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Is Medical History Dead?

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04/08/2014

By | The Researcher’s View

Is medical history dead? So suggests Richard Horton, editor of the Lancet, in a recent comment piece (unless you’re a Wellcome Library member you’ll need to register to read it or pay $31.50 to rent the page for a day).

The dead alive! H. Wigstead, 1784. Wellcome Image no. L0031335.

The dead alive! H. Wigstead, 1784. Wellcome Image no. L0031335.

Citing Owsei Temkin’s call to historians of medicine to use their understanding of the past to connect to the present, Horton asserts that Temkin’s successors are falling short: “Most,” he claims, “have nothing to say about important issues of the past as they might relate to the present. They are invisible, inaudible, and, as a result, inconsequential. “The result, Horton believes, is that medical history “is a corpus of activity lying moribund on its way to the scholarly mortuary.”

It is strong physick, and has prompted an appropriately emetic response on Twitter. Carsten Timmermann (@ctimmermann) is among those who have risen to Horton’s challenge to suggest recent books that do precisely what Temkin wanted. And Carsten and others have a point.

Horton cites Helen Bynum’s excellent book Spitting Blood: The history of tuberculosis (which Horton reviewed for the Guardian in 2012) as an ‘exception’, conveniently overlooking the OUP Biography of Disease series, edited by Helen and Bill Bynum, from which it stemmed, and which has helped historicise our understanding of conditions such as breast cancer (Ilana Lowy), obesity (Sander Gilman) and asthma (Mark Jackson). The winner of last year’s Dingle Prize, awarded by the British Society for the History of Science for the best book on history of science, technology and medicine aimed at a wide readership went to David Wright’s Downs: The history of a disability, another volume which emerged from the same series.

Among the books shortlisted for the 2014 Wellcome Book Prize was Emily Mayhew’s Wounded: The long journey home from the Great War, a fine piece of historical research which feels pertinent not just because of the forthcoming centenary, but because of a more recent history which has once again put injured service men and women into the public eye.

Relevance

In fact, compiling a list of examples with which to refute Horton’s charge soon spirals out of the compass of a single blog post. Looking just at recent or current Wellcome Trust-funded projects reveals historians engaging global health practitioners and policy-makers (Sanjoy Bhattacharya in York); or tackling rich and resonant subjects such as the history of stress (Mark Jackson), pain (Joanna Bourke), the emotions (Thomas Dixon and colleagues) and genomic medicine (Steve Sturdy).

The EC-funded project Diseases of Modern Life: 19th century perspectives, headed by Sally Shuttleworth, is another reminder that the conditions we think unique to our present have historical antecedents. And this research can and does have an impact. Virginia Berridge (author of Demons: Our changing attitude to alcohol, tobacco and drugs) is one example of an academic who has used her expertise to inform government current policy by providing a historical perspective on intractable problems.

There is plenty of evidence too of historians engaging more widely with audiences outside of academia, from the Guardian’s H-word blog (co-authored by medical historian Vanessa Heggie and historian of science Rebekah Higgitt) to appearances by Exeter-based expert in Welsh medicine Alun Withey on BBC Six Music.

Nor should we accept at face-value Horton’s assertion that to be meaningful, history of medicine must always speak only to current issues. Just as biomedical science would be immeasurably poorer if every project had to have demonstrable clinical impact, so too there must be space for research that simply enriches our understanding of human history (something which was certainly not alien to Roy Porter, whose untimely passing seems, to Horton at least, to have marked the death knell of history of medicine). Fittingly, last year’s Roy Porter lecture, by Colin Jones, traced the history of the smile in eighteenth-century Paris. The story will be more amply told in his forthcoming book, The Smile Revolution (due in September). Let’s hope that this, at least, might lift the gloom that has enveloped the Lancet HQ.

Author: Dr Simon Chaplin is Head of the Wellcome Library.

Simon Chaplin

Simon Chaplin is Director of Culture & Society at the Wellcome Library.

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9 comments on Is Medical History Dead?
  • Niall Boyce

    04/08/2014

    Just pointing out a factual error: the Lancet piece is free to access with email registration, not behind a paywall.

