The Obvious in a Nutshell: Science, Medicine, Knowledge, and History

The scope and mission of the history of science have been constant objects of reflection and debate within the profession. Recently, Lorraine Daston has called for a shift of focus: from the history of science to the history of knowledge. Such a move is an attempt at broadening the field and ridding it of the contradictions deriving from its modernist myth of origin and principle of demarcation. Taking the move from a pluralistic concept of medicine, the present paper explores the actual and possible contributions that a history of knowledge can offer to the history of medicine in particular. As we will argue, the history of medicine has always been a history of knowledge, but for good reasons has always stuck to the concept of medicine as its object and problem throughout the ages, including the modern, scientific one. We argue that, in the history of medicine, the demarcation between scientific and non‐scientific represents an accident, but is not foundational as in the case of natural science. Furthermore, the history of medicine programmatically played a role in at least two academic domains (history proper and medical education), adjusting historical narratives of medical knowledge to its audience. Accordingly, we underscore that the history of both science and medicine, as traditionally defined, already provides room for almost the whole spectrum of approaches to history. Moreover, their different myths of origin can, and indeed must, be included in the reflexivity of the historical gaze. We argue that the position towards a history of science, medicine, or knowledge is not a question of narrative or theory, rather, it is a question of relevance and awareness of extant contexts.

In ourp aper,w ew illr eflect on theseq uestions ando nt he relationsb etween thehistories of knowledge, medicine,and science. We will startfromthe obvious: theh istory of medicine is nott he historyo fs cience,d espite thet wo seemingt o converge at points,o ra tl east flirting more than occasionally.T hist rivial statement conflatesa tl east threed ifferent lineso fa rgument: thei ntrinsicd ifference between medicine andscience (levelofthe subjectmatter);the differenthistories of scienceand medicine (level of the resgestae proper); andthe differentroles historiography played in identity building.
Quiteu nlikeD aston'sC apital-S-Science,b otht he resg estae andt he historia rerumgestarum of medicine have always been definedbyt he ongoingopposition of tradition andinnovation. That is to say, demarcationisnot as defining andprimary af actort om edicine as it is to Capital-S-Science-it is an eventw ithini ts history, as opposedtoamark of origin.Alternatively,itcan be perceivedasarecurring tropethroughoutt he wholeh istory of medicine-the demarcationb etween dogmatic andp ragmatic;s cientifica nd practical. Thesed emarcationso ccur at differentt imes in history, from differentp oints of view,a nd with contrasting aims.The historyofmedicine hasplayedasignificant(if notalwaysclearly specified)r olei nd efiningt he identity,m eaning,a nd perspectiveo ft he complex system we call medicine.
This leadsustoamodest reflection upon onepointo fDaston'sa rgumentfor moving to ahistory of knowledge: thenarrownessoft he very term science.O nce thew ider,o riginalm eaning of thew ordh as been restored,i tw ould appear that as ignificant proportion of Daston's proposed program wouldb ea lready accomplished, as it is in thehistory of medicine (and science).The modernistnarrative that underpinst he historyo fs cience andprovidesi ts very raison d'Þtre wouldb e incorporated into am uchb roader (fromt heology, queeno fs ciences, to particle physics),a nd longer( at leastf romt he Greeks,i nW estern culture) outlook, within whichthe very question of modern science wouldbereinstated as aspecific problem.
Equally,t he meaningso f Wissenschaft and Sciences Humaines would ipso facto be turned from ah eadachei ntoaresearch topic, just as theo rigina nd debated suitability of theveryrecentword scientist hasalready been. 59 In his Ways of Knowing,J ohnP ickstone proposed af ine-graineda pproacht ot hisc omplex relation; that is non-teleological, open to complexity andc ontingency,a nd allows fora n expansionofthe outlook bothintimeand throughthe intertwinement of ways of knowing and wayso fm aking.F urthermore,i tb alances ak eena ttention fort he local with an ambitiousb readth.N ot by chance he used medicine to introduce ther eaders of his Ways of Knowing to thei deao f" critical pluralism" (p.25) regardingh istoricala nalyseso fp ractices,s copeso fa ctions,s ystems,a nd spheres. 60 This progresses, in ouro pinion,t owards Daston's proposed program.Y et,P ickstonee nvisages ad ifferent pointo fa nchorage,a sc an be evincedf romh is triple introduction,a ddressed to historians,p ractitioners,a nd thepublic. This attempt at balancingt he needsa nd views of different, present constituencies is linked to theneedofbeing relevant to allofthem, butcomes at thecostofnot completely obliterating theg reat categories he analyzes-science,t echnology,a nd medicine. 59 Ross 1962.W em ay incidentally notice that theS ciencesH umaines( unea utre sciencef rancaise, commel ac hemie) have always been both ah eadachea nd ar esearcht opic ever sincet heyw ere defined, andare only oneofthe last instancesofoverarching sciences of Man appearinginthe history of theW est, includinge volutionaryb iology,t he studyo ft he Classics,C omteianS ociology and even some interpretationso fp hysiology (see on this Piaget 1970,1-60).A nother interestingr esearch topic-cum-headache couldbethe question aboutwhy,inFrench, thescientist is stillcurrently andhappily called a savant (aswellasascientifique), andinSpanish a sabio (or, only later, "cientifico").N oc omparative history of thew ords cientist in differentl anguages or cultures is at present available,atleast to ourknowledge. 60 Pickstone2000.

