Arkansas Medical Monthly (1880)

Notes, Primary Sources, Thesis Research

“Eureka Springs.” Arkansas Medical Monthly 1, no. 1 (1880): 1-3.

“Notwithstanding, however, the ludicrous aspect placed upon the reputation of these springs in the eyes of the medical profession, induced by the enthusiastic exageration [sic] of the people, there is evidently something about them worthy of our attention and careful inquiry.” (34)

“We visited the place during the latter part of December last, but owing to the fact that no analysis has as yet been made of the water (or, at least, none has come under our observation), it is impossible to base a scientific opinion upon its proposed therapeutic value.” (34)

Chemistry, Medicine, and the Legitimization of English Spas, 1740-1840

Notes, Summaries & Reviews, Thesis Research

Christopher Hamlin, “Chemistry, Medicine, and the Legitimization of English Spas, 1740-1840,” Medical History, Supplement No. 10 (1990): 67-81.

Hamlin, much like he does in A Science of Impurity, discusses the role of chemistry in the legitimization of health spas. He argues that their domination of the conversation was not due to any sort of revolution in techniques — there were actually a lot of widely recognized problems with analyzing mineral waters — but due to a myriad of factors that included the rise of the profession as a whole and individual chemists’ abilities to assert their ability to explain scientifically and objectively the concrete reasons for different spas’ medical effects.

Foucault: The Birth of the Clinic

Notes, Summaries & Reviews

Foucault’s is a history (if we can call it that) of discourse — of the way people talked about the body, particularly in its diseased state, and the way they’ve understood the doctor and the patient himself in relation to the disease.

« …commenter, c’est admettre par définition un excès du signifie sur le signifiant, un reste nécessairement non formule de la pensée que le langage a laisse dans l’ombre, résidu qui en est l’essence elle-même, poussée hors de son secret; mais commenter suppose aussi que ce non-parle dort dans la parole, et que, par une surabondance propre au signifiant, on peut en l’interrogeant faire parler un contenu qui n’était pas explicitement signifie. »

To comment on something is to assume that the ultimate meaning of what you’re getting at is more important than what you’re saying — that there’s something more, something left in the shadows of your words. I think Foucault is laying the foundations for the kind of work he will do in the rest of the book here, asserting that if we can read through the way that doctors talk about the body, the patient, the disease, and themselves in relation to it, we can understand at a deeper, more complex level how they saw and understood these concepts.

This is a history of reading between the lines, of seeing what was not explicitly stated and looking underneath for larger take-aways. I’m unsure how I feel about this, because it doesn’t seem to be based in anything tangible. It feels farfetched and difficult to substantiate, problems that Foucault does resolve, in my mind, in the remainder of the text.

I think it has the potential to be very powerful, though, and I love that Foucault states he is not arguing that this epistemic change in the late 18th century was doctors/scientists suddenly waking up and seeing what had really been there all along — rather, that a new kind of science (by which I mean what was considered scientific) emerged, and through its lenses, scientists and doctors saw different things. They were looking for different things.This way of looking at things, I think, is something a lot of historians of science don’t like. It’s the ultimate critique to the progress narrative and to positivism, to viewing the history of science, technology, and medicine as the story of how scientists eventually “got it right.”

Espaces et Classes

Primary (disease), secondary (disease + individual), tertiary (disease + individual + health infrastructure, or « l’ensemble des gestes par lesquels la maladie, dans une société, est cernée, médicalement investie, isolée, repartie dans des régions privilégiées et closes, ou distribuée a travers des milieux de guérison, aménages pour être favorables »). Big changes took place in the tertiary.

Une Conscience Politique

Begins by talking about epidemics, exploring how they were understood and why the concept of contagion was largely unimportant.

« On a discute beaucoup et longuement, et maintenant encore, pour savoir si les médecins du 18ieme siècle en avaient saisi la caractère contagieux, et s’ils avaient pose le problème de l’agent de leur transmission. Oiseuse question… »

Details growing « conscience collective » of medicine, as observations around France were being collectivized and disseminated through medical infrastructure.

« Le lieu où se forme le savoir, ce n’est plus ce jardin pathologique où Dieu avait distribue les espèces, c’est une conscience médicale généralisée, diffuse dans l’espace et dans le temps, ouverte et mobile, liée à chaque existence individuelle, mais bien à la vie collective de la nation, toujours éveillée sur le domaine indéfini où le mal trahit, sous ses aspects divers, sa grande forme massive. »

Discusses change in the doctor’s role being reinstituting an individual, idiosyncratic “normal” to, in the 19th century onwards, adhering to a common, popular normal as the standard for health.

Importance of the concept of healing the state — health as something the entire nation should be concerned about.

Le  Champ Libre

Account of the debates surround the reformation of medical education during the French Revolution;

Hospitals should be abolished; they shouldn’t be needed in the ideal state, because everyone will be healthy. They end up becoming the new “natural” place for disease, though, replacing the family.

Arguments over whether education/medical field should be regulated.

