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History at the heart of medicine
Wellcome Open Research
Abstract
With a focus on the challenges of today and tomorrow in the critical medical humanities the role of history is often overlooked. Yet history and medicine are closely intertwined. Right now, with the surfacing of knotty problems such as changing demographics, chronic pain, loneliness and Long Covid – and the consequent necessity to change directions and policies – history seems more urgent than ever. However, historians of medicine have sometimes been reticent to play a role in medicine and policymaking. The recent and welcome development of the critical medical humanities has intervened in medicine in important ways, but often without clear engagement with the history of medicine. In this letter, we make a renewed case for coherence and collaboration between history of medicine, medicine, and medical humanities, emphasising the continuity and links between all three. The skills and focus of the historian of medicine bring crucial historical context to the table, enabling better understanding of medical collecting, new imaginative futures, profound critiques of key medical concepts, and understandings of the body through time. By emphasising what historians can do for medicine and medical humanities, we call for building historical work into how medicine, illness and health are understood now and in the future. We suggest three potential roles for historians: keepers of memories, conversation partners, and futurist thinkers.
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William Hunter's anatomical inquiry employed all of his senses, but how did his personal experiences with the cadaver become generalized scientific knowledge teachable to students and understandable by fellow practitioners? Moving beyond a historiographical focus on Hunter's images and extending Lorraine Daston's (2008) concept of an ‘ ontology of scientific observation’ to include non-visual senses, I argue that Hunter's work aimed to create a stabilized object of the cadaver that he and his students could perceive in common. Crucial to this stabilization was the sense of touch and its interaction with other senses, creating intersensory knowledge of the cadaver. Through a close reading of his neglected posthumous publication An Anatomical Description of the Human Gravid Uterus (1794), I demonstrate that Hunter wrote extensively about touch and other sensory experiences, using comparative metaphors and other linguistic strategies to engender clear ideas of the cadaver in the mind of the reader. That these ideas could be consistent between practitioners was guaranteed by God, but required practitioners to appropriately reflect on their sensory experiences with cadavers. Hunter's experimental practice encompassed both simple and complex methods, all aimed at increasing the range of sensorial experiences he had with the gravid uterus. His preservations of these experiences in text, image and preparation could then be used to support further anatomical investigations.
What can the medical humanities achieve? This paper does not seek to define what is meant by the medical humanities, nor to adjudicate the exact disciplinary or interdisciplinary knowledges it should offer, but rather to consider what it might be capable of doing. Exploring the many valences of the word 'critical', we argue here for a critical medical humanities characterised by: (i) a widening of the sites and scales of 'the medical' beyond the primal scene of the clinical encounter; (ii) greater attention not simply to the context and experience of health and illness, but to their constitution at multiple levels; (iii) closer engagement with critical theory, queer and disability studies, activist politics and other allied fields; (iv) recognition that the arts, humanities and social sciences are best viewed not as in service or in opposition to the clinical and life sciences, but as productively entangled with a 'biomedical culture'; and, following on from this, (v) robust commitment to new forms of interdisciplinary and cross-sector collaboration. We go on to introduce the five other articles published in this special issue of the journal, reflecting on the ways in which collaboration and critique are articulated in their analyses of immunology, critical neuroscience, toxicity, global clinical labour, and psychological coercion and workfare. As these articles demonstrate, embracing the complex role of critical collaborator-one based on notions of entanglement, rather than servility or antagonism-will, we suggest, develop the imaginative and creative heterodox qualities and practices which have long been recognised as core strengths of the medical humanities.
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Old as Methuselah? Centenarians, narrative wisdom and the importance of history for health According to the Arnhem Courant of 21 October 1828, there were 1,672 people between 100 and 185 years old in northern Europe in the 18th century. This news report defies the imagination, because who really believes that so many people could live to that age, and centuries ago too? In her inaugural lecture, Rina Knoeff shows that we should indeed take this story - and stories about unusual diseases, miraculous cures and remarkable scientific insights - seriously. People in the past were not stupid. Historical accounts of centenarians show how knowledge and experience of health were embedded in historically grown cultural patterns in which moral views and political motivations prevailed alongside medical theories. This is no different today. The historian, like no other, can show that our ideas about health are place-bound. It is precisely by studying historical narratives that seem strange to us that we can recognise what is particular about our own perceptions of health. This skill, which Knoeff characterises as "narrative wisdom", is also crucial for analysing and improving public health care. In her inaugural lecture, Knoeff shows that health is not an exclusively biomedical, but above all a social issue. This also means that in public health care, we should be less guided by a clinical view, and give more space to the humanities, which are much better at explaining the cultural factors that determine our health. Translated with www.DeepL.com/Translator (free version)
This is a history of medicine that takes its point of departure in the specimens of human bodily material used to produce medical knowledge. An ordering principle of scale prompts a material and epistemic history of 18th-21st century medicine that highlights shifts in interest towards smaller and smaller units of study: from organs in pathological collections, over microscope slides, to samples in biobanks. The account reveals a set of connected scales of the site of disease, time of diagnosis, size of cohorts, number of disease categories, and technologies of investigation. Moreover, the principle of following the scale of specimens demonstrates the continued importance of physical specimens in medicine, it synthesizes studies of important epistemic objects of medicine such as the organ specimen, the microscope slide and the blood sample, and it draws new historical connections from pathological collections to biobanks.
