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The Era of Biomedicine: Science, Medicine, and Public Health in Britain and France after the Second World War

Published online by Cambridge University Press:  07 December 2011

Viviane Quirke
Centre for Health, Medicine and Society, Oxford Brookes University, Headington Campus, Gipsy Lane, Oxford OX3 0BP, UK.
Jean-Paul Gaudillière
Centre de Recherche Médecine, Sciences, Santé et Société (CERMES), Site CNRS, 7 rue Guy Môquet, 094801 Villejuif Cedex, France.
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The relationship between medicine and the study of life is as old as medicine itself. Nevertheless, historians have highlighted the great transformation that took place in the nineteenth century when first physiology and then bacteriology became important resources for the classification, diagnosis, and treatment of human diseases. In that period, significant links developed between the sites specializing in biological experimentation (i.e. laboratories) on the one hand, and the places of healing (i.e. hospitals, dispensaries) and public health offices on the other. Together, they helped to fashion modern, professional medicine. However, many historical studies have also argued that this mobilization of biological knowledge exerted a limited impact on medical practice in general, and clinical practice in particular.

Copyright © The Author(s) 2008. Published by Cambridge University Press


1W F Bynum, Science and the practice of medicine in the nineteenth century, Cambridge University Press, 1994; idem, ‘The rise of science in medicine, 1850–1913’, in W F Bynum, Anne Hardy, Stephen Jacyna, Christopher Lawrence, and E M Tansey, The western medical tradition 1800 to 2000, Cambridge University Press, 2006, pp. 103–230.

2The development of medicine as a modern profession has been discussed most thoroughly in relation to the United States and Germany; on the American example, see John Harley Warner, The therapeutic perspective: medical knowledge, practice, and professional identity in America, 1820–1885, Cambridge, MA, Harvard University Press, 1984; on Germany, see Charles E McClelland, The German experience of professionalization: modern learned professions and their organizations from the early nineteenth century to the Hitler era, Cambridge University Press, 1991; on France: Matthew Ramsay, ‘The politics of professional monopoly in nineteenth-century medicine: the French model and its rivals’, in Gerald L Geison (ed.), Professions and the French state, 1700–1900, Philadelphia, University of Pennsylvania Press, 1984; on Britain: Ivan Waddington, The medical profession in the industrial revolution, Dublin, Gill and Macmillan, 1984.

3For historical overviews of clinical research, see Christopher C Booth, ‘Clinical research’, in W F Bynum and Roy Porter (eds), Companion encyclopedia of the history of medicine, London and New York, Routledge, 1990, vol. 1, pp. 205–9; Christiane Sinding, Le clinicien et le chercheur: des grandes maladies de carence à la médecine moléculaire, Paris, PUF, 1991; Christopher Lawrence, ‘Clinical research’, in John Krige and Dominique Pestre (eds), Science in the twentieth century, Amsterdam, Harwood Academic, 1997, pp. 439–59. See also Christopher Lawrence and George Weisz (eds), Greater than the parts: holism in medicine, 1920–1950, Oxford University Press, 1998.

4For an introduction to the debates about the impact of medical science on public health, see Thomas McKeown, The role of medicine: dream, mirage, or nemesis?, London, Nuffield Provincial Hospitals Trust, 1976; Paul Weindling, ‘From infectious to chronic diseases: changing patterns of sickness in the nineteenth and twentieth centuries’, in Andrew Wear (ed.), Medicine in society; historical essays, Cambridge University Press, 1992, pp. 303–16; Anne Hardy, ‘On the cusp: epidemiology and bacteriology at the Local Government Board, 1890–1905’, Med. Hist., 1998, 42: 328–46.

5Christoph Gradmann, Krankheit im Labor: Robert Koch und die medizinische Bakteriologie, Göttingen, Wallstein, 2005; Christian Bonah, Etienne Lepicard and Volcker Roelcke, La médecine expérimentale au tribunal, Paris, Editions des Archives Contemporaines, 2003; Jean-Paul Gaudillière and Ilana Löwy (eds), Heredity and infection: a history of disease transmission, London, Routledge, 1998; Michael Worboys and Flurin Condrau (eds), Tuberculosis then and now: interdisciplinary perspectives on a post-modern plague, forthcoming.

