The Routledge History of Disease

Mark Jackson

• Publisher: Routledge
• Year: 2016
• Print ISBN: 9780415720014
• eBook ISBN: 9781134857944
• Edition: 1
• Topic: History
• Subtopic: Social History
• Index: History

The Routledge History of Disease draws on innovative scholarship in the history of medicine to explore the challenges involved in writing about health and disease throughout the past and across the globe, presenting a varied range of case studies and perspectives on the patterns, technologies and narratives of disease that can be identified in the past and that continue to influence our present.

Organized thematically, chapters examine particular forms and conceptualizations of disease, covering subjects from leprosy in medieval Europe and cancer screening practices in twentieth-century USA to the ayurvedic tradition in ancient India and the pioneering studies of mental illness that took place in nineteenth-century Paris, as well as discussing the various sources and methods that can be used to understand the social and cultural contexts of disease.

Chapter 24 of this book is freely available as a downloadable Open Access PDF under a Creative Commons Attribution-Non Commercial-No Derivatives 3.0 license. https://www.routledgehandbooks.com/doi/10.4324/9781315543420.ch24

1

PERSPECTIVES ON THE HISTORY OF DISEASE

Mark Jackson

There is arguably no more important object of historical enquiry than the fluctuating manifestations and meanings of disease. Agents of pain, distress and death throughout the history of the world, diseases have not only reflected the customs, behaviours and lifestyles of populations, but have also in turn impacted on the lives and fortunes of individuals, families, communities, and nations. On the one hand, patterns and experiences of disease have been shaped by the demands of trade, by the import, export and consumption of commodities, by the transport of animals and the migration of peoples, and by the effects of warfare, work and living conditions.¹ Such links between disease and circumstance betray the impact of hunger, poverty, overcrowding, and sometimes leisure and luxury, on health and happiness. On the other hand, the symptoms and consequences of disease have in turn dictated personal and collective destinies, determining the outcome of conflicts, the inheritance of thrones and family estates, and the capacity to impose or resist values, norms and judgements. The designation of certain physical and emotional states as diseases has been used to marginalise, disenfranchise and subordinate sections of the population, to liberate or legitimate particular classes and professions, and to create and protect identities, agency and power.

In spite of our awareness of their historical significance and in spite of unrelenting efforts to prevent, control or eradicate diseases across periods and cultures, disease is difficult to define in either theoretical or practical terms. Diseases are not fixed entities: they change biologically in response to environmental conditions; and they are understood, experienced and responded to in strikingly different ways within different cultural and social contexts. What constitutes a specific disease in one place and time might be disputed in another, reflecting not only contrasting ecological circumstances and lifestyles, but also distinctive theoretical models, cultural values, social and political constraints, technological capabilities, and individual and collective expectations. As economic and political powers have shifted, so too has the locus of authority to name, define and manage disease. From this perspective, the history of disease (and the wider history of medicine) must necessarily be a social and cultural history, one that situates diseases in their immediate and historical contexts rather than privileging disease as a category external to, and unmediated by, social conventions and material conditions.²

Explanations, experiences and patterns of disease have directed the focus of historians of medicine as well as the efforts of biomedical scientists, governments, charities, and health-care services. The impact of disease on historical scholarship can be understood, in the broadest possible sense, as political. Both Allan Brandt and Virginia Berridge have emphasised the manner in which the challenges and fears created by the AIDS epidemic transformed the history of medicine as much as they changed the aspirations and paradigms of public health.³ Similarly, the accelerating epidemiological shift from infectious to non-infectious degenerative disease across the twentieth century encouraged a turn towards histories of the chronic scourges of modern populations, such as cancer, heart disease, allergies, diabetes, and arthritis, which together accounted for an increasingly large proportion of illness and death particularly in industrialised regions of the world.⁴ Like scientists and doctors, then, historians of medicine are clearly influenced by the ‘questions, approaches, and concerns’ of the present, as much as by those of the past.⁵ The link between disease and historical research can also be personal. As the prefaces and acknowledgements of many scholarly monographs testify, an historian’s choice of subject, period and place is often, perhaps necessarily, dictated by their own experiences and interests as well as by a spectrum of contemporary medical and political concerns.⁶

Disease has occupied a pivotal place in most histories of medicine. In some cases, a relatively well-recognised disease has been the explicit focus of analysis: fine studies exist of diseases as diverse as cholera, smallpox, salmonella, plague, tuberculosis, lung cancer, malaria, polio, silicosis, leprosy, diabetes, gout, syphilis, madness, haemophilia, breast cancer, influenza, sickle cell anaemia, mania, and AIDS.⁷ Although there are methodological and conceptual challenges posed by writing histories of what are generally regarded as distinct and discrete diseases,⁸ the best studies move beyond naïve notions of diseases as natural categories to explore the manner in which the naming and framing of diseases have been social and cultural enterprises that carry significant personal and political weight. In other histories of medicine, disease lingers either abstractly or concretely in the shadows of studies that have focused more directly on the processes of medical professionalisation, the development of state and charitable welfare services, the rise of national institutions and international health agencies, the politics of imperialism, and the impact of economic and environmental inequalities on health and well-being in a variety of geographical, cultural and chronological settings.⁹ Written from an alternative perspective than more intentional histories of disease, these studies too reveal the contingent and contested nature of medical knowledge, health policies, clinical practices, and patient experiences.

