A further introduction to the History of Medicine

Philippa Kaina, a first year medical student at Barts and the London, recounts her experiences of the ‘Introduction to the History of Medicine’ course run by the Wellcome Library and Society of Apothecaries .

Engraving of a bust of the Greek physician Hippocrates (from EPB 28843/B/1, Wellcome Library)

The three-day ‘Introduction to the History of Medicine’ course came as welcome relief from my Spring break revision on the anatomy of the nervous system. The course took the form of a series of lectures tracing the development of this history. This begins with its ‘founding father’ Hippocrates whose legacy is still in evidence today. Although newly qualified doctors no longer swear by the Hippocratic Oath, the General Medical Council’s ethical code of practice to which medical professionals must abide, is close to that set down by Hippocrates almost two and a half thousand years ago.

As Prof Bill Bynum explained Hippocrates’ holistic understanding of health and disease paved the way for the development of humoral theory, the notion that the body’s four humours – and their respective excess or deficiency – were responsible for the patient’s state of health or disease. Humoralism held sway over the Middle Ages and permeated all aspects of daily life. This is evident in the Regimen Sanitatus (a genre of literature comparable to the ‘healthy living’ books so popular today) which dispended dietary and lifestyle advice. These make interesting reading: those with a melancholic disposition are advised to take exercise out of doors and partake in gardening, whilst the phlegmatic patient is advised to steer clear of lettuce in order not to exacerbate his condition further!

Today, this all seems like a rather esoteric basis on which to ground medical practice and the practices associated with humoralism such as bleeding and purging, are now entirely discredited, if not condemned as downright barbaric. Nevertheless, it is important to understand that these physicians were working according to entirely different systems of knowledge regarding the origins of disease and that humoralism represented a perfectly rational modus operandi that they and, importantly, the patients they treated, believed in.

Andreas Vesalius. Woodcut, 1543, after J. S. van Calcar (Wellcome Library No. 9397i)

Basing their diagnosis on the outward manifestations of illness and disease observed the ‘bedside’, the humoral physician had very little knowledge of the ‘inside’ of the body and its visceral functions. Although anatomy is central to the medical curriculum today, this was not always the case. This began to change with Andreas Vesalius, whose De humani corporis fabrica (1543), attempted a systematic investigation of human anatomy. Containing detailed drawings of the dissected human body it can be seen as an early from of medical text book.

It was the development of anatomical knowledge and its basis on the empirical study of the human body which paved the way for many important physiological discoveries.  Key here is William Harvey’s treatise on the integrated nature of the circulatory system (before this venous blood thought to originate in the liver). Harvey arrived at his conclusions through empirical experiment and investigation, a modus operandi that remains the fundamental basis of scientific enquiry to this day.

Another key shift in the development of medical practice took place in the nineteenth century – towards a more ‘localized’ understanding of disease. This emerged from the Paris hospitals set up to care for the casualties of the revolution. It was context that a systematic physical examination of the patient developed in order to locate the precise locus of their illness (it was in this context that the stethoscope was invented) and is a procedure that is taught to medical students learning clinical skills to this day.

The western medical tradition is by definition a male dominated discourse where the female body has most often figured as a passive object of investigation – as embodied in the figure of the hysteric, subjected to various (to modern eyes) bizarre treatments throughout the ages. It was therefore interesting therefore to see how some speakers highlighted the agency of women in this narrative. It was usually the woman of the house who would take responsibility for the health and wellbeing of her family. Helen Wakely showed us examples from the Wellcome’s collection of home recipe books which list ingredients for preparations as diverse as emetics, detox drinks, cough linctus and haemorrhoid treatments! Although circulating within the domestic context, these recipes are based on dialogues with physicians, apothecaries and contemporary medical literature.  Professional medical training was of course off limits to women until well into the nineteenth century. The situation today is now very different, with females now representing 55% of the medical school intake each year (although still remaining underrepresented at the highest levels).

The Physick Garden, Chelsea: viewed from the river, showing water gate, mooring posts and steps. Wood engraving by W. J. Palmer (Wellcome Library no. 20775i)

Many of the lectures were held in the rooms of the Worshipful Society of Apothecaries. Surrounded by their magnificent collection of porcelain apothecary jars, which originally contained exotic ingredients sourced from all corners of the earth, this setting really helped to bring the content of the lectures alive.  We also visited a range of museums and collections associated with London’s rich medical history. We visited Chelsea Physic Garden, established by the Society of Apothecaries in the seventeenth century for the study of medicinal plants. At the Old Operating Theatre our guide Sue Weir recruited members of our group to recreate nineteenth-century scene of amputation. Surrounded by onlookers, and dosed only with a tot of brandy, the patient would be held down by a pair of burly students while the surgeon set to work. Examining the glass cabinets at the Hunterian Museum at the Royal College of Surgeons we peered at the weird and wonderful pathology collection of John Hunter including pickled foetuses in jars and the skeleton of a 7’ 7” giant! And at the Science Museum we were given a glimpse into the diversity of the Wellcome collection showing us tattoos on preserved human skin (originally collected by a French doctor).

Dragging myself back to the library after the course had finished was not an easy task. But whilst the immense of amount of information that medical students must take on board during their training is something that we perennially bemoan, the History of Medicine course gave me a new insight into the development of this knowledge that we are fortunate enough to be able to take for granted.