Focus: between and beyond "histories of science" and "histories of medicine". Introduction.

Historians tend to treat science and medicine as having developed in parallel, and we maintain separate societies and journals, often giving primacy to science, at least for intellectual history. Yet much of "science" before circa 1800 was dependent on the organizations of medicine, and much of science now is promoted for the improvement of medical diagnoses and therapies. This Focus section unpicks some of the historical and historiographical relationships, recognizing the present prominence of biomedicine and the diminishing utility of distinctions between science, medicine, and technology.

Sketching together the modern histories of science, technology, and medicine.

This essay explores ways to "write together" the awkwardly jointed histories of "science" and "me dicine"--but it also includes other "arts" (in the old sense) and technologies. It draws especially on the historiography of medicine, but I try to use terms that are applicable across all of science, technology, and medicine (STM). I stress the variety of knowledges and practices in play at any time and the ways in which the ensembles change. I focus on the various relations of "science" and "medicine," as they were understood for a succession of periods--from mainly agricultural societies, through industrial societies, to our biomedical present--trying to sketch a history that encompasses daily practices and understandings as well as major conceptual and technical innovations. The model is meant to facilitate inquiry across topics and across times, including those to come.

Early dialysis in Britain: Leeds and beyond.

In parallel with the experience in most countries, early clinical experiments with dialysis in Britain did not lead to general adoption of the treatment. After a decade, dialysis for acute kidney failure was re-established at Leeds General Infirmary under the direction of Dr Frank Parsons, who had been inspired by Dr John Merrill in Boston. The intervening period was not characterized by indifference to kidney failure, but was devoted to defining acute kidney failure and successfully applying "conservative" measures, such as dietary regimens based on the scientific understanding and teaching of the time. The circumstances influencing the start of dialysis therapy at Leeds in 1956 and subsequent events up to the early 1960s are discussed in relation to the national medical scene.

Working knowledges before and after circa 1800: practices and disciplines in the history of science, technology, and medicine.

Historians of science, inasmuch as they are concerned with knowledges and practices rather than institutions, have tended of late to focus on case studies of common processes such as experiment and publication. In so doing, they tend to treat science as a single category, with various local instantiations. Or, alternatively, they relate cases to their specific local contexts. In neither approach do the cases or their contexts build easily into broader histories, reconstructing changing knowledge practices across time and space. This essay argues that by systematically deconstructing the practices of science and technology and medicine (STM) into common, recurrent elements, we can gain usefully "configurational" views, not just of particular cases and contexts but of synchronic variety and diachronic changes, both short term and long. To this end, we can begin with the customary actors' disciplines of early modern knowledge (natural philosophy, natural history, mixed mathematics, and experimental philosophy), which can be understood as elemental "ways of knowing and working," variously combined and disputed. I argue that these same working knowledges, together with a later mode-synthetic experimentation and systematic invention-may also serve for the analysis of STM from the late eighteenth century to the present. The old divisions continued explicitly and importantly after circa 1800, but they were also "built into" an array of new sciences. This historiographic analysis can help clarify a number of common problems: about the multiplicity of the sciences, the importance of various styles in science, and the relations between science and technology and medicine. It suggests new readings of major changes in STM, including the first and second scientific revolutions and the transformations of biomedicine from the later twentieth century. It offers ways of recasting both microhistories and macrohistories, so reducing the apparent distance between them. And it may thus facilitate both more constructive uses of case studies and more innovative and acceptable longer histories.

Contested cumulations: configurations of cancer treatments through the twentieth century.

The treatment of cancer through the twentieth century may be seen as the successive addition of modalities: first surgery; then radiotherapy, especially between the world wars; and then chemotherapy, from the 1960s. This paper explores some of the systematic differences between the modalities, and how these additions were negotiated in different countries, with different long-term consequences for the development of services and specialization. It focuses chiefly on the United Kingdom and the United States, the former exemplifying a centralized health polity, and the latter, liberal markets combined with large and crucial postwar inputs from government. The differences between health polities were especially important for interwar radiotherapy, which in its centralized form appeared as paradigmatic of the analytical/rationalizing mode in modern medicine. Chemotherapy exemplified a more inventive and experimentalist mode that became common after World War II, and that, through the practice of trials, shaped the new subprofession of medical oncology. The interactions of the modalities, at various levels, are modeled as contested cumulations showing strong path dependency. The paper ends by reviewing the present situation, especially for Britain, and by underlining the relevance of history.