Medical History

Ian Miller

• Publisher: Bloomsbury Academic
• Year: 2018
• ISBN:
  9781350307544
• Edition: 1
• Topic: Geschichte
• Subtopic: Historiographie

This introductory textbook presents medical history as a theoretically rich discipline, one that constantly engages with major social questions about ethics, bodies, state power, disease, public health and mental disorder. Providing both instructors and students with an account of the changing nature of medical history research since it first emerged as a distinct discipline in 19th century Germany, this essential guide covers the theoretical development of medical history and evaluates the various approaches adopted by doctors, historians and sociologists. Synthesising historiographical material ranging from the 19th to 21st centuries, this is an ideal resource for postgraduate students from History and History of Medicine degrees taking courses on historiography, the theory of history and medical history.

1History of Medical History

What does medical history mean to different people? Who should write it – doctors or historians? Is it purely an academic exercise or can it have practical uses for doctors and patients? Since medical history first emerged as a distinct discipline in the mid-nineteenth century, these questions have been heavily debated. Issues of ownership and authority have permeated discussion on the purpose and function of analysing medicine’s past. In many respects, medical history differs from other types of history. Breaking beyond the confines of humanities research, medical history sits, sometimes uncomfortably, at the intersection between historical research and medical practice. It is actively pursued by historians, doctors and amateurs alike, researchers with different aims, needs, agendas and perspectives. This also raises questions about audiences. Who should medical history be written for? Whose needs should it serve: doctors’, patients’, policy makers’, historians’, the public’s?

This capturing of medical history by an assortment of researchers has bred considerable methodological and theoretical diversity. Researchers currently use various conceptual resources: cultural histories of the body, historical epidemiology, social constructionism, feminism, post-colonial theory, autobiographical analysis, to name but a few. Amid this methodological diversity rests a persistent tendency among social historians of medicine to discount histories written by doctors as Whiggish, positivist and triumphalist. They see internalist, practitioner-written accounts as haplessly led by a simplistic urge to present the medical past as a linear tale of constant discovery, advancement and innovation. Undoubtedly, tendencies exist for doctors to pick up their pens and write history books that lack the deep levels of contextualisation and reflection preferred by most historians. But is their work really of lesser value than that of the humanities-trained scholar? Or is it perhaps the case that medical history means something different to the author-practitioner who might view history as a somewhat indulgent pursuit when faced with the day-to-day urgencies of hospital life?

When I first commenced doctoral research into the history of gastric illness at the University of Manchester in 2006, I was unexpectedly confronted with competing views on the paths which my research should follow. Funded by a prominent gastroenterologist but supervised by a prestigious group of medical historians, these rifts and competing perspectives immediately became clear. The gastroenterologists thought that the best course would be for me to chart the epidemiological spread of gastric ulcer disease over the nineteenth and twentieth centuries to shed light on the aetiology of the condition and potentially aid present-day diagnosis; the medical historians saw greater value in elucidating the social and cultural meanings of gastric ulcer disease over time. The gastroenterologists wanted me to explain what they saw as a very real rise in gastric ulcer disease incidence between around 1850 and 1950 (then followed by a sharp, unexplained decline); the historians encouraged me to question the nature, even the reality, of that rise and fall by considering how diagnoses were formed and how changing medical structures may have impacted on the process of diagnosis. The gastroenterologists were enamoured by (who they termed) their ‘fore-fathers’, the great surgeons who had advanced knowledge of gastric conditions; the historians more interested in matters such as patients, power relations, the socio-cultural meanings of the abdomen, the lived experience of the stomach.

In the early 2010s, two very different books about stomachs emerged. In 2013, prominent gastroenterologist Hugh Baron published his The Stomach: A Biography. Despite the title, Baron didn’t really write a biography of the stomach per se but instead focused mainly on the doctors and surgeons who treated stomach complaints in the past and the actual incidence of stomach problems over an ambitious 4,000-year period.¹ The book was undoubtedly of interest to clinicians, particularly gastroenterologists, seeking information on how particular operations had developed or the numbers of patients recorded as having suffered or died from gastric problems historically. But it was of far less interest to academic historians, not least because it seemed to present medical activity as somehow separated and detached from the social, cultural and political milieu in which it was performed. My own book on the subject, A Modern History of the Stomach: Gastric Illness, Medicine and British Society, c.1800–1950 (2011), inspired more by social history of medicine methodologies, came across matters such as the ethical problems posed by using stomach tubes to force-feed suffragette hunger strikers between 1909 and 1914; the problematic, painful procedures performed on un-anaesthetised animals by late-nineteenth-century physiologists seeking to decipher new information on the workings of the stomach; and the over-ambitious nature of late-nineteenth-century surgical operations. In the misguided hope of curing the rather mundane problem of indigestion, it transpired that a number of surgeons had entirely removed stomachs from some patients, most of whom subsequently died. Rather than having simply advanced, the path towards securing professionalism within medicine seemed to have been fraught with difficulties, problems and controversies.

