History of medicine and modern healthcare: past caring?
Jenny Hey and Elizabeth Leyland intercalated in History of Medicine at the University of Leeds in 2006-07. With the benefit of hindsight, they decided to share some of the ways in which they feel history relates to modern global practice.
Studying medicine requires understanding of a range of subjects, from anatomy to psychology and epidemiology to pharmacology. There is so much to learn about current local practice that looking beyond the ‘here and now’ could appear to be educationally extravagant. Is there anything to be gained from exploring the ‘bigger picture’? We certainly think so. But how? Considering global health is one way to broaden horizons. Looking at the history of medicine adds another dimension; one that we feel deserves some attention.
Medicine is constantly evolving. Current practice represents a point on its journey, a snapshot in time. Using a few examples, we will attempt to illustrate how ‘old’ gives rise to ‘new’, which in turn quickly becomes ‘old’. History of medicine holds explanations for the names of anatomical parts, surgical tools and techniques, and countless weird and wonderful syndromes. We realise it is not for everyone, but we hope that some will appreciate how inspirational history can be in the bid to make medical advances.
Anatomy: back to basics
Nowadays we take for granted the pivotal role of anatomy in understanding disease pathology and treatment. Historically, however, anatomy was not always so intricately intertwined with practice. The Hippocratics relied entirely on what patients said about their illness and defined diseases according to these experiences – the interior of the body was assumed invisible. Understanding of anatomy started with Aristotle – a philosopher. His work was based on dissection of animals not humans. The birth of human anatomy came with Herophilus and Erasistratus – medical practitioners. For centuries, however, doctors trusted what had been previously written, rather than dissecting for themselves again.
In its early days, anatomically based medicine was controversial, because people believed that the causes of illness were obvious externally. Regardless, the way the body worked was deemed irrelevant, because treatment was based on previous experience. (1) Anatomists such as Andreas Vesalius reignited enthusiasm for anatomy. Subsequently, university dissections led to greater awareness and new findings of structure and function followed, for example, William Harvey’s discovery of the circulation of the blood. (2) Understanding of the relationship between illness, disease, and pathological changes happened even later.
So, ethical dilemmas about dissection, post-mortem, and respecting the dead are certainly nothing new. By looking at anatomy’s history, we can appreciate how advances and setbacks reflected what was happening philosophically, religiously, and politically. Modern medical anatomy is a product of these historical changes.
Evidence Based Medicine: proving a point
Ethical restrictions governing research today would make many historical experiments impossible, but without these trials would evidence based medicine have developed as it did, with such attention to detail, and use of controls and statistics? Today, it is seen as a cornerstone of good clinical practice. Although the phrase came into use very recently, the concept was beginning to form in the 1700s. Experiments with smallpox vaccinations used very simple versions of ‘trials’.
Should Edward Jenner have intentionally potentially infected James Phipps, a healthy boy, with smallpox? (3) Having previously ‘vaccinated’ James with cowpox, Jenner had his reasons for thinking James would not contract smallpox. Today we might see this as unethical, but the example highlights how perceptions change. The early history of evidence based medicine highlights the importance of stringent and transparent ethics. Having said that, we should not judge what happened previously according to current values. What might we think of today tomorrow?
Revolution: politics and medicine
In the past, just as in modern medicine, politics and current issues shaped beliefs about best medical practice. In England, the ‘Glorious Revolution’ changed previous patterns of authority and medical practice because social barriers were broken down. (4) Following the French Revolution, institutions underwent major transition, which contributed to clinical examination becoming an important part of patient assessment. Physic, surgery and pathological anatomy had previously remained separate. However, post-revolution, large-scale clinical teaching developed and there was free availability of hospital cadavers due to the educational and hospital-governing changes that occurred. This allowed the linking of disease symptoms with pathological anatomy. (5) What can these major historical events tell us about what might feasibly happen following future global changes?
Set in stone: divided professions?
History also gives us a window through which we can observe how and where modern stereotypes originated. Taking the example of the ‘difference of opinion’ between physician and surgeon we see how the rift dates back to before 1688. Back then it was all down to governing guilds not agreeing upon overlapping practices, and the supposed superiority of physicians over surgeons! (4) Today, however, there is an overwhelming emphasis on the ‘multidisciplinary team’ approach. Why not use past events to appreciate the context in which these hierarchies developed and see that they no longer have any grounding? History can help us recognise the divisions between groups of healthcare professionals, strive for multidisciplinary care, and build bridges.
History: present and future
Just as modern medicine has been shaped by past cultures and conflicts, the medicine of the future will be moulded by past, present, and future events. Different beliefs will continue to fuel debate about emotive issues such as genetics, stem cells and scarcity of resources. Moreover, in the current environment of ever-increasing globalisation, nobody knows what major world events could lead to groundbreaking new medical ideas. By appreciating how medicine has developed so far, we can begin to understand current change and predict future advances. We see past mistakes and learn from them. The history of medicine is the foundation upon which modern medicine is built and to which we forever continue to add. It is not only about knowing what happened in history, but appreciating that we are forever in history. We should never be past caring about past caring.
Jennifer Hey, 4th year medical student at the University of Edinburgh, UK.
je-hey@hotmail.com
and
Elizabeth Leyland, 5th year medical student at the University of Leeds, UK
lizleyland@hotmail.com
References
(1) Wesley Smith, The Hippocratic Tradition (Ithaca NY, Cornell University Press, 1979)
(2) Andrew Cunningham, The Anatomical Renaissance: the resurrection of the anatomical projects of the ancients (Aldreshot, Scolar Press, 1997)
(3) JR Smith, The Speckled Monster (Essex, Essex Record Office, 1987) p. 93
(4) Harold J Cook, ‘Practical medicine and the British armed forces after the “Glorious Revolution”‘, Medical History 34 (1990) pp. 1-26
(5) Michel Foucault, The Birth of the Clinic: an archaeology or medical perception (French original 1963; London, Tavistock, 1973)