The challenge of our era is to find ways to respond to the ecological, social and political breakdown our world is facing as an entwined and inseverable phenomenon. These interwoven crises are taking place in a context where fatalistic and managerialist conceptions of change enjoy almost hegemonic power in key institutions. If society is to be remade in ways that preserve a commitment to democracy, it is crucial that citizens be imaginatively equipped to be able to respond to deterministic claims that refuse their agency as members of multiple political communities. This is precisely the kind of orientation that historicity enables. Our times call upon historians to understand themselves as community-builders whose task is, through dialogue, to connect the past to the present and gather the people so that we might build a better kind of world together.
This paper examines medical scientists’ accounts of their rediscoveries and reassessments of old materials. It looks at how historical patient files and brain samples of the first cases of Alzheimer’s disease became reused as scientific objects of inquiry in the 1990s, when a genetic neuropathologist from Munich and a psychiatrist from Frankfurt lead searches for left-overs of Alzheimer’s ‘founder cases’ from the 1900s. How and why did these researchers use historical methods, materials and narratives, and why did the biomedical community cherish their findings as valuable scientific facts about Alzheimer’s disease? The paper approaches these questions by analysing how researchers conceptualised ‘history’ while backtracking and reassessing clinical and histological materials from the past. It elucidates six ways of conceptualising history as a biomedical matter: (1) scientific assessments of the past, i.e. natural scientific understandings of ‘historical facts’; (2) history in biomedicine, e.g. uses of old histological collections in present day brain banks; (3) provenance research, e.g. applying historical methods to ensure the authenticity of brain samples; (4) technical biomedical history, e.g. reproducing original staining techniques to identify how old histological slides were made; (5) founding traditions, i.e. references to historical objects and persons within founding stories of scientific communities; and (6) priority debates, e.g. evaluating the role particular persons played in the discovery of a disease such as Alzheimer’s. Against this background, the paper concludes with how the various ways of using and understanding ‘history’ were put forward to re-present historic cases as ‘proto-types’ for studying Alzheimer’s disease in the present.
This essay was delivered as a commencement address at the University of California-Berkeley School of Public Health on May 17, 2015. Reflecting on events spanning from 1990 to 1999 to 2015, when I gave my first, second, and third commencement talks at the school, I discuss four notable features of our present era and offer five insights for ensuring that health equity be the guiding star to orient us all. The four notable features are: (1) growing recognition of the planetary emergency of global climate change; (2) almost daily headlines about armed conflicts and atrocities; (3) growing public awareness of and debate about epic levels of income and wealth inequalities; and (4) growing activism about police killings and, more broadly, "Black Lives Matter." The five insights are: (1) public health is a public good, not a commodity; (2) the "tragedy of the commons" is a canard; the lack of a common good is what ails us; (3) good science is not enough, and bad science is harmful; (4) good evidence-however vital-is not enough to change the world; and (5) history is vital, because we live our history, embodied. Our goal: a just and sustainable world in which we and every being on this planet may truly thrive.
© The Author(s) 2015.
The paper examines some of the ways in which a social constructionist perspective may be useful for social historians of medicine. It outlines the streams of thought that, over the last twenty years or so, have contributed to this perspective. Some of the problems and issues raised by social constructionism are considered. The relationships between the history of science and the history of medicine are discussed in order to clarify the extent to which the latter can and should be modeled on the former. I suggest that social constructionism is useful, partly because it gives weight to ideas, and that there is a potentially fruitful alliance to be considered between the social history of medicine and cultural history.
The imaginary crisis (and how we might quicken social and public imagination).
- G Mulgan