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Social histories of medicine – ‘Beyond the Great Doctors’

A book published in 1979, edited by two young historians Susan Reverby and David Rosner, and titled Health care in America: essays in social history, was among the first to popularize new ways of thinking about the history of medicine. The introductory essay was titled ‘Beyond “the Great Doctors”‘. A primary concern here was that people needed to look at medicine and its history as a much more diverse and wide social enterprise, and not simply as the domain of doctors.

This volume is a contribution toward a social history of health care in America. We purposefully use the term “health care” rather than “medicine” because these essays examine the social relations of health care, rather than the activity and intellectual concerns of physicians alone. “The history of medicine is infinitely more than the history of the great doctors and their books,” wrote Henry E. Sigerist, a prominent medical historian, nearly a half century ago.

In this essay Reverby and Rosner trace some of the journey of the history of medicine as a discipline in American academic institutions.

Until the end of the nineteenth century many of the theoretical and practical formulations of medical practitioners were derived from history. An understanding of the Ancients, their therapeutic regimens and theoretical justifications, lent credence to various medical practices. Hippocrates, Aristotle, and Galen dot the pages of pre-twentieth-century medical writings. Medical history was written by practitioners for practitioners… [Later] With the development of science as the dominant ideology and material base of medicine, history lost its function as medicine’s source of authority. [But even during this period of scientific dominance, some educators] were aware that medicine and nursing entailed more than scientific knowledge and technical skills.

With the growing importance of science, they were deeply concerned that the art of medical and nursing practice might be lost. For them, the art entailed clinical decision-making, “bedside manner,” the development of the physician’s and nurse’s “character,” and a sensitivity to the patient’s humanity. They saw the training of their students in this “humanism” as an essential counterweight to the possible dehumanizing effects of the new science. For them, the study of history was the linchpin that could hold together both the science and the art of medicine and nursing… The students thus acquired a peculiar vision of medical history — rooted deep in historical time but focused narrowly on specific individuals and discoveries.

[Later] the relationship between history and medicine took on a new meaning with the appointment of Henry E. Sigerist as the head of the Johns Hopkins Institute of the History of Medicine in 1932. A physician-philologist, trained as a medical historian under Karl Sudhoff at the University of Leipzig’s Institute of the History of Medicine, Sigerist professionalized the history of medicine in America.

It was particularly after Sigerist that the history of medicine began to go, even if in small measure, beyond simply the stories of ‘great doctors’ doing ‘great’ things. And then in the 1970s a further expansion into social histories of medicine, or as we saw above, a ‘history of health care’, began. In this particular understanding, the patient’s/general public’s side of the story began to be given more importance than before. British historian Roy Porter elaborated this strand of thought in a 1985 essay titled ‘The patient’s view: doing medical history from below’:

Medicine today is a supremely well-entrenched, prestigious profession. It is hardly surprising, then, that it has tended to produce histories of itself essentially cast in the mold of its own current image, stories of successive breakthroughs in medical science, heroic pioneers of surgical techniques… Even historians and historical sociologists who have taken more skeptical views of medicine’s past, perhaps stressing its failures or underlining the self-serving features of professionalization, have nevertheless implicitly endorsed the view that the history of healing is par excellence the history of doctors.

[But] it takes two to make a medical encounter – the sick person as well as the doctor; and for this reason, one might contend that medical history ought centrally to be about the two-way encounters between doctors and patients. Indeed, it often takes many more than two, because medical events have frequently been complex social rituals involving family and community as well as sufferers.

One of the best early examples of the social history approach is the 1993 book by historian David Arnold, ‘Colonizing the Body: State Medicine and Epidemic Disease in Nineteenth-Century India’. Here we get to learn about the introduction and spread of biomedicine (‘Western medicine’) in India, but less from the privileged perspective of the big European doctors writing (mostly) about a ‘backward’ India and its ‘unscientific’ traditions, and mainly from the perspectives of Indian people themselves. How did Indians – including their own stratified communities – react to ‘Western’ medicine? Did they accept it unquestioningly as a superior art of healing? What were their reactions to European doctors coming in their villages and towns for practice?

Here is an excerpt from Arnold’s book on reactions to British measures against the great plague epidemic of the 1890s:

“Unprecedented in character and scale, the measures adopted to combat epidemic plague in 1896-98 provoked the greatest upsurge of public resistance to Western medicine and sanitation that nineteenth-century India had witnessed. To judge by the reactions of the Indian press and by official accounts of the riots and disturbances that followed, as well as by the rumors that circulated, the early plague years represented a profound crisis for Western medicine and for the power of the colonial state.. In explaining the extreme unpopularity of hospitals, the [local newspaper] Mahratta pointed in November 1897 to the difficulty patients experienced in keeping in touch with their families: ‘The relatives of the sick man find it extremely difficult even to send word to him, not to speak of approaching him and assuaging his distress by loving attendance and affectionate words. As for attendance and nursing, how effective they might be can well be imagined from the fact that the hospital servants are at best mere strangers,invariably callous and patent mercenaries, and that the sick man, once within the hospital compound, is almost cutoff from his private resources.'”

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