AQuestionofRelevance
Instancesofconsistentwaysofconnectingmedical sciencetothe historyofsciences, andusing knowledges (wayso fknowing/making)a salink area lready available.T he question here from am edical-historicalp erspectivei s, however, what wouldwegainfromasystematicand institutionalizedreshufflingofour (contingent, historically constructed) basicc ategories, andw hatw ould we lose? Would thed e-potentiation of ourc ontingentc ategoriesb eara ny advantagea gainst,s ay, ac onstant, reflexive, andc riticalc onsideration of theirm eaning andi ts change over time?W ould we really gain from a new grand narrative to replacet he old, when we canfruitfullyengagewiththe ambiguitiesand changesofthe latter, not simply as object or foundation of ourh istory,b ut as bona fide historiographical problems?E vent he historyo fk nowledget oc omew illh avea si ts foundational narrativethe simplification of averycomplex historical development to the disciplinary neurosis provoked by thei ncompatibility of twop rinciples: Modernism andH istoricism.I st here aw ay outo ft his? What should we take from this escapeless entanglement?

History
Thefinaleofthissurelyincompleteand partialoutline will focusonapointthat we consider essential( although it wasa tb esti ndicated in the above),a nd one that is surprisingly absent from Daston's analysis.Thisproverbialelephantparked outsidet he room is historicity, or,b etter, thes cience of history( Geschichtswissenschaft). Isn'tthiskindo fk nowledge also historically situated andinteractingwith others?H asn'tK uhn'sg ame-changing historicists tancea lsoahistory? Hasn't it come to himt hrough contact with thes cience of hisd ay (ont he oneh and) as well as throughthe influenceand appropriationofschemes andapproaches(most notably thoseofLudwikFleck)comingfromafarawayland, time,and culture 61 ? Wasi tn ot in relation to then atural sciences that theh uman sciences wered efined? Is historyj ustt he past of whatever happenst ohappen, allo ver thew orld or arethere otherhistorical gazes,perhaps incommensurabletoours? Long ago,BenedettoCroce musedthat" everyhistory hasthe characterofcontemporaryh istory," ac haracter it derivesf romt he "practical need,l ayinga tt he bottom of everyhistorical judgement" andanchoring everyhistory "tothe present need ands ituation, in whicht he historical factsr esonate." 62 Withoutn ecessarily having to adoptt he complete paradigm of absolute historicism, we stillf ind much sense in Croce'sd efinitiono ft he historical inquirya sm orally grounded anda ctuallyr ootedi nt he here-and-now,i nacontemporaneousm ind, rather than in theabstract, self-obliviousre-definition of an epistemic space. It is of primary importance to thehistorian,embarking upon so hard ataskasre-consideringt he extent andi mporto fascientific field, to strive ford epth,a sw ella sf or length andb readth.Ani mportant elementi nt hise xercise, as we have suggested in thebeginning,istocontextualize oneselfinthe firstplace.