Lung cancer, chronic disease epidemiology, and medicine, 1948-1964

Beginning in the early 1950s, a series of epidemiological, biochemical, pathological, and animal studies demonstrated a link between cigarette smoking and lung cancer. A number of reputable scientists challenged these findings, but for a variety of reasons, including the behavior of the tobacco industry, historians have assumed that these objections were insubstantial and disingenuous. Viewing these objections in scientific and medical perspective, however, suggests that there was a legitimate and reasonable scientific controversy over cigarette smoking and lung cancer in the 1950s and early 1960s. That controversy had important consequences. A new chronic disease epidemiology emerged, transforming the role and importance of epidemiology to medical research. This new epidemiology supplemented Koch's postulates, establishing a statistical method that allowed for linking environmental factors to the etiology of chronic diseases. The 1964 report to the surgeon general, Smoking and Health, represented the denouement and codification of these developments. This reexamination of the scientific controversy over smoking in the 1950s and early 1960s provides an important context for understanding the subsequent public relations battles between the tobacco industry and public health after 1964.     

Appropriate remedial action? medical students, medical schools, and smoking and health education in New York and the United States, 1964-87

The Surgeon General's 1964 report on smoking and health, which declared that cigarette smoking was a cause of lung cancer, is considered a landmark in the history of medicine and public health. This article examines the impact of the report on medical student education by reviewing how the relationship between smoking and lung cancer was presented in medical school textbooks and syllabi between 1964 and 1987, changes in hospital smoking regulations and doctors' attitudes toward smoking following the publication of the report, and medical students' smoking patterns and attitudes toward cigarette smoking in the years after 1964. Although it provided some advanced students with additional insight into mechanisms of pathogenesis related to smoking, the education that many medical students received seems to have been neither a primary influence on their smoking patterns nor an important source of their scientific understanding of the causal link between smoking and lung cancer for at least a decade following the publication of the Surgeon General's report.     

The Emergence of Multiple Sclerosis as a Nosological Category in France, 1838–1868

Neurologists have retold a story about the discovery of multiple sclerosis (MS) in essentially the same form from the 1870s to the present. Upon close analysis this narrative was found to be problematic. Once the nosological category of MS came into existence in 1868, physicians reread the scientific past through this new category and created a linear story. Following generations received this story uncritically, rereading the past through the conceptual lens of their own times. Writers selected the earlier cases, illustrations, and medical writings in the literature for inclusion in the discovery narrative and did not analyze them in their original historical contexts. The author offers an alternative account of the discovery of MS. The creation of the disease category of MS by Charcot in France was the result of several converging factors including a new histopathological technology, a unique relationship between patient and physicians in the clinic, a unique relationship between the clinic and the autopsy room, and a neurological culture emphasizing disease specificity.     

The emergence of multiple sclerosis as a nosological category in France, 1838-1868

Neurologists have retold a story about the discovery of multiple sclerosis (MS) in essentially the same form from the 1870s to the present. Upon close analysis this narrative was found to be problematic. Once the nosological category of MS came into existence in 1868, physicians reread the scientific past through this new category and created a linear story. Following generations received this story uncritically, rereading the past through the conceptual lens of their own times. Writers selected the earlier cases, illustrations, and medical writings in the literature for inclusion in the discovery narrative and did not analyze them in their original historical contexts. The author offers an alternative account of the discovery of MS. The creation of the disease category of MS by Charcot in France was the result of several converging factors including a new histopathological technology, a unique relationship between patient and physicians in the clinic, a unique relationship between the clinic and the autopsy room, and a neurological culture emphasizing disease specificity.