nation-wide epidemics was put into practice. It is only when we take into account these practices that we can understand the epidemiological order the statistics produced. The preprinted weekly report (...) form registered Jews and Christians separately. Yet, the imagined national epidemiological space that emerged from it hardly took notice of this separation. Rather, the category that differentiated Polish epidemiological space in medical discourse was the capacity of contributing to the state-making practices of epidemic surveillance. This category divided Poland into two regions: a civilized and modern western region and a backward and peripheral eastern region. (shrink)

This article offers a brief overview of recent studies on note taking and paperwork in histories of early modern science. Showcasing the wide variety of note-taking practices performed by a range of historical actors across diverse sites and knowledge practices, it argues that a focus on note taking and “paper technologies” enables us to put in conversation a number of linked epistemic practices from reading and writing to making and doing to observing and surveying to classifying and categorizing. By viewing (...) these practices as a continuum rather than as distinct parts, we are able to further understand early modern knowledge production. (shrink)

Existing accounts of the early history of Alzheimer’s disease have focused on Alois Alzheimer’s (1864–1915) publications of two ‘peculiar cases’ of middle-aged patients who showed symptoms associated with senile dementia, and Emil Kraepelin’s (1856–1926) discussion of these and a few other cases under the newly introduced name of ‘Alzheimer’s disease’ in his Textbook of Psychiatry. This article questions the underpinnings of these accounts that rely mainly on publications and describe ‘presenility’ as a defining characteristic of the disease. Drawing on archival (...) research in the Munich psychiatric clinic, in which Alzheimer and Kraepelin practised, this article looks at the use of the category as a diagnostic label in practice. It argues that the first cases only got their exemplary status as key referents of Alzheimer’s disease in later readings of the original publications. In the 1900s, the published cases rather functioned as material to think about the limits of the category of senile dementia. The examination of paper technologies in the Munich psychiatric clinic reveals that the use of the clinical diagnosis of Alzheimer’s disease was not limited to patients of a certain age and did not exclude ‘senile’ cases. Moreover, the archival records reflect that many diagnoses of Alzheimer’s disease were noted in the medical records as suspicions rather than conclusions. Against this background, the article argues that in theory and practice, Alzheimer’s disease was not treated as a well-defined disease entity in the Munich clinic, but as an exploratory category for the clinical and histopathological investigation of varieties of organic brain diseases. (shrink)

This paper looks at phrenological charts as mediators of scientific knowledge to individual clients who used them as a means of self-assessment. Phrenologists propagated the idea that the human mind could be categorized into different mental faculties, with each particular faculty represented in a different area of the brain and by bumps on the head. In the US and the UK popular phrenologists examined individual clients for a fee. Drawing on a collection of phrenological charts completed for individual clients, this (...) paper shows how charts aspired to convey new ideals of selfhood by using the authority of science in tailor-made certificates, and by teaching clients some of the basic practices of that science. Hitherto historians studying phrenology have focused mainly on the attraction of the content of phrenological knowledge for the wider public, but in this paper I show how the charts enabled clients to participate actively in creating knowledge of their own bodies and selves. (shrink)

The development of paper-based information technologies in the early modern period is a field of enquiry that has lately benefited from extensive studies by intellectual historians and historians o...

ArgumentDrawing and writing number among the most widespread scientific practices of representation. Neither photography, graphic recording apparatuses, typewriters, nor digital word- and image-processing ever completely replaced drawing and writing by hand. The interaction of hand, paper, and pen indeed involves much more than simply recording or visualizing what was previously thought, observed, or imagined. Both writing and drawing have the power to translate concepts and observations into two-dimensional, manageable, reproducible objects. They help to develop research questions and they open up (...) an interaction between the gathering of phenomena and the formation of theses. Related to the manifold studies of representational activities in the sciences and the humanities, this topical issue tries to refine our understanding of the capacities of drawing and writing as research techniques; i.e. as productive epistemic practices. In particular the contributions address three aspects: the material conditions and configurations of the “scene of drawing and writing,” the involved procedures of production, and the languages of inscription. (shrink)

