Medical History. Heritage or Sociology?

If the historical record is meant to be the ‘best available approximation of the truth’, then historians must acquire an intimate knowledge of the subject and objectively apply and interpret valid fact finding methods. Within the history of medicine, there is an ongoing and decades old debate over the relative merits of physicians versus social scientists as the most reliable or pertinent narrators. In trying to “locate” the discipline along a spectrum of mind-sets and skill-sets, there is no better place to start then the venerable program in the History of Medicine at Johns Hopkins University.

 Johns Hopkins University

Johns Hopkins University

Team Osler and Team Sigerist

Here we find the embodiments of the polarization in the discipline in the persons of William Osler (1849-1919) and Henry Sigerist (1891-1957). Both were physicians, receiving, respectively, MD degrees from MgGill in Canada and the University of Zurich in Switzerland. And both were historians. Osler founded, in 1912, the History of Medicine Society of the Royal Society of Medicine. Sigerist headed the Institute for the History of Medicine at Hopkins from 1932-1947.

But the contrasts in their careers presaged the present schism in the field of study. Osler became perhaps the most preeminent ‘bedside’ physician and clinical teacher in American history. His focus on medical history was as inspirational lore, a catechism for professional integrity. Sigerist was not a practitioner but a social theoretician. For him, medical history was to be mined for policy initiatives. 

In his essay Medical Historians and the History of Medicine, Howard Kushner, of the Rollins School of Public Health and the Graduate Institute of Liberal Arts at Emory University, observantly notes an institutional legacy of these different mind-sets. At the annual meeting of the American Association of the History of Medicine (AAHM) there is a separate meeting of the American Osler Society (AOS). And it turns out there is yet another faction meeting on the margins of the AAHM—the Sigerist Circle. Significance? Let’s look at some self descriptions:

 Osler

Osler

 Sigerist

Sigerist

AAHM:

“Founded in 1925, the American Association for the History of Medicine (AAHM) is a professional association of historians, physicians, nurses, archivists, curators, librarians, and others. The AAHM promotes and encourages research, study, writing, and interest in the history of medicine and allied fields.”

AOS:

“The American Osler Society is a group of physicians, medical historians, and members of related professions united by the common purpose of keeping alive the memory of William Osler…”

 Sigerist Circle:

"We are a group of medical historians, scholars in other fields, and others interested in the history of health...who give special attention to the issues of class, race, ane gender and/or use Marxist, feminist, and related clinical mehodologies in the analysis of medical history."

The AAHA is open to ‘others’. The AOS wants ‘professionals’ and to join, one needs two letters of recommendation from existing members. The Sigerist Circle is, I would venture, open but self-selective.

Step-siblings

The Bulletin of the History of Medicine, published by Johns Hopkins University Press for the AAHM, is a major academic journal, and characteristically promotes articles that are mostly rooted in social science, often with a focus on reinterpreting the record and/or social injustice. The AOS, a much smaller organization, does not have a publication of similar stature.

Both organizations serve a laudable purpose, but the separateness and exclusiveness of the AOS suggests a certain retrenchment from the mainstream of medical history, at least in terms of a public voice. To be fair, they’ve been sort of pushed there. Medical history for many decades was the purview of doctors. But with the rise of the academic social history movement of the 1960s and 1970s “the new medical historians captured control of the production and publication of medical history…”

 Heritage

Heritage

 Sociology

Sociology

My own exposure during a clinical career as a physician, was to the biographies and quirky vignettes about this or that historical practice which pop up in medical journals from time to time. As I took on a broader reading, in textbooks and journals, I discovered a few things early on about the academic literature. Firstly, the language of social science can be frustratingly obtuse. One suspects that some of the, often poorly defined, terms are intended as shibboleths, employed to gain entry into publication. Also, it seems that many articles with explicit or implied political points of view, as opposed a reportorial perspective, are taken ex cathedra.

Remedy

Returning to the role of physicians vs academic historians, what’s wanted is a collaboration. There are good reasons for this, but barriers to overcome. See the Kushner article for a detailed account. 

He enumerates some cultural differences between the two camps:

• Humanists [Social Scientists] are funded  by salaries; health scientists by grants and fees.

• Historians prefer solitary research, (collaborative papers are devalued by tenure committees); medical researches work in teams.

• Vocabularies, even citation methods are distinct: footnotes for historians are for evidentiary discourse; references in medical journals serve to legitimate claims.

• Journal editors in each camp value differently the nature of evidence. Academic history journals discount biomedical data and medical journals discount social science methods when such is offered as the major scaffold of a thesis.

Just as CP Snow advocated in 1959 bridging The Two Cultures, Kushner says we need to “bring the two strands together” in  real world training and practice by providing:

“…an educational effort that exposes academic historians to…patients’ care and medical science and that provides physicians with [an appreciation of] the extent to which treatment and research take place within historical…contexts.”

To each his own

That said, each ‘culture’ should continue to play to its own strength. It took the likes of Max Wintrobe MD, the Father of Modern Hematology, to write and edit the definitive scientific history of his field in Blood, Pure and Eloquent. And it took the likes of Michel Foucault, philosopher and historian of ideas, to write an original and erudite The Birth of the Clinic, An Archaeology of Medical Perception.

 Wintrobe

Wintrobe

 Foucault

Foucault

In Depth

Another informative exposition on this topic is the chapter in Locating Medical History (Huismann and Warner, Johns Hopkins University Press, 2004) entitled Using Medical History to Shape a Profession, The Ideals of William Osler and Henry E. Sigerist by Elizabeth Fee and Theodore M. Brown gives a thorough accounting of medical history as ‘secular religion’ (Osler) and as ‘Romantic socialism’ (Sigerist).

These pages are worth mining for such nuggets as…

For an accessible survey of the history or medicine by a physician adept at narrative non-fiction see History of Medicine by Jacalyn Duffin.

Article
Medical historians and the history of medicine. 
Kushner. Lancet 2008.

Web Sites
Sigerist Circle
American Osler Society
American Association for the History of Medicine

Books
Locating Medical History.
Huisman and Warner 2004.

HIstory of Medicine.
Jacalyn Duffin. 2010.

You can check them out on our Amazon affiliate link, as well as other History of Medcine books.

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