6In addition to Worboys and Condrau (eds), op. cit., note 5 above, see John E Lesch, The first miracle drugs: how the sulfa drugs transformed medicine, Oxford University Press, 2007; Jean-Paul Gaudillière, ‘The invention of screening: Bayer, Rhône-Poulenc und die Geburt von Tuberkulose Therapie nach dem zweiten Weltkrieg’, Medizinisches Historisches Journal, forthcoming.

7On biological and medical research after 1945, see Jean-Paul Gaudillière, Inventer la biomédecine: la France, l'Amérique et la production des savoirs du vivant (1945–1965), Paris, La Découverte, 2002 (English translation forthcoming from Yale University Press); Peter Keating and Alberto Cambrosio, Biomedical platforms: realigning the normal and the pathological in late-twentieth-century medicine, Cambridge, MA, MIT Press, 2003; Ilana Löwy, Between bench and bedside: science, healing and interleukine-2 in a cancer ward, Cambridge, MA, Harvard University Press, 1996; Roger Cooter and John Pickstone (eds), Medicine in the twentieth century, Amsterdam, Harwood Academic Publishers, 2000; Paul Starr, The social transformation of American medicine: the rise of a sovereign profession and the making of a vast industry, New York, Basic Books, 1982. See also Anne Hardy and E M Tansey, ‘Medical enterprise and global response, 1945–2000’, in Bynum, et al., The western medical tradition, op. cit., note 1 above, pp. 405–533.

8See, for example, David Cantor, ‘Cortisone and the politics of drama, 1949–1955’, in John V Pickstone (ed.), Medical innovations in historical perspective, Basingstoke, Macmillan, 1992, pp. 163–84; James Le Fanu, The rise and fall of modern medicine, London, Abacus, 1999; Toine Pieters, Interferon: the science and selling of a miracle drug, Abingdon and New York, Routledge, 2005; Lesch, op. cit., note 6 above; Robert Bud, Penicillin: triumph and tragedy, Oxford University Press, 2007; Viviane Quirke, ‘From evidence to market: Alfred Spinks's 1953 survey of new fields of pharmacological research, and the origins of ICI's cardiovascular programme’, in Virginia Berridge and Kelly Loughlin (eds), Medicine, the market and the mass media: producing health in the twentieth century, London and New York, Routledge, 2005, pp. 146–71; Viviane Quirke, ‘Putting theory into practice: James Black, receptor theory and the development of the beta-blockers at ICI, 1958–1978’, Med. Hist., 2006, 50: 69–92.

9John V Pickstone, Ways of knowing: a new history of science, technology and medicine, Manchester University Press, 2000.

10Anne Hardy and E M Tansey, ‘Bibliographical essays’, in Bynum, et al., The western medical tradition, op. cit., note 2 above, pp. 537–64, on p. 555.

11Robert E Kohler, Partners in science: foundations and natural scientists, 1900–1945, University of Chicago Press, 1991; Lily E Kay, The molecular vision of life: Caltech, the Rockefeller Foundation, and the rise of the new biology, Oxford and New York, Oxford University Press, 1993; Nicolas Rasmussen, Picture control: the electron microscope and the transformation of biology in America, 1900–1960, Stanford University Press, 1997; Pnina G Abir-Am, ‘The molecular transformation of twentieth-century biology’, in Krige and Pestre (eds), op. cit., note 3 above, pp. 495–523; Angela N H Creager, The life of a virus: tobacco mosaic virus as an experimental model, 1930–1965, University of Chicago Press, 2002; Soraya de Chadarevian, Designs for life: molecular biology after World War II, Cambridge University Press, 2002; Gaudillière, op. cit., note 7 above.

12Lily E Kay, Who wrote the book of life? A history of the genetic code, Stanford University Press, 2000.

13In addition to above mentioned works, see the collection of essays gathered by David Cantor in the special issue of the Bulletin of the History of Medicine (2007, 81 [1]) on cancer after the Second World War.

14The relationship between drug companies and clinicians has begun to receive special attention from historians. See Nicolas Rasmussen, ‘The drug industry and clinical research in interwar America: three types of physician collaborator’, Bull. Hist. Med., 2005, 79: 50–80; Jeremy A Greene, Prescribing by numbers: drugs and the definition of disease, Baltimore, Johns Hopkins University Press, 2007; Viviane Quirke, Collaboration in the pharmaceutical industry: changing relationships in Britain and France, 1935–1965, Abingdon and New York, Routledge, 2008, pp. 241–2.

