Laboratory science

Labs entered hospital medicine more slowly than public health medicine: “Elite doctors resisted the introduction of new laboratory technique into their practice for the same reason as they resisted specialization: because they reared that such techniques would tend to undermine the personal and individualized social relations around which they built their highly lucrative private practices (18) . . . administrative interests lay behind the introduction of laboratories into increasingly large areas of personal as well as public health practice from the beginning of the twentieth century. . . . In this guise, medical laboratories clearly served administrative interests, being used to discipline and standardize general practice with the aim of creating a routinized system of mass medicine” (20). These “interests” meant that in clinical teaching, concentration on idiosyncrasies of individual patients would be replaced “by more routinized and standardized forms of knowledge that were more in keeping with the administrative demands of state medicine” (21). Efforts to reform medical education in years before WWI (i.e., creating full-time professorship and severing the connection between clinical teaching and elite private practice) “were intimately bound up with proposals for a closer integration of the laboratory sciences into hospital practice, and especially into the practical training of prospective doctors” (21). The “importation of laboratory science” benefited the reform campaign in “contingent ways”: (1) preclinical lab sciences already harbored a body of professional full-time academics; (2) much of the science conducted by academics was “at least in keeping with, and often informed by, administrative interests”; and (3) the lab sciences “provided a model of how the work of the hospitals might itself be reorganized in the interests of greater efficiency” (22. cf. 27 on “contingent outcome”). . . . “the overall effect of the academicization of clinical medicine and the expansion of clinical research, within the new organizational structures of the NHS, was to encourage the growth of more administratively inflected forms of medical knowledge and practice throughout the system. As a class, the new breed of consultants were less concerned than their predecessors to be seen as individual medical virtuosi, and more inclined to identify themselves with the most technically sophisticated and specialized forms of diagnosis and treatment” (25-26). In the case of British medicine, “laboratory science actually developed as an instrument of scientific management. This confluence of science and management lay at the heart of the transformation in British medicine. The world of medicine was remade, not because of science, but through a logic of efficiency that science could be mobilized to confirm” (29).