In the early 1970s, the young MD-PhD student Edward H. Shortliffe started work on his dissertation within Stanford University's Department of Computer Science. His PhD thesis, completed in 1975, involved the development of a computer program called MYCIN, an early expert system that aimed to furnish advice concerning the diagnosis and treatment of bacterial infections. MYCIN immediately attracted wide attention: it matured into a much larger research enterprise at Stanford and spawned larger conversations about whether and how to apply computers to the problem of medical diagnosis. This paper recounts this early effort to computerize medical diagnosis and decision making. It pays particularly close attention to the interrelations among computing, authority, and trust. How could a physician using the system know that its advice was accurate and trustworthy? What did the developers of MYCIN do to make the system's reasoning comprehensible to its human users? If the system's advice could not be understood, what perceived implications would that have for the physician's status as the ultimate decision maker? Such concerns about trust, authority, and comprehensibility animated both the development of and the responses to MYCIN. As artificial intelligence and machine learning are increasingly integrated into modern clinical care, these concerns endure today.

 
 
Since the 1970’s epidemiological measures focusing on “health-related quality of life” have figured increasingly as endpoints in clinical trials. Before the 1970’s these measures were known, generically, as functional measures or health status measures. Relabeled as “quality of life measures” they were first used in cancer trials. They were relabeled again in the early 2000’s as “patient-reported outcome measures” or PROMs, in their service to the FDA to support drug labeling claims. Despite their importance in medicine over the past seventy years, remarkably little historical research has been done on them. This is problematic. First, lacking a historical account, the quality of life literature itself fails to recognize how certain themes have developed, themes that should inform current practice. Second, adjunct literatures, such as philosophy, misappropriate these instruments in terms of quality of life measures originating in economics and development—measures that are more familiar to philosophical analysis.
I begin by discussing their history by linking their contemporary significance to two post-WWII trends: standardization of medical decisions and the autonomy model in medical ethics. I will show how these instruments set themselves apart from other categories of quality of life measurement by their commitment to “capturing patients’ perspectives”. This commitment, evident in high impact journals, policy bodies and funding agencies, creates an interesting tension regarding what it means to be a “measure”. I conclude that this emphasis on patient perspectives affects the ability of researchers to settle epistemic and methodological questions.

From the 1850s onwards, the Parisian Academy of Sciences awarded the Prix Bréant to incentivize all sorts of contributions in the fight against cholera. We use the Bréant archive in order to reappraise an old debate within the History of Spanish medicine regarding the merits of Jaume Ferrán’s anti-cholera vaccine. In 1884, Ferrán, a Catalan physician, claimed to have synthesized in his laboratory a vaccine. It was then widely used in the Valencia 1885 epidemic. A self-proclaimed symbol of progressivism, Ferrán sought national and international recognition in order to develop his treatment. But he was caught in several political controversies that still loom large on the interpretation of his findings. Although Ferrán started applying for the Bréant as early as 1885, it was not awarded a mention until 1907. Spanish historians have interpreted the delay as a sign of a nationalist bias on the part of the French jury. Drawing on the archival materials of Ferrán’s submissions, we suggest a different interpretation in terms of the quality of the data that Ferrán presented. Although the physicians in the jury were not yet familiar with statistical inference, they were already demanding clarity and order in the presentation of data on clinical experiments, a requirement which Ferrán clearly failed to carry out, as we shall see. The jury’s demand for data cleanliness illustrates how a new standard of clinical data management emerged in medicine at the turn of the 20th century.