15For a comparative study of the development of biochemistry, see Robert E Kohler, From medical chemistry to biochemistry: the making of a biomedical discipline, Cambridge University Press, 1982. Regarding French and British medical sciences and the pharmaceutical industry, see Quirke, op. cit., note 14 above. Concerning medicine and the life sciences in France, in addition to already mentioned works, see Claude Debru, Jean Gayon, and Jean-François Picard (eds), Les sciences biologiques et médicales en France, 1920–1950, Paris, CNRS Editions, 1994; in Britain: Steve Sturdy, ‘Medical chemistry and clinical medicine: academics and the scientisation of medical practice in Britain, 1900–1925’, in Ilana Löwy, Olga Amsterdamska, John Pickstone and Patrice Pinell (eds), Medicine and change: historical and sociological studies of medical innovation, Montrouge, John Libbey Eurotext, and Paris, INSERM, 1993, pp. 371–93; Soraya de Chadarevian and Harmke Kaminga (eds), Molecularizing biology and medicine: new practices and alliances, 1910s–1970s, Amsterdam, Harwood Academic Publishers, 1997.

16John Krige, American hegemony and the postwar reconstruction of science in Europe, Cambridge, MA, MIT Press, 2006; in relation to the pharmaceutical industry, see Viviane Quirke, ‘Anglo-American relations and the co-production of American hegemony in pharmaceuticals’, in Hubert Bonin and Ferry de Goey (eds), American firms in Europe, Geneva, Droz, forthcoming, pp. 306–26.

17Keating and Cambrosio, op. cit., note 7 above, p. 52.

18Joan Austoker, ‘Walter Morley Fletcher and the origins of a basic biomedical research policy’, in Joan Austoker and Linda Bryder (eds), Historical perspectives on the role of the MRC: essays in the history of the Medical Research Council of the United Kingdom and its predecessor, the Medical Research Committee, 1913–53, Oxford University Press, 1989, pp. 23–33, and other contributions in this volume.

19On the MRC's contribution to British clinical research, see especially Booth, op. cit., note 3 above, pp. 205–9.

20Gaudillière, op. cit., note 7 above, ch. 8, pp. 292–317.

21Jean-François Picard, ‘Poussée scientifique ou demande de médecins? La recherche médicale en France de l'Institut National d'Hygiène à l'INSERM: contributions à l'histoire de la recherche médicale en France au XXème siècle’, Sciences Sociales et Santé, 1992, 10: 47–106; idem, ‘De la médecine expérimentale (1865) à l'INSERM (1964)’, in Debru, et al. (eds), op. cit., note 15 above, pp. 329–43, on p. 342.

22These have mainly dealt with the pharmaceutical industry, for example, Leigh M Hancher, Regulating for competition: government, law and the pharmaceutical industry in the United Kingdom and France, Oxford, Clarendon, 1990; Lacy G Thomas, ‘Implicit industrial policy: the triumph of Britain and the failure of France in global pharmaceuticals’, Industrial and Corporate Change, 1994, 3: 451–89; Quirke, op. cit., note 14 above.

23Cooter and Pickstone (eds), op. cit., note 7 above.

24Jean-François Picard, La république des savants: la recherche française et le CNRS, Paris, Flammarion, 1990; Picard, ‘Poussée scientifique’, op. cit., note 21 above; Michael Sanderson, The universities and British industry, 1850–1970, London, Routledge and Kegan Paul, 1972; Quirke, op. cit., note 14 above, Part III; Clive Field and John Pickstone, A centre of intelligence: the development of science, technology and medicine in Manchester and its university, Manchester, John Rylands University Library of Manchester, 1992; Arthur W Chapman, The story of a modern university: a history of the University of Sheffield, London, Oxford University Press, 1995; Jack Morrell, Science at Oxford, 1914–1939: transforming an arts university, Oxford, Clarendon Press, 1997; Mark Weatherall, Gentlemen, scientists and doctors: medicine at Cambridge, 1800–1940, Woodbridge, Boydell Press, 2000.

25See, for example, Michel Morange, Histoire de la biologie moléculaire, Paris, La Découverte, 1994, especially ch. 14 on the French school of molecular biology, and Gaudillière, op. cit., note 7 above, chs 7 and 8.

26For a general description of the transformation of US medicine after 1945, see Starr, op. cit., note 7 above.