    Reply

    • Simon Chaplin

      04/08/2014

      Yes, my mistake – have amended the post.

      Reply

  • David Harley

    04/08/2014

    Not only do policymakers, whether or not they are practitioners, notice historical work and cite it in their articles, they frequently notice work directed to historians and work on pre-modern periods.

    It has surely always been the case that writers on medical specialties have begun with an introductory chapter on their subdiscipline’s history. Medical students take courses on the history, sociology or anthropology of medicine.

    Wherever there are historians of medicine working nearby or in the same institution, there has been interaction.

    As an honorary professor at the London School of Hygiene and Tropical Medicine, and at University College London, perhaps the editor of The Lancet should spend time at that model of such interaction, the Wellcome Institute for the History of Medicine. Oh, he can’t. The bureaucrats and professors of medicine who run the Wellcome Trust closed it down.

    Oh well, he can go to the far more modest UCL Centre for the History of Medicine. Oh, he can’t. The Trust has closed it down.

    Reply

    • Silverstein, Arthur M.

      05/08/2014

      Richard Horton’s comment on the ‘failings’ of modern history of medicine appear to echo the politicians’ call for “translational medicine”– the support of research for its present practical value in understanding and treating disease. But he, and they, neglect the many advances that have emerged from the intellectual adventures into the unknown by the scientist (or into the past by the historian). Our present culture rests on that past, and praised be he who explores and exposes it. Finally, anyone who knew Owsei Temkin will appreciate that “connection to the present” was only a small part of the wonder and satisfaction which he derived from his forays into the history of medicine.

      Reply

  • Donald Forsdyke

    07/08/2014

    Actually, if there is a guilty party, it is the doctors themselves. While one can argue about the precise date, in many respects the modern biomedical research system was established in the wake of WWII. The medics and researchers persuaded the general public and the powers-that-be that they had a sufficient grasp of medical history to be able to advise on funding priorities. Take the NIH in the USA for example. At first a large Institute for the History and Science and Medicine (IHSM) should have been surrounded by much smaller institutes for infectious diseases, cancer, etc. A key mandate of the ISHM would be to study the history of medical discovery in order to advise whether it was possible for peer-review committees to predict which of the many proposals it received was likely to best advance the NIH mission (for the UK read the MRC). If it was possible, then what criteria should be employed (e.g. should we fund projects or people)? Given this knowledge, it would then be possible to rationally support the other institutes that, over the years, would have grown in size. Instead, we didn’t just get the cart before the horse, we barely acknowledged the horse’s existence!

    Reply

  • EH

    08/08/2014

    As a practicing NHS doctor with a degree in the history of medicine I can say that at the frontline of medicine it’s history has stopped appearing relevant to the majority engaged in it and certainly academic history of medicine doesn’t penetrate the frontline clinical world…

    Reply

    • David Harley

      05/02/2015

      EH — “academic history of medicine doesn’t penetrate the frontline clinical world…”

      Perhaps because it’s history. The academic history of politics doesn’t look at David Cameron’s leadership. One needs a little distance to assess phenomena historically. Historians of medicine usually look at what WAS the cutting edge and the debates about innovation in the past.

      There are always comparisons to be drawn, but they may well be misleading if a historian tries too hard for “relevance.” Perhaps EH should look at the sociology and anthropology of medicine.

      Reply

  • chris holme

    11/08/2014

    No harm in Richard Horton using the Lancet to stimulate debate. That’s what it is for.
    he first thing any clinician does is take a patient’s history so the notion of history offering wider perspectives is not an alien one.
    Temkin’s comments would be echoed by Osler (his predecessor at Johns Hopkins and just as passionate about history as medicine).
    Anyway, this has reawakened my interest in TB so must read Helen Bynum’s book….

    Reply

  • David Taylor, MD

    13/08/2014

    Richard Horton is one of the people that historians of medicine study; historians do not need their subjects’ approval of their agendas or approaches. As a physician, I do not expect my patients to judge my history-taking and physical examination skills.

    Reply

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