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Understanding the History of Medicine
- David Wootton (30 March 2007)
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Do we ever learn from history?
- M Justin S Zaman (27 April 2007)
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Haiku for Doctors, Too
- Hugh Mann (13 March 2008)
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David Wootton, Professor of History University of York YO10 5DD
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Balaji Ravichandran says that Andrew Cunningham, in his BBC Radio series "The Making of Modern Medicine," "tries to make sense of the past in its own terms." This is what historians generally try to do, and it makes perfect sense if you are interpreting social behaviour. But if you apply this approach systematically to the history of medicine you end up with the view, put forward in all seriousness by Bruno Latour, that to say that the pharaoh Ramses II (d. 1200 BC) died of tuberculosis is as anachronistic as to say that he died of machine gun fire -- the tuberculosis bacillus, after all, was discoverd by Robert Koch in 1882, just as the machine gun was invented by Gatling in 1861. As Ravichandran recognizes, my book, Bad Medicine: Doctors Doing Harm Since Hippocrates adopts a different approach: I take it for granted that tuberculosis existed before Koch discovered it. Let me give an example of the difference this makes. In 1868 (the year after Lister published on antiseptic surgery) John Hughes Bennett, a professor of medicine at Edinburgh, published an article demonstrating that the whole approach of Pasteur and Lister was misconceived: he reported experiments that "proved" that germs generate spontaneously, so one could never create a germ-free environment. In his own understanding, Hughes Bennett (who was a serious scientist -- he discovered leukaemia) had disproved the germ theory of disease. In our understanding, on the other hand, Hughes Bennett had failed adequately to sterilize his experimental apparatus. If we want to know what really happened we need to use our own science; if we try to understand the past in its own terms we will never make sense of it. Proponents of the "make sense of the past in its own terms" school advocate "charitable interpretation", but there are limits to charity in a case like this: no amount of charitable interpretation will make Hughes Bennett right and Pasteur and Lister wrong. Historians of medicine thus have a simple choice: on the one hand you can understand the past in its own terms (in which case Hippocrates and Galen saved lives), or on the other you can understand the past in the light of modern science (in which case they killed much more often than they cured). Most historians try to fudge the issue, but Hughes Bennett versus the germ theory of disease is a straight choice that can't be fudged. How do they get around the problem? By leaving Hughes Bennett out of the "unreflective popular celebratory history" that Ravichandran rightly finds unsatisfactory. Competing interests: None declared |
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M Justin S Zaman, Research Fellow in Epidemiology and Honorary Specialist Registrar in Cardiology University College London, WC1E 6BT
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Does the study of history of medicine have any practical application bar intellectual self-satisfaction? Studying recent medical history in developed countries may be of much use to those who are approaching their own 'history' in the developing world, rather than studying medieval practice. I speak in ignorance, and in a desire to find out more of the utility of 'history of medicine' Do we ever learn from history? What if history were right in front of us? The increase in the prevalence of chronic, non-communicable diseases in now-rich countries from the start of the 20th century has being well documented to have followed their rapid economic growth that began in the 19th century. The developing world is now rapidly developing and urbanising, and shows marked increases in both coronary heart disease prevalence and risk factors when compared with rural settings. Non- communicable diseases have overtaken infectious diseases as the leading cause of mortality and disability. The history of Medicine from the developed world of the 20th century is being played out in the developing world today in the 21st century. So can we use history to benefit present and future populations? Coronary heart disease mortality rates have declined by around 60% in the last 30-40 years in rich nations, mostly attributed to population-wide improvements in the major risk factors, particularly smoking, cholesterol, and blood pressure, rather than modern medical management. The Interheart study revealed that the risk factors for myocardial infarction are those that were already known, and that these were consistent across populations. Thus, it is likely that lowering these risk factors in the population is likely to reduce the incidence of disease be it in India or the US. The history of 20th century medicine in Japan points to substantially lower mortality rates from coronary heart disease than in Western countries, attributed to a diet low in saturated fat and lower rates of smoking. The case of Japan illustrates that cardiovascular disease is not inevitable with increased economic development. Is it possible for a developing country to develop economically without developing the disease trajectory experienced by rich countries? For this to be possible, present-day public health policies in poorer countries must take on board the medical history of the epidemic of coronary disease in rich countries. A multi-disciplinary population approach to primary prevention that takes into account the vested interests that conflict with the prevention of non-communicable disease, such as those of the tobacco industry and multinational fast-food companies, is needed to achieve a leftward shift in the normal distribution of disease risk. Political action, including changes in urban planning, education, and policies regarding the agriculture, food, and tobacco industries are needed and can in part be based on historical evidence from rich countries. In developing countries, any increase in the proportion of government spending spent on health should not be used to imitate the western healthcare model of high-risk and secondary prevention as history suggests this is not the most effective nor the most cost- effective way. Using the much-studied history of one non-communicable epidemic may allay another epidemic in today’s poor and developing countries, affording an opportunity for history to not repeat itself. Competing interests: None declared |
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Hugh Mann, Physician Eagle Rock, MO 65641 USA
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Hippocrates said Competing interests: None declared |
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