27For an example, see Jean-Paul Gaudillière, ‘Paris–New York roundtrip: transatlantic crossings and the reconstruction of the biological sciences in post-war France’, Stud. Hist. Philos. Biolog. Biomed. Sci., 2002, 33: 389–417. For a tri-partite comparison in relation to molecular biology, see Pnina G Abir-Am, ‘Molecular biology in the context of British, French, and American cultures’, Inter. Soc. Sci. J., 2001, 168: 187–99.

28For an overview of the origins and development of the NHS, see Charles Webster, The National Health Service: a political history, Oxford University Press, 1998. See also Rudolf Klein, The new politics of the NHS, 3rd ed., London, Longman, 1995; Geoffrey Rivett, From cradle to grave: fifty years of the NHS, London, King's Fund, 1998.

29Dorothy Porter (ed.), Health, civilization and the state: a history of public health from ancient to modern times, London, Routledge, 1999. See also Virginia Berridge, Health and society in Britain since 1939, Cambridge University Press, 1999; Anne Hardy, Health and medicine in Britain since 1860, Basingstoke, Macmillan, 2000.

30Jean-François Picard, ‘Aux origins de l'INSERM: André Chevallier et l'Institut National d'Hygiène et l'INSERM’, Sciences Sociales et Santé, 2003, 21: 5–26.

31For a British history of clinical trials, see J Rosser Matthews, ‘Major Greenwood versus Almroth Wright: contrasting visions of “scientific” medicine in Edwardian Britain’, Bull. Hist. Med., 1995, 69: pp. 30–43; idem, Quantification and the quest for medical certainty, Princeton University Press, 1995; A Yoshioka, ‘Use of randomisation in the Medical Research Council's clinical trial of streptomycin in pulmonary tuberculosis in the 1940s’, Br. med. J., 1998, 317: 1220–3; Eileen Magnello and Anne Hardy (eds), The road to medical statistics, Amsterdam and New York, Rodopi, 2002; Iain Chalmers and Mike Clarke, ‘The 1944 patulin trial: the first properly conducted multicentre trial conducted under the aegis of the British Medical Research Council’, Inter. J. Epidemiol., 2004, 33: 253–60.

32On cancer research, see, for example, Joan Austoker, A history of the Imperial Cancer Research Fund, 1902–1986, Oxford University Press, 1988.

33Harry M Marks, The progress of experiment: science and therapeutic reform in the United States, 1900–1990, Cambridge University Press, 1997; Stefan Timmermans and Marc Berg, The gold standard: the challenge of evidence-based medicine and standardization in health care, Philadelphia, PA, Temple University Press, 2003.

34Marks, op. cit., note 33 above; Arthur A Daemmrich, Pharmacopolitics: drug regulation in the United States and Germany, Chapel Hill, University of North Carolina Press, 2004.

35Daemmrich, op. cit., note 34 above, ch. 2; Marks, op. cit., note 33 above, ch. 8.

36Löwy, op. cit., note 7 above; Peter Keating and Alberto Cambrosio, ‘From screening to clinical research: the cure of leukemia and the early development of the cooperative oncology groups, 1955–1966’, Bull. Hist. Med., 2002, 76: 299–334. See also Peter Keating and Alberto Cambrosio, ‘Cancer clinical trials: the emergence and development of a new style of practice’, Bull. Hist. Med., 2007, 81: 197–223, on p. 199.

37R F Bud, ‘Strategy in American cancer research after World War Two: a case study’, Soc. Stud. Sci., 1978, 8: 425–59; Ilana Löwy and Jean-Paul Gaudillière, ‘Disciplining cancer: mice and the practice of genetic purity’, in Jean-Paul Gaudillière and Ilana Löwy (eds), The invisible industrialist: manufactures and the production of scientific knowledge, Basingstoke, Macmillan, 1998, pp. 209–49.

38Jean-Paul Gaudillière, La médecine et les sciences, XIXè–XXè siècles, Paris, La Découverte, 2006, pp. 48–65, 89–92.

39Keating and Cambrosio, ‘From screening to clinical research’, op. cit., note 36 above.

40Adele E Clarke, Janet K Shim, Laura Mamo, Jennifer R Fosket, and Jennifer R Fishman, ‘Biomedicalization: technoscientific transformations of health, illness and U.S. biomedicine’, Am. Sociol. Rev., 2003, 68: 161–94.