History of Medicine between tradition and modernity

Abstract

History of medicine is an extensive and very complex science. In a simple and classical understanding, it has an informative and associative role. Although it is not easy for students to understand the multiple implications of the history of medicine, its importance becomes more evident during their academic formation. The students must be persuaded particularly about the ethical and cultural values that history of medicine has in their training. Furthermore, history of medicine participates in creating the necessary perspective for shaping the future of medicine in the next decades. This is, perhaps, the most interesting role that the history of medicine should play from the modern point of view of students and young physicians. This paper presents different ways of understanding the roles of the history of medicine regarded from the traditional perspective to the contemporary point of view.

Introduction

History of medicine is an extensive and a very complex science, with many interesting and even fascinating aspects, which should be studied carefully and with no partisan bias. This paper is a plea for studying history of medicine in the higher medical education.

As 2017 marks 125 years since Valeriu Lucian Bologa (1892–1971) – the first Romanian professor of history of medicine – was born, we bring thus a homage to his memory.

We publish this paper in “Clujul Medical” journal, because Bologa was professor and head of Department of the History of Medicine at the Cluj Faculty of Medicine for more than three decades (1930–1962) and also a member of the editorial board of this publication.

The history of medicine between positive and negative understanding

The evolution of medicine has interested many historians of medicine in the past and new arguments continue to be brought about the need of its study [1].

It is necessary to show that the formative role of the history of medicine has been discussed since the second half of the nineteenth century. After a century, emphasizing the significance of the history of medicine in the training of the future doctors, V. L. Bologa evidenced several objectives: to give to physician the possibility to refresh and enlarge his general culture; to focus his attention on one of the most beautiful chapters from the history of civilization and to promote respect for the past of medicine for its outstanding protagonists [2].

However, it is strange to observe that the interest of some students is not sufficiently developed for learning the history of medicine. There could be different reasons for this situation.

One reason is the fact that the present time has its focus on “what is” – the immediate present – and “what is to be” – the future. In this context, Farokh Erach Udwadia put the question “it is therefore worthwhile to give the reader a glimpse of the recent past?” His answer is significant: “I do believe so, for the past in any field of endeavour permeates the present and lies buried within the future” [3]. Referring to history of medicine, he added: “to gain a proper perspective, the never-ending canvas of medicine is best viewed in its entirety – the past, the present, the changing unfinished future” [3].

The misunderstanding regarding the formative role of history of medicine for students can be explained in another way. The period of accelerated progress involves the appearance of many professional notions, new conceptions etc. Their consequence is the need to introduce new topics or types of lectures in the academic curricula. Implicitly, they lead to a compression of classical subjects of study, although they could be important for the professional training of students or for their general culture.

Referring directly to the history of medicine, the study of the past of medicine permits a better understanding of its present and gives the possibility to do develop strategies for its future.

Studying history of medicine, students learn how to understand and to think different medical events from various perspectives: how to correlate various medical profiles apparently without connection with each other, or how the same discovery may occur several times at intervals of centuries and without continuity in time. For example, students can understand how the important anatomist Giovanni Battista Morgagni (1682–1771) can be regarded as the father of modern pathology. Another significant example is that students learn that the cataract surgery – which is considered an operation specific for modern times – was practiced in antiquity and mentioned by Aulus Cornelius Celsus (c. 25 BC – c. 50 AD) [4] and later, in the Middle Ages, by Abulcasis (936–1013). Learning the history of medicine, students reach a certain level of understanding, like how it was possible that Galen’s influence on European medicine lasted nearly fifteen centuries after his death.

The correct analysis of the past of medical science allows us to understand not only the progressive phases of medicine, but also the periods of stagnation or regression. This is a significant advantage, because knowing the negative experiences of the past, future errors can be avoided.

An interesting point of view was discussed by Jacalyn Duffin (b. 1950): the history of medicine offers a “conceptual tool for learning about medicine”. She added: “medical students are intelligent. Even if they last studied humanities in high school, they soon grasp the thrill and an adventure of a debate over questions and context. In reaching for this modest goal, students learn something about the past; however, they can select the events that seem more relevant for their own personal lives and career goal” [5].

Why should students memorize different names and data from the past of medicine? The effort to memorize is useful, because it will help students to learn easier some diseases and syndromes having proper names. Certainly, not all historical data have the same significance. It is more useful to remember the century or the historical period in which different personalities lived, rather than their years of birth and death. Also, not all titles of books they wrote are important to be kept in mind, but only those that marked the progress of medicine. For example, is very useful to memorize the title “De humani corporis fabrica” of Andreas Vesalius (sixteen century), because it marked a turning point in the evolution of anatomy.