Although much has been accomplished by historians tracing and situating patterns of disease in the past, there remain significant empirical, conceptual and historiographical challenges to the historical reconstruction of models, patterns and experiences of disease. In a provocative essay intended to set out a methodology for exploring the interlinkages between biology and culture in histories of disease, Charles Rosenberg pointed out some decades ago that we ‘need to know more about the individual experience of disease in time and place, the influence of culture on definitions of disease and of disease in the creation of culture, and the role of the state in defining and responding to disease’.¹⁰ As the chapters in this volume testify, in the intervening years historians have energetically addressed many of the substantive questions raised by Rosenberg. In particular, scholars have begun critically to utilise a richer array of sources, including case notes, personal correspondence, memoirs and visual media, in order to reveal the expectations and experiences of patients and their doctors and to integrate patient narratives into broader contextual studies.¹¹ Yet, in spite of successful engagement with much of Rosenberg’s research agenda, historians have remained divided on an appropriate or consistent conceptual approach to writing histories of disease. While individual contributions in this volume give witness to the depth and diversity of recent scholarship, the aim of this introduction is to establish some of the key historiographical perspectives that have dominated the field in order to provide a framework for engaging with the substantive studies that follow.

Framing histories of disease

Histories of medicine and disease have always been methodologically diverse. Older, more traditional histories of medicine tend to regard disease as a stable ontological category, determined by immutable biological characteristics and largely unaffected by shifting social and cultural contexts. In Disease and History, for example, first published in 1972 and appearing in a revised form in 2000, Frederick Cartwright and Michael Biddiss explore ‘some of the many maladies which have afflicted the world’ in order to ‘illustrate their effect not only upon historically important individuals but also upon peoples’.¹² In a sweeping narrative that stretches from the ancient to the modern world, the authors trace in turn the roles of the Black Death, syphilis, smallpox, typhus, cholera, tuberculosis, malaria, haemophilia, ‘mob hysteria’ in Nazi Germany, and AIDS in shaping major military, political, colonial, and social events. Cartwright and Biddiss’s approach is not without its merits: written evocatively for a general audience, it effectively situates health, medicine and disease within a rich tapestry of historical continuities and change, reminding historians of medicine to engage fully with the social, political and economic histories of their period.

There are, however, limitations to this approach. In the first place, many broad essentialist histories of medicine, like Disease and History, focus almost exclusively on the impact of human disease on Western societies, ignoring vast regions of the world in which animal and human diseases were manifest, experienced and understood in different ways. Secondly, such histories sometimes adopt judgemental tones in their evaluation of past practices and behaviour. Cartwright and Biddiss, for example, too readily dismiss Galen’s ‘huge collection of noisome and useless remedies’ and blame the modern resurgence of syphilis in Britain and North America unproblematically on ‘the sheer carelessness of young people’ during the 1960s, without reflecting more closely on the contextual determinants of either clinical efficacy in ancient Greece and Rome or sexual behaviour in the modern world.¹³

More significantly, however, in the present context, such works display a tendency to retrospective diagnosis, that is, a propensity to project current scientific knowledge onto the past without considering contemporary diagnostic fashions and disputes. Used either to diagnose the diseases of great men, such as Socrates, Beethoven, Napoleon, George III, Charles Darwin and Frederic Chopin, or to establish continuities in the aetiology and pathology of what are regarded as singular diseases, retrospective diagnosis has been widely criticised by social historians of medicine. Both ‘pathographies’ of individuals and ‘biographies’ of disease have been dismissed as populist and presentist accounts of the past, as insufficiently attentive to change across time, or as forms of unsubstantiated anachronistic speculation. There is some truth in these accusations. Retrospective diagnosis certainly carries ontological and epistemological dangers, serving to reduce illnesses to biological categories alone, to reify and venerate current diagnostic nosologies, and to ignore the cultural contexts of health and disease.¹⁴

Yet, retrospective diagnosis need not be as antithetical to the disciplinary conventions of history as critics have suggested. History is retrospective: we write about the monarchy, the Crusades, the working classes, the Church, the Labour party, fascism, the media and colonialism in the past and present as if these labels and concepts too have some categorical continuity and stability across time and without forever needing to question or qualify subtle (or even manifest) semantic and structural shifts. Historians regularly impose present knowledge on past beliefs and experiences, and the impacts of subjective personal perspectives are often explicitly acknowledged by scholars. To argue that retrospective diagnosis prioritises biological knowledge of disease at the expense of objective ‘historical understanding’, as some scholars have insisted, is a disciplinary conceit: the history of medicine is no less ‘historically fashioned’ or less subjective than the modern science and medicine that historians often wish to denigrate.¹⁵ Perhaps more importantly, however, critics of retrospective diagnosis restrict the potential for history to help answer pivotal questions about continuities as well as change: How do we account for the adoption of shared languages of disease in different periods and different cultures? How do we explain commonalities (as well as differences) in experience, of breathing difficulties, pain and mental distress for example, across time and space? And how do we understand bio-archaeological evidence that demonstrates the presence in skeletal remains of m...

Table of contents

• Cover Page
• The Routledge History of Disease
• The Routledge Histories
• Title
• Copyright
• Contents
• List of Illustrations
• Notes on Contributors
• Acknowledgements
• 1 Perspectives on the History Of Disease
• Part I Models
• Part II Patterns
• Part III Technologies
• Part IV Narratives
• Index