The Old Age of the Clinic

“Before it became a corpus of knowledge, the clinic was a universal relationship of mankind with itself; the age of absolute happiness for medicine. And the decline began when writing and secrecy were introduced, that is, the concentration of this knowledge in a privileged group, and the dissociation of the immediate relationship, which had neither obstacle nor limits between Gaze and Speech: what was known was no longer communicated to others but put to practical use once it had passed through esotericism of knowledge.”

Theory vs. seeing — to what extent do our theories dictate what we see? (“When Hippocrates had reduced medicine to a system, observation was abandoned and philosophy was introduced into medicine.”)

I’ve felt this way about learning history a lot. If I read so much theory, it’s going to change the way I do history. It’s going to change the way I read sources, the way that I understand them, and the way that I relate them to contemporaneous and modern-day situations and ideas. Is this less pure? Or merely substituting someone else’s bias for my own?

Details how the clinic is different from a hospital, one being that, while in a hospital, “one is dealing with individuals who might suffer from one disease or another,” in the clinic, “one is dealing with diseases that happen to be afflicting this or that patient: what is present is the disease itself, in the body that is appropriate to it, which is not that of the patient, but that of its truth.”

The Lesson of the Hospitals

Clinical hospitals became a space where “truth teaches itself… offers itself to the gaze of both the experienced observer and the naive apprentice; for both there is only one language…”

They made possible “the immediate communication of teaching within the concrete field of experience… effac[ing] dogmatic language as an essential stage in the transmission of truth.” (68)

Interesting, although I’d still argue there was a lot going on with medical language at this time. Someone didn’t just walk in and know how to talk about the body. The body still wasn’t speaking for itself.

“What makes medicine, thus understood, a corpus of knowledge of use to all citizens is its immediate relationship with nature; instead of being, like the old Faculty, the locus of an esoteric, bookish corpus of knowledge, the new school would be ‘the temple of nature’; there one would learn not what the old masters thought they knew, but that form of truth open to all that is manifested in everyday practice…” (70)

Signs and Cases

Begins by discussing similarities and differences between natural history and this new brand of medicine; continuing conversation distinguishing classificatory medicine and clinical medicine. Instead of just classifying everything by their differences and similarities, clinical medicine embodied “a gaze… not bound by the narrow grid of structure (form, arrangement, number, size), but that could and should grasp colors, variations, tiny anomalies… it must make it possible to outline chance sand risks; it was calculating.” (89)

Discusses signs and symptoms — actually kind of defines something for once — and the changing amount of space between what was a signifier and what was signified. Symptoms, instead of being a sign of something, become themselves part of the whole of the disease.

Fascinating discussion of the rising importance of statistics in medicine (WISH THERE WAS MORE SUBSTANTIAL EVIDENCE), which “gave the clinical field a new structure in which the individual in question was not so much a sick person as the endlessly reproducible pathological fact to be found in all patients suffering in a similar way; in which the plurality of observations was no longer simply a contradiction or confirmation, but a progressive, theoretically endless convergence…” (97) “The only normative observer is the totality of observers…’Several observers never see the same fact in an identical way, unless nature has really presented it to them in the same way.’” (102)

Seeing and Knowing

Difference between experimentation and observation

“The observing gaze manifests its virtues only in a double silence: the relative silence of theories, imaginings, and whatever serves as an obstacle to the sensible immediate; and the absolute silence of all language that is anterior to that of the visible.” (108)

The setting of the hospital is important, permitting “pathological events to be reduced to the homogenous; the hospital domain is no doubt not pure transparency to truth, but the refraction that is proper to make possible, through its constancy, the analysis of truth.” (110)

“…by saying what one sees, one integrates it spontaneously into knowledge…” (114)

This is a really important point for Foucault, I think. He’s writing about discourse as a way of knowing. How we put into language what we see is how we construct knowledge.

Long-winded analogy between disease and languages:

“Disease, like the word, is deprived of being, but, like the word, it is endowed with a configuration.” (119) – nominalistic (denies the existence of universals and abstract objects, but affirms the existence of general or abstract terms and predicates)

Open Up a Few Corpses

Argues that the histories of anatomy that posit dissection was not common until the mid-19th century are false, constructed to explain why pathological anatomy (the correlation of lesions with symptoms) wasn’t a thing earlier.

Historical narratives constructed as “retrospective justifications.”

A Science of Impurity

Notes, Summaries & Reviews, Thesis Research

Christopher Hamlin, A Science of Impurity: Water Analysis in Nineteenth Century Britain (Berkeley: University of California Press, 1990).

In a case study of the political, social, cultural, and newly scientific conversation surrounding concerns about water quality in 19th century England, Christopher Hamlin shows that through the powerful claim at absolute, unbiased, and natural knowledge, science (especially chemistry) was used as a way of arguing for different standards and policies.

Hamlin points out something very interesting in his introduction. The 19th century is often seen as home to “the great watershed in environmental medicine, separating a pre-scientific period in which medicine could offer little more than a false cultural authority from the contemporary period of scientific precision where the authority is real,” an idea he takes as “unsatisfactory.” (3)

His first argument against the above narrative was the precarious financial situation of scientists, who often couldn’t count on their professorships to pay the bills if they weren’t already independently wealthy (a situation probably even more common in the US than in Britain). He cites chemists specifically, who often felt the need to accumulate side acts; “as consultants, witnesses, authors, entrepreneurs, as well as teachers.” This may help explain the historical record I’ve uncovered of Dr. Juan H. Wright, who seemed to have made a career (or at least part of one) by providing chemical analyses of springs around the midwest.

