The Laboratory Versus the Clinic: The Fight for the Curriculum, 1870-1890

What was most compelling in the case for science in medicine after 1870 were the stunning achievements in laboratory medicine by that time. During the preceding decades, the work of laboratory scientists, especially in France and Germany, had brought a far more sophisticated understanding of the physical and chemical makeup and functioning of the human body and had produced a host of new tests, instruments, and techniques that were being increasingly used to study the sick patient. The role of bacteria in fermentation and then in wound pus had been demonstrated in the years preceding 1870, and they were now claimed to be responsible for a number of specific diseases. These discoveries, in turn, stimulated a great burst of energy in surgery, eventually gave a new and more certain basis to public health work, infused new optimism into the search for pharmacological remedies, and opened up new possibilities of protection against illness through deliberate immunization. Virtually no subject in the medical curriculum was untouched by the changes in medical knowledge, as dozens of new courses were created to teach the new viewpoints in disease. The new viewpoints were deemed necessary for students to master, even though they had as yet little impact on therapy. Contrary to some later critics, medicine has always been more than the simple application of “cures” to human ailments. For thousands of years as well as in our own time, the understanding of disease, its origins and causes, its transmission, and its prevention, prognosis, and palliation have been principal reasons for consulting a physician. In the years around 1870, in particular, science made enormous gains in understanding ancient afflictions and was gaining in ways to control, alleviate, and, in a few cases, to cure them. Was science important to medicine in these years, despite the slow pace of therapeutic change? Indeed it was, even if much of ordinary medical practice, especially the healing of many illnesses, was not immediately affected by what students learned. The rapid-fire developments of these years created a vision of an experimentally based, irresistible medical science that would soon sweep all doubts before it.