Not that my book was by any means entirely intent on criticising doctors. It also sought to demonstrate that ideas about stomach problems were always inflected by the particular socio-cultural contexts in which they were experienced and treated. It transpired that the Victorians had developed an obsession with the stomach and its problems, particularly indigestion, which I interpreted as a reflection of broader socio-cultural concerns about changing dietary habits in an urbanising society, marked by the rising consumption of processed and imported foreign foods. Similarly, I interpreted concern about rising levels of perforating stomach ulcers during air raids in Second World War London as a manifestation of new ideas in the 1940s about stress and psychosomatic disorders.² The history of the stomach seemed to be saying something about the history of British society itself; as one reviewer in London Review of Books suggested, ‘a history of the stomach really does work as a site for understanding how we’ve come to think about minds, bodies and modernity’.³

The clinical value of my book amounted to somewhere near zero. Presumably no lives had been saved simply because I had taken it upon myself to advance academic knowledge of a subject as obscure as Victorian indigestion. But the endeavour proved not altogether meaningless. What followed included interview requests with BBC Radio 4 to help explain why British politicians were suffering crippling stomach problems during the 2015 general election; citations by human rights scholars using my research to address ongoing ethical issues in hunger strike management; an article in the New Yorker entitled ‘Our Stomach Obsession, Then and Now’ which compared Victorian ideas on the brain–gut relationship to those of present-day medical scientists; even requests for information from online food magazines and food companies interested in recreating the traditional Ulster fry-up. If a subject as obscure as the history of the stomach could find such diverse appeal and cultural usefulness (if not clinical utility), then it follows that medical historians studying much grander subjects that touch upon race, gender, class and politics have much to contribute, not necessarily to the clinic, but certainly to society, culture, even politics.

Which approach, then, is most valuable? Medical approaches contain greater possibilities for extending clinical knowledge but historical perspectives bring to life the human, social and cultural aspects of medicine which often matter considerably, or at least prove interesting, to patients and people. To address this question, this introductory chapter outlines the different meanings which medical history has had for particular individuals and groups as a means of better understanding the points of contestation. It ultimately presents medical history as a multifaceted field with various, sometimes competing, uses and meanings: clinical, social, cultural, political. The chapter also provides a chronological backdrop to the various theories, debates and problems that the reader will encounter while perusing the remainder of this book.

▶Origins of medical history

In their 2004 study, Locating Medical History: The Stories and their Meanings, Frank Huisman and John Harley Warner asked: are ‘traditional’ medical histories written by doctors really all that bad? Or have social historians of medicine unfairly caricaturised histories written by practitioners as deficient?⁴ Whatever the answer, Huisman and Warner’s study made clear that much practitioner-written medical history was theoretically and conceptu-ally richer than is often assumed. Medical history first emerged in its modern form in nineteenth-century Germany and was spearheaded initially by medical practitioners. German physician Kurt Sprengel (1766–1833) is conventionally termed the ‘founder of modern medical history’. Born in Boldekow (in present-day Germany) in 1766, Sprengel moved to Halle in 1785 where he developed strong academic interests in both history and medicine. In 1788, he received an academic appointment and progressed to the post of Professor Extraordinarius just a year later. Sprengel was heavily influenced by a broader Enlightenment belief in the potential usefulness of studying medical history to understanding epidemiological patterns and the causes and effects of disease more generally.⁵