Although very few, there are students who consider history as a boring and unimportant subject. This is due to the fact that they are not convinced by what means history. This is a consequence that during school years, history is presented in a thematic approach. Thus, it is difficult for future students to understand that the correct study of the history is “the past of mankind since ancient times till today, according to the specifics of geographic areas and of communities” [6]. Ioan-Aurel Pop (b. 1955) shows that: “the facts of the past, removed from space and time have no historical relevance. Being dispersed, they serve the political discourse, the writer, the musician, filmmaker, essayist, philosopher, etc., but these are not history” [6].

How medical history should be presented in order to be clearly understood?

To teach the history of medicine is a great responsibility, being necessary to analyze every medico-historical aspect in various ethical, socio-economic, cultural etc. perspectives. As Giorgio Zanchin (b. 1945) puts into evidence: “if history is understood as a succession of events determined by specific causes, with specific consequences that vary according to social, economic, and political conditions, a historical analysis is essential for a dynamic interpretation of scientific theories in a social-cultural context of reference” [7].

In a book exploring the continuities and discontinuities in medical thought and practice, Keir Waddington shows that “this approach encouraged readers to think about how medicine has been used to fashion and refashion views of the body and disease; how it informed access to healthcare and welfare policies; and how this was related to different political, cultural, intellectual and socioeconomic contexts” [8]. About his volume entitled “An Introduction to the Social History of Medicine” he noted that it “focuses not on individuals, institutions or discoveries, but on a comparative examination of key theme in the social history in Europe” [8].

There is also the approach of history of medicine in terms of the conditions in which the discoveries were made. Michael T. Kennedy (b. 1938) noted in the introduction of his book entitled “A brief history of disease, science and medicine” that much of what medical students learned from the past has now been shown to be in error. For that reason, his concept of history of medicine includes other subjects than those in a «classical» account. Thus, he gave explanations about his interest “in how infectious diseases evolved and [I] think it important to understand this aspect of science to make sense of the story of smallpox in the New World and syphilis in the old” [9].

Regarding the history of medicine presented in essays we consider that it can be correctly understood only by those who have a solid knowledge of history. For example, this type of approach can be used with certain intentions, as Olivier Faure (b. 1953) did, gathering his articles previously published in various journals. However, this approach is limited only for shorter periods of time and is focused on some social aspects of medicine. Faure used a certain style of presentation, as he noted: “an absence of mastery of academic codes or contempt for them, this propensity to direct language is the sign of the enthusiasm and passion with which I have always approached the subjects I have dealt with” [10].

A book of history of medicine that aims to include more subjects, such as the evolution of different medical discoveries, the evolution of techniques and medical innovations, controversies in medicine etc. is difficult to be elaborated and published in only one comprehensive volume. It should be written by several authors. This gives the authors the responsibility, but also the opportunity to approach the problems in their own way. This multiple approach can have, as result, a book which is it not unitarily written. Moreover, this type of book exceeds the requirements of medical students in higher education. Furthermore it could give rise to heated debates on issues related to these thematic problems [11].

Discussing the importance of the scientific research in history of medicine, John L. Thorthon reveals that “The history of medicine has been studied for centuries, but remains a fluid subject. Fresh facts can reveal new fields of research, and even result in a re-evaluation of the subject. A misinterpretation may have led to false assumptions which in turn have misled later writers, resulting in errors which have been perpetuated for centuries. Only comparatively recently have professional medical historians, armed with an appreciation of both medical knowledge and a background of social history, attempted to unravel the intricacies of the development of medical progress” [12].

At the end of our paper, we consider adequate to remember some ideas of Nicolae Vătămanu (1897–1977) and Gheorghe Brătescu (b. 1923): “knowing the past of this exciting science [history of medicine] is meant to attract alike the young man who strives to embrace the medical profession, and the one that deepens it with passion: it [history of medicine] is useful for the physician who needs a [...] quick and safe orientation, as for the inexperienced scholar, sensitive to all what is noble, profound and useful in human activity” [13].

Conclusions

1. The study of the past of medicine permits a better understanding of its present and gives the possibility to develop adequate strategies for its future.

2. The study of the history of medicine offers the students the possibility to correlate various medical profiles seemingly without connection with each other.

3. To teach history of medicine is a great responsibility, being necessary to analyze medico-historical aspects in various ethical, socio-economic and cultural perspectives.

4. There are different ways of understanding the roles of the history of medicine regarded from the traditional perspective to the contemporary point of view.

5. Fresh medico-historical facts can reveal new fields of research, and even a re-evaluation of the same subject.