This paper examines medical scientists’ accounts of their rediscoveries and reassessments of old materials. It looks at how historical patient files and brain samples of the first cases of Alzheimer’s disease became reused as scientific objects of inquiry in the 1990s, when a genetic neuropathologist from Munich and a psychiatrist from Frankfurt lead searches for left-overs of Alzheimer’s ‘founder cases’ from the 1900s. How and why did these researchers use historical methods, materials and narratives, and why did the biomedical community (...) cherish their findings as valuable scientific facts about Alzheimer’s disease? The paper approaches these questions by analysing how researchers conceptualised ‘history’ while backtracking and reassessing clinical and histological materials from the past. It elucidates six ways of conceptualising history as a biomedical matter: (1) scientific assessments of the past, i.e. natural scientific understandings of ‘historical facts’; (2) history in biomedicine, e.g. uses of old histological collections in present day brain banks; (3) provenance research, e.g. applying historical methods to ensure the authenticity of brain samples; (4) technical biomedical history, e.g. reproducing original staining techniques to identify how old histological slides were made; (5) founding traditions, i.e. references to historical objects and persons within founding stories of scientific communities; and (6) priority debates, e.g. evaluating the role particular persons played in the discovery of a disease such as Alzheimer’s. Against this background, the paper concludes with how the various ways of using and understanding ‘history’ were put forward to re-present historic cases as ‘proto-types’ for studying Alzheimer’s disease in the present. (shrink)

During the Italian campaigns of the French Revolutionary Wars (1796–1801), several epidemic outbreaks sparked acrimonious aetiological debates: were the fevers spread by soldiers and prisoners of war, or produced by environmental factors? This debate was not only a scientific issue, but also a political one, for causation was linked to accountability. Looking at a series of medical investigations written by French military practitioners, this paper argues that theories of contagion were used by civilians to accuse the army of spreading disease, (...) in what I describe as an “aetiology of blame.” Likewise, military officials attempted to absolve themselves of responsibility for the spread of disease by focusing on unwholesome environments, depicting diseases as unavoidable fatalities. Military doctors thus supported French imperial endeavours by obscuring the army's responsibility for the spread of diseases, putting forward aetiologies of fate and blaming individual behaviour. Even when they did not radically dismiss contagionist perspectives, military practitioners insisted on a wide range of pathogenic causes. Their discourses were in line with medical theories of the time, but they downplayed the responsibility of the army for the spread of diseases, which they depicted as a factor among others. Military doctors were thus not always involved in the direct and deliberate production of ignorance, but they did sustain controversies and uncertainty. (shrink)

This article delves into a problem that is still seldom addressed by historians—namely, the use of medical records testifying to the implementation of a psychoanalytically inspired treatment within a psychiatric institution for historical research. Based on publications, a broad spectrum of medical patient records, and interviews with former practitioners, it more broadly addresses issues related to the attention to patients’ voices at the University Psychiatric Clinic of Strasbourg, a central institution of psychiatric care in Northeastern France that was once considered (...) a bastion of French Freudianism. Eventually, it contends with the fundamentally elusive nature of medical patient records when it comes to talking cures, highlighting the challenges and limitations inherent in the historical exploitation of this type of source. (shrink)

This paper investigates the history of a discursive figure that one could call the intelligent whaler. I argue that this figure's success was made possible by the construal and public distribution of whaling intelligence in an important currency of science – facts – in the preparatory phase for the United States Exploring Expedition (1838–1842). The strongest case for the necessity of the enterprise was New England whalers who were said to cruise uncharted parts of the oceans and whose discoveries of (...) uncharted islands were reported in the local press. The document that stood at the core of the lobbying for an expedition was a table that newspaperman and public lecturer Jeremiah Reynolds had compiled after interviewing whaling captains in the country's principal whaling ports. Presenting whalers’ experience in tabular and synoptic form, Reynolds's table helped forge the figure of the ‘intelligent whaler’, a mariner who had better geographical knowledge than other seafarers. By investigating the paper technologies that produced the ‘intelligent whaler’, this paper shows how Reynolds's translation of ‘whaling intelligence’ from news into facts marks the beginning of the intelligent whaler's long career in US-American debates about expansionism, exploration and science. (shrink)

In 1947, the Cornell psychiatrist Keeve Brodman and a handful of colleagues began developing what would become one of the most widely used health questionnaires of its time—the Cornell Medical Index (CMI). A rigidly standardized form, the CMI presented 195 yes-no questions designed to capture the health status of “the total patient.” Over the following decades, Brodman’s project of standardizing medical history taking gradually evolved into a project of mathematizing and computerizing diagnosis: out of the CMI grew the Medical Data (...) Screen (MDS), one of the first computerized methods of deriving diagnoses from patient data. This essay follows the life course of these tools through the second half of the twentieth century. It argues for a genealogy of biomedical computing and computerized diagnosis that takes more seriously the continuities between computer-based digital practices and paper-based analog ones. The computerized MDS evolved from, and rested upon, paper data practices associated with questionnaires and surveys. The interlocking histories of the CMI and the MDS prompt a reconsideration of the material and temporal parameters within which the history of computerized medicine has conventionally been understood. (shrink)

