In Evaluating and Standardizing Therapeutic Agents, Christoph Gradmann and Jonathan Simon add new and important insights into the role of standards in pharmaceutical and medical practice, thus complementing a growing literature concerned with the part played by standards in building communities of scientists from the end of the nineteenth until the middle of the twentieth century. Much of this literature has focused on the standardization of scientific practice in connection with the electrical industry, showing how, in order to communicate new findings and assess their validity, expanding disciplinary communities in the physical sciences depended increasingly on ‘technologies of trust’ (e.g. machines enabling quantitative measurements). This edited volume adds to this literature by gathering essays on the topic of pharmacy and medicine, which have so far received far less attention from historians and philosophers of science. Although physical instruments have also contributed to the standardization of medical practice (as Volker Hess has demonstrated in the case of the thermometer), this volume is concerned with drugs – more specifically, biological therapies – which became a mainstay of medical intervention in the period under study. Like physical instruments, drugs not only contributed to the standardization of medical practice, transforming doctor–patient relationships in the process, they also themselves became standardized. Until the advent of vaccines and sera, the dominant method for standardizing drugs had been the ‘chemical approach’, i.e. either the synthesis or the purification of a substance and the determination of its precise weight – an approach that emerged not from the apothecary's shop, but from the laboratories of the nascent chemical industry, reflecting a shift in the main mode of pharmaceutical production at the end of the nineteenth century. However, the novel biological therapies that were developed in the 1890s could not be weighed in the same manner as chemical compounds. For their quality to be measured and controlled, numerical values had to be assigned to their physiological activity instead. Like the weight of chemical drugs, the measure of physiological activity therefore helped to legitimize the incorporation of biological therapies into the modern therapeutic arsenal, and the techniques that permitted such a measure were later extended to chemical remedies as well.

These changes did not happen in an economic and political vacuum. They occurred against a background of growing state involvement in public health, principally in imperial Germany and other countries of western Europe, where government institutions showed increasing interest in the value of novel therapeutic agents. Hence the concept of Wertbestimmung, meaning ‘determination of value’, is introduced by the editors at the beginning of the book, and its influence on the development of the medical sciences and pharmacy in the twentieth century is explored in several of the volume's contributions. Because of its public-health importance, and the particular production problems it posed, diphtheria antiserum played a pivotal role in this evolution, and is the subject of the first chapters, on the early serum institutes and other producers in specific national contexts (Germany, France and, to provide an example other than that of the two great microbiological pioneers, Switzerland). In her paper on the role of the League of Nations in establishing international biological standards, Pauline Mazumdar also shows that diphtheria antiserum played a major part on the international political scene. Concluding this first part of the book is a chapter by Anne Hardy on the State Serum Institute in Denmark, which was the crucial thread tying together the international standardization project described by Mazumdar. The book then examines how the practices developed for the evaluation of diphtheria antiserum came to serve as a model for biological therapies of other kinds – with more or less success, as in the case of Almroth Wright's therapeutic vaccines, the plant extract digitalin, the sex hormones and the polio vaccines. In that sense, Wertbestimmung also functioned as a ‘boundary object’, helping to communicate knowledge and mediate the interests of a variety of actors well beyond the initial model of diphtheria antiserum. Like electrical units, therefore, standard measures of physiological activity reveal the interpenetration of a wide range of interests, whether scientific, medical, political or economic. Finally, in a postface that extracts common themes from the volume, linking them to studies of recent medical science, Alberto Cambrosio highlights the fact that the essays in Evaluating and Standardizing Therapeutic Agents describe the beginnings of biomedicine (i.e. a ‘direct interaction between biology and medicine’ (p. 262)). This was associated with a new kind of objectivity, referred to by Cambrosio and others as ‘regulatory objectivity’, which has become a constitutive element of modern medical practices and entities (including drug therapies), and at the centre of which standards and standardization have been situated.

In sum, by engaging with concepts such as Wertberstimmung and providing a rich body of empirical evidence on the role of standards in the development of biological therapies, Christoph Gradmann, Jonathan Simon and their co-contributors throw significant new light on the origins of biomedicine in the late nineteenth and early twentieth centuries.