Chapter one deals with the chemistry behind mineral water analysis, breaking early- to mid-19th century strategies down into three contemporaneously recognized categories; physical examination (smell, taste, color, observed medicinal properties), “qualitative examination through the use of reagents, and a quantitative analysis of the evaporative residue.” (24-27) All were generally employed, although the last two were considered more scientifically telling. Hamlin makes clear that there was much debate within chemistry itself as to which tests were the most useful, when they should be employed, and how accurate they were. There seems to have been a lot of concern about how the tests themselves might alter the water and about whether certain combinations of chemicals in the water could affect a test’s outcome.

Interestingly, due to the way chemical reactions were understood before the late 19th century, when discussing medicinal benefits of waters chemists did not often take into account how the water’s contents may interact chemically within the human body. Physicians (and by extension spa proprietors and customers/patients) were used to working under the assumption that it was the salts, not ions, contained within mineral waters that were responsible for their medicinal value. The uncertainty-driven debates within the community of analytical chemists were not comfortable or economically valuable for those seeking water analyses, so they were generally glossed over and older conventions (tables of salts instead of ions) used. (36-37)

Chapter two, “Water Analysis and the Hegemony of Chemistry, 1800-40,” contains a lot of work that helps to clear up some of the stuff I’ve been seeing in my primary sources. Hamlin begins by briefly describing the rise of “trained ‘practical’ chemists” who did not limit their work to exploration and discovery but applied chemical techniques to “industry, commerce, government, law, and education.” (47) A more prominent role in society meant that these men were gaining authority, but how? Hamlin argues it was not because of “the progress of pure chemistry,” but rather due to “a combination of social needs and aggressive marketing…” (48)

Hamlin contends that a new kind of chemist — embodied by his two examples, William Thomas Brande and Alfred Swaine Taylor — emerged at the beginning of the 19th century whose contributions to original research were scanty but whose public presence and ability to sell chemistry as the answer to many of society’s most pressing problems was impressive. “…with decent laboratory skills, passing familiarity with the contents of the journals, tolerable lecturing talents, good connections, and untouchable confidence, one could make a decent living in London as a practical chemist.” (50) Oftentimes these men were hired by people with a vested interest in the medicinal benefits of the spa, and they would publish their results in both scientific journals and pamphlets for the springs. Many “pure” chemists (i.e., Humphry Davy) found these men problematic and quackish, but Hamlin is careful to state that the modern distinction between pure and applied science was in its infancy. Not every chemist and certainly not every layperson would have recognized this as bad chemistry, which helps to explain why the conflicts of interest were not seen as horrendously problematic. Another consideration is the kind of science these men thought they were doing; if they could gather enough analyses, payed for by whomever and for whatever reason, they may be able to draw larger conclusions from the data. Hamlin terms this “Baconian” science and argues that it helps to explain the willingness for chemists and doctors to accept what we would consider biased information as probable fact.

Though he does not explain in detail how these men made themselves visible to spa proprietors or physicians, Hamlin does argue that chemists became an important vehicle for providing scientific legitimization to the medical claims being made about mineral waters. It allowed comparisons to be made between mineral waters (OUR springs contain similar elements to Baden-Baden, and they’re found in your backyard!) and “symbolized that someone knew what was going on, that the medicinal environment one was to encounter was comprehended and would be applied in a precise and rational way.” (54) Chemists would often provide an analysis, then immediately below state possible medicinal benefits of the waters without explaining how the two connected; Hamlin argues that this is because it would have been understood by wealthy client or physician, and for the rest, that “it was the appearance of thoroughness that was to impress the reader.” (54)

The next section deals with attempts at synthesizing mineral waters, which is interesting but not immediately relevant. Maybe come back to this later?

Another facet of the relationship between chemists and doctors in the testing of mineral waters was which set of knowledge to begin from. Doctors and some chemists believed that it was the chemist’s job to take the observed medicinal effects of the water and explain them with an analysis. If the analysis yielded results that didn’t make sense, it must be a problem with the chemist’s method. Some, however, thought that “chemical composition was the only thing that could be empirically determined.” (60) Claims about medical benefits were unfounded assertions based on testimonial, and so it must be that medical benefits should be deduced from the chemical composition of the waters. We see again that the patient’s narrative is taken out of the equation in an attempt at an objective, scientific truth.

This context helps to explain some of the analyses in pamphlets and government documents alike that read like advertisements at times and situates the chemistry these men were doing in the context of practical and analytical chemistry. I wonder to what extent Hamlin’s conclusions carry over to the American situation and plan on supplementing this book with one about American chemistry. In reading the quotes he provides from his primary sources and seeing the format of the tables, however, it seems to me that the situation I’m working with is very similar to 19th century England.