This paper examines medical scientists’ accounts of their rediscoveries and reassessments of old materials. It looks at how historical patient files and brain samples of the first cases of Alzheimer’s disease became reused as scientific objects of inquiry in the 1990s, when a genetic neuropathologist from Munich and a psychiatrist from Frankfurt lead searches for left-overs of Alzheimer’s ‘founder cases’ from the 1900s. How and why did these researchers use historical methods, materials and narratives, and why did the biomedical community (...) cherish their findings as valuable scientific facts about Alzheimer’s disease? The paper approaches these questions by analysing how researchers conceptualised ‘history’ while backtracking and reassessing clinical and histological materials from the past. It elucidates six ways of conceptualising history as a biomedical matter: scientific assessments of the past, i.e. natural scientific understandings of ‘historical facts’; history in biomedicine, e.g. uses of old histological collections in present day brain banks; provenance research, e.g. applying historical methods to ensure the authenticity of brain samples; technical biomedical history, e.g. reproducing original staining techniques to identify how old histological slides were made; founding traditions, i.e. references to historical objects and persons within founding stories of scientific communities; and priority debates, e.g. evaluating the role particular persons played in the discovery of a disease such as Alzheimer’s. Against this background, the paper concludes with how the various ways of using and understanding ‘history’ were put forward to re-present historic cases as ‘proto-types’ for studying Alzheimer’s disease in the present. (shrink)

This paper shows that the history of clinical medicine in the eighteenth century supports Paul Hoyningen-Huene’s thesis that there is a correlation between science and systematicity. For example, James Jurin’s assessment of the safety of variolation as a protection against smallpox adopted a systematic approach to the assessment of interventions in order to eliminate sources of cognitive bias that would compromise inquiry. Clinical medicine thereby became a science. I use this confirming instance to motivate a broader hypothesis, that systematicity is (...) a distinctive feature of science because systematicity is required by processes of knowledge generation that go beyond our everyday cognitive capacities, and these processes are required to produce knowledge of the kinds that science aims at. (shrink)

During the age of colonial expansion, European merchant companies used paper technologies as tools of control. This article analyses a set of tables produced in the 1690s by employees of the Dutch East India Company, as they recorded their daily efforts on a new method of desalinating ocean water. These printed “formulieren” should be viewed not only as a novel extension of the nautical logbook but also as an early phase in the development of questionnaires. Adapted from clerical formularies, these (...) structured tabular records are an early instance of a single-purpose data collection document, one linked with a new piece of technology, for which performance was to be measured daily. These sparse columns allow us to recover the practices of the “watermakers” themselves: some filled out the tables diligently, others gave rough estimates after the fact. Each of these men approached a supposedly standard technology in a different way, allowing us to uncover surprising individualism from within columns of numbers. (shrink)

This special issue of History of the Humane Sciences intends to shed light on a series of psychopathological entities that do not target well defined conditions and experiences, but rather aim at delimiting zones of uncertainty that defy psychopathology’s order of things: mild diagnoses or subthreshold disorders, borderline conditions, culture bound syndromes, or ideas of dimensions and dimensionality. While these categories have come to play an increasingly central role in psychiatric and psychological thinking during the last 50 years, historians and (...) social scientists have had remarkably little to say about how they have been created, what they have been used for, and what kind of realities they have helped to shape. In this introductory article we propose the concept of ‘psychopathological fringes’ to refer to these categories that are located somewhere at the border of psychopathological classifications and refer to zones of conceptual underdetermination. The notion of fringes serves to highlight both the conceptually and the socially marginal nature of the conditions, personal identities, and worlds delimited by these categories. The fringes of psychopathology are zones of vagueness, of epistemic uncertainty, and moral ambiguity. This introduction proposes a first incursion in these zones. It suggests some of the reason why they might have had attracted little interest in the past and why they may be more salient recently. It follows some analytical clues that might help chart a way through it and proposes a map through the collection of articles included in this issue. (shrink)

Although cases are central to the epistemic practices utilized within clinical medicine, they appear to be limited in their ability to provide evidence about causal relations because they provide detailed accounts of particular patients without explicit filtering of those attributes most likely to be relevant for explaining the phenomena observed. This paper uses a series of recent case reports to explore the role of cases in casual attribution in medical diagnosis. It is argued that cases are brought together by practitioners (...) to generate causal attributions and testable predictions using a manipulability view of causation. (shrink)