Sprengel kick-started a number of trends in practitioner-led medical history. Firstly, he believed that medical history should ideally have pragmatic utility for doctors. He resolutely believed that physicians could (and should) learn from the past to advance medicine.⁶ By looking to the past, Sprengel aimed to improve current knowledge. Accordingly, his historical research agendas were always attuned to the needs of his time. For instance, he took a deep interest in the Greek physician Hippocrates whose belief in the healing power of nature mirrored the idea, popular in the eighteenth century, that the physician’s main role was to support nature’s healing power.⁷ However, by promoting a pragmatic, clinically orientated medical history, Sprengel limited the potential topics that the medical historian could explore. Secondly, and importantly, he strengthened a sense that doctors needed to retain intellectual authority over their own past and protect it from the inquisi-tiveness of outsiders, planting the seeds of a tradition that still held sway in the twentieth century.⁸ But this undermined the value of humanities scholarship in making sense of medicine’s history. Thirdly, it was Sprengel who first offered a model that framed medical history as constant progress – an approach that saw medicine as ever advancing and improving, a progressive, intellectual endeavour marked by constant discovery.⁹ At the time, this undoubtedly served professional purposes. To write the history of one’s own past helped nineteenth-century doctors to professionalise at a time when they were striving to improve their social standing. However, it excluded other ways of interpreting medicine’s past and undoubtedly encouraged a deep-rooted bias. From the outset, then, a tradition emerged among doctors of using the medical past as a clinical resource, preserving the discipline for the profession and seeing linear progression where complexity and depth had undoubtedly existed.

The basic thrust of Sprengel’s approaches proved influential. Later in the century, German psychiatrist Heinrich Damerow (1798–1866) argued that physicians unaware of their own history would always have to discover everything anew and remain prone to making unnecessary mistakes.¹⁰ Although Damerow was attentive to the socio-cultural aspects of medicine, he was also pragmatic; he hoped to predict future trends by exploring past ones. Intriguingly, he predicted that psychiatry would become the most promising and important medical science of the future which, perhaps to some extent, it did. Notably, like Sprengel’s, Damerow’s model was evolutionary in nature; his understanding of history was based on ideas of constant development and progress towards a goal of enhanced perfection.¹¹ ‘The history of medicine’, explained Damerow, ‘is like a living organism and has an inner spiritual force which directs its development through time and space’.¹² Adopting an equally pragmatic approach, Berlin professor Justus Hecker (1795–1850) presented historical pathology as an invaluable epistemological tool. He argued that present-day disease trends could be better understood, even predicted, by investigating historical epidemiological trends. Among his achievements, Hecker popularised interest in the plague or ‘black death’.¹³

Despite such an active start, the German medical community soon lost interest in medical history. Between around 1860 and 1890, medicine became increasingly scientific and empirical. This was a period of rapid advances: the discovery of germs, the rise of laboratory medicine, more effective public health initiatives. Medical science became increasingly orientated around the laboratory, a space where germs, cells and diseases could be scientifically analysed. As medical knowledge became increasingly accurate, the medical past began to look suspiciously like a long list of errors and mistakes. What use, then, did it have for the new breed of medical scientists? Why scrutinise the past for knowledge when the microscope was providing far more fruitful results? The history of medicine was swiftly deemed antiquarian and indulgent in light of the scientific progresses being made in laboratories and clinics.¹⁴ The idea that medical history could be pragmatic was severely undermined. Nonetheless, there was no corresponding weakening of the idea that medicine was ‘evolving’ and that only doctors were equipped to write about its history. For Carl Wunderlich (1815–1877), an important figure in clinical thermometry, the only acceptable type of medical history was that which legitimated the emerging medical science by docu-menting its rise, celebrating its achievements and bolstering its self-confidence.¹⁵ This was an approach with clear ideological and self-serving professional agendas, one that helped to legitimise a particular worldview in which medical science was ascendant (all the more important in an era when religious perspectives to the body and its health were beginning to give way to secular and scientific perspectives). This was a type of medical history intended to support and legitimate the growing social status of late-nineteenth-century doctors.

By 1900, medical history had, for the most part, lost its pragmatic edge. However, a small group of doctors continued to promote nuanced agendas for medical historical research including Julius Pagel (1851–1912), Max Neuburger (1868–1955) and Karl Sudhoff (1853–1938). They sought to create a new discipline that retained strong ties to medicine but which used research methodologies drawn from the humanities. Both Neuburger and Pagel believed that historical analysis could be useful to medical practice but refused to restrict themselves solely to that agenda. They also infused their writings with a strong interest in medical culture.¹⁶ Pagel explored themes and issues often neglected by earlier researchers: religion, law, art, even female practitioners (the latter being unusua...