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"Ways of writing. How physicians know, 1550-1950"

Final Report Summary - PAPERTECH (Ways of writing. How physicians know, 1550-1950)

You don’t know how physicians know? We do. That is because we have studied the primary medium in which medical knowledge – like much of modern knowledge – occurs, namely, writing and its organization and reorganization on paper. Note-taking, copying, compiling; cutting and pasting; sorting into lists and tables of all kinds; filling in forms and extracting from them: these are techniques of mastering the human and natural world on and by paper. They do more than organize. They define objects of attention, structure observation, and enable judgment and generalization.
Paper technology: that is what we studied over the five centuries from bedside medicine in the Renaissance to the digital repositories of modern medicine. This collaborative research project was designed and led by Volker Hess (Charité University Medicine Berlin) and Andrew Mendelsohn (Queen Mary University of London). Research was conducted on hundreds of books and hundreds of other printed sources in six languages and on archival material in seven European countries and North America. Manuscripts, notebooks, and files from courtrooms, hospital wards, physicians private and public offices, health boards, and insurance organizations were analyzed for understanding these deceptively simple, flat tools that comprise a sprawling, evolving technology of knowledge. We aimed to learn how paper technology works, how human beings know and deal with the physical world through operations of pen and paper.
These aims were realized with three achievements. (1) Focusing strategically on physicians’ manifold duties and interests in and beyond healing, we showed that knowledge and practice operated in areas as disparate as bureaucracy, bedside patient examination, juridical proceedings, and natural history through a limited set of basic ways of writing, or written rational practices of observation, information, evaluation, and generalization. (2) The project was able to build foundations for a new history of medicine and knowledge. The focus on paper technology in the longue durée (Braudel) revealed centuries-long continuities across standard periods, “revolutions,” and premodern/modern divide. (3) We showed that how physicians know and how aspects of society work – case by case – are the same activity looked at from two sides. Each problem tackled by physicians (alongside others) was at once social and epistemic – and became, in the hands of physicians, knowledge-producing. Neither “science” nor “society” was the “context” or “construction” of the other. Being in society was epistemically productive, contrary to the standard view that carving out separate spaces makes science possible. Ours may be one way of conceptually extending and empirically expanding and deepening what “co-production,” actor-network theory, and other work beyond “context” and “construction” studies share.
Contrary to the subtle technological determinism of media studies and media history, we showed through dozens of detailed studies as well as collective volumes ranging across centuries that media technology is itself also social relations, forms of organization and regulation, political and economic values. Through dual or multiple use of, say, tables or files, and through transfer across domains by multifunctional figures like doctors, this leaves plenty of room for unintended, sometimes momentous media effects.
Knowing in cases was at the project’s center. We went beyond recent research attributing the social and epistemic function of cases to their narrative form. Our detailed studies suggest it may be precisely because cases are at once epistemic and social and practical – and narrative form has a part in this functionality – rather than because of virtues of narrative form as such that doctors are still “telling stories,” even in the digital age.