ZusammenfassungNach zwölf Jahren intensiver Forschung etablierte der Ophthalmologe Theodor Leber (1840–1917) am Ende des 19. Jahrhunderts in der Entzündungsforschung die Chemotaxis der Leukozyten. Obwohl sich seine Theorie damals reibungslos in die immunologische Forschung einschrieb, wird sein Name jedoch bis heute nur in der englischsprachigen Fachliteratur mit der Chemotaxis verknüpft. In seinem Experimentalsystem hatte Leber zwar schon Anfang der 1880er Jahre eine Theorie der chemischen Attraktion der Leukozyten beim Entzündungsprozess entwickeln können. Aber seine unkonventionelle Methodik—die Einführung von chemisch indifferentem Fremdmaterial zur (...) Auslösung einer Entzündung am Kaninchenauge—widersprach schon vom Ansatz her dem zu diesem Zeitpunkt dominant bakteriologischen Denkstil der Entzündungsforschung. In diesem Forschungsfeld hielt Leber an einer Forschungspraxis fest, die aus einer engen Verzahnung von experimenteller und theoretischer Arbeit bestand. Erst als eine Öffnung des bakteriologischen Denkstils eingetreten war, gelang es Leber seine auf losen Protokollseiten festgehaltenen Versuchsbeobachtungen in überzeugende Belege seiner Entzündungstheorie zu transformieren. Die mikrohistorische Rekonstruktion von Lebers experimenteller und schriftlicher Arbeit anhand seiner Laborprotokolle erschließt die Forschungspraxis eines Wissenschaftlers, der in der damals etablierten mikrobiologischen Entzündungsforschung kaum Anerkennung fand. Durch Verbindung der mikrohistorischen Rekonstruktion mit einer makrohistorischen Analyse lassen sich außerdem Beharrungsfaktoren im Prozess der Wissensentstehung offenlegen. Leber entwickelte eine spezifische Papiertechnik, durch die er seine experimentellen Erkenntnisse zwar mobilisierte und stabilisierte, aber nicht mit dem Fortschreiten der Wissenschaft mithalten konnte. (shrink)

This essay investigates the translatability of experience in seventeenth-century medical practica. It reconstructs the translation and the retranslation of the chapter on smallpox and measles taken from the immensely popular Praxis medica of Lazare Rivière. This text was adapted by two Jewish physicians: Jacob Zahalon, who translated it into Hebrew; and Abraham Wallich, who then modified it further. Both presented this work as their own. Reconstructing the decision making that went into their work, the essay argues that the erasure of (...) some practical and experiential content does not constitute a failure of translation but, rather, a reevaluation of the content’s applicability in a new context. The essay, dealing with Jewish learned physicians, also examines how different environments were reflected in these physicians’ writing. It therefore shows how physicians of comparable expertise resorted to dissimilar practices. (shrink)

This article introduces Turing’s idea of a “paper machine” to identify and understand one important mode of clinical research in the modern hospital, how that research worked, and how office technology and industrialized labor shaped and helped drive it. The unusually rich archives of Berlin psychiatry allow detailed reconstruction of the making of the new diagnostic category “hyperkinetic syndrome” in the 1920s. From the generating of data to the processing of information to the visualizing of the nature and course of (...) the new syndrome in the lives of more than sixty patients, this case study shows how clinical research could be based on the apparatus of the clerks’ room (folders, registers, inventories, and the dispatch of documents), office technologies (new filing systems, preprinted forms, and duplicating machines), and the principles and paper practices of the division and rationalization of labor (charts organizing worktime in complex organizations). The result is an important example of clinical research embedded in the broader history of office technology, industrial labor, and the modern hospital. (shrink)

Labeling, Recovering and Reactivating: The Role of Labels on Microscope Slides in the Finding System on the Basis of Alzheimer's Auguste D. Preparations. This study discusses the role of labels in the process of the reactivation of preparations. Labels on slides together with corresponding lists on cards or sheets build what is here called a specific finding system. In the sciences of the archive the disciplinary memory together with such a finding system are the basis to the ability of the (...) sciences today to reactivate preparations from the beginning of the last century as it occurs with the Auguste D. preparations. The case of Alzheimer's micropreparations of brain parts of Auguste D. – the case that he used to show that hers was a specific brain disease unknown before – serves to describe Alzheimer's writing on the labels. It is compared to slides and labels prepared by other medical researchers between the 1890s and 1920s and the respective finding systems. Being an epistemologicum, micropreparations, as they are data, in their hybrid status of both image and material in one, cross the boundaries between icon and index. This is proven by the reactivation of Auguste D. micropreparations in molecular biological studies over 100 years after their production. (shrink)