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A Short History of Medicine

Revised and Expanded Edition
Erwin H. Ackerknecht
John Hopkins University Press


From Why Medical History?

There are many ways to study medical history and many reasons for such a study. Some study it in order to gain a better understanding of history in general. Medi­cine and disease have had an undeniable effect on the whole of history, and the medical behavior of a period can be regarded as a kind of projective test of the total culture of that period. We know much more about a society when we know how it treated its sick and what it thought disease to be.

But perhaps the most usual reason for studying medical history is the desire to understand medicine itself and to grasp its techniques, its organization, and its underlying ideas. The desire and need to understand medicine is not confined to the medical profession. It is of personal concern to the object of medical practice—the patient. And virtually everyone is a patient today. We live in a pe­riod in which, as Galdston says, "we have converted mortality into morbidity." Yet, while the average person now gets far more medical attention than in any previous period, it is paradoxical that the meaning of disease and its treatment is even more obscure to him than to his ancestors.

The medical systems of earlier times are instructive both in their similarities and in their dissimilarities to the medicine of today. Though these systems dif­fered profoundly from our own, it must always be remembered that they func­tioned, that they fulfilled their task. Studying the history of medicine from this point of view has an illuminating and sobering effect and takes away a little from the smugness of the proud citizen of the hydrogen-bomb age. On the other hand, in spite of all the unfamiliar theories and techniques, the medicine of former periods has many important similarities to our own system. Most of the prob­lems were the same. The study of how solutions were approached, obtained, or missed in the past helps in finding, or at least understanding, the solutions of our own time. Parallel to discontinuity there runs a great continuity in the history of medicine. Answers given to problems today become more intelligible when they are seen as the continuation of answers given in former times.

One of the great obstacles to an understanding of modern medicine is its com­plexity, its incredible wealth of seemingly unrelated details. This complexity has led to specialization, which in turn has further intensified the complexity. There is no better way than the study of medical history to bring some order and coher­ence into this oppressive mass of details. As the details are ordered historically, the fundamental ideas that govern modern medical thinking and action begin to stand out; and the observer is enabled to apply them to the modern picture. The student of medicine must grasp the role of anatomy in the growth of medi­cine since Vesalius, the periodic victories of the chemical approach, the part played by the laboratory in clinical medicine since the middle of the last century, and the recurrent idea that the healing force of nature can be replaced by the curative activities of the physician. Only then will he have a clear understanding of the essential features and trends of present-day medicine. As the only discipline that presents medicine as a whole, medical history is a valuable antidote to certain mental attitudes growing out of the unavoidable specialization of which medical men rightly complain.

Medical men are accustomed to analyzing the organism historically by means of embryology and to determining the status of their patients through case histo­ries. But when it comes to understanding their own craft they, and the laymen who necessarily follow them, are liable to forego the historical approach. They live, thus, with the misconception that every good thought and useful technique was invented only yesterday and that most important problems are very close to final solution. The widespread absence of real understanding is reflected in the continuous use of such expressions as "miracle drug" or "miraculous operation," which underlines the fact that at heart many of our contemporaries feel them­selves to be surrounded by a magic universe, just as their Stone Age or medieval ancestors did. In historical perspective medicine loses its miraculous quality. It remains complex and fascinating, but it becomes an understandable phenomenon.

Medical history is often accused of dealing with "old theories." This reproach overlooks the fact that modern medicine, too, depends upon certain basic philo­sophical assumptions and scientific theories, even though it may not formulate them as clearly as its predecessors. These will be the "old theories" of tomorrow. Modern men, no less than men of former times, see only what they are prepared to see, and a new outlook is always needed in order to see something fundamen­tally new. Therefore it is a most valuable feature of medical history that it makes us conscious of the important role of theories, for better or worse, at all times. The knowledge of old theories offers an additional advantage to the doctor in that many of his patients still cling to a variety of medical beliefs which can be traced to the Stone Age, the ancient Greeks, Paracelsus, or the Scotsman John Brown. Of course, even more important, but also far more difficult to know, is what doctors did in the past. Theory and practice sometimes differ considerably.

Medical history is more than "mental gymnastics." The history of clinical ob­servation and therapeutics, and particularly of the diseases, furnishes data which, if properly handled, will still yield new insights. But even if medical history lacked these immediately useful aspects, it would be far from valueless. Scientific medicine became possible only through cultivation of the not immediately useful. The rapid rise of medicine in this country in recent years coincides very closely with the large-scale introduction into the medical curriculum of what is not immediately useful. The "useful" detail, on the other hand, is often quickly super­seded and has to be dropped.

It must also be emphasized that disease is more than the physiological and psychological breakdown of an individual. Powerful social factors determine whether people fall sick or not, and how and with what results they are treated. A doctor cannot appreciate too early the fact that his profession is a part and product of society and that it is always closely connected with religion, philosophy, eco­nomics, politics, and the whole of human culture. His education, social status, and remuneration—and, unfortunately, his specialization as well—depend in the last instance on the tastes and decisions of society. Medical history is forced to deal with this nonscientific social background of medicine and thus serves, as no other medical discipline can, to open the eyes to those social factors without which the problems of health and disease cannot be properly understood.

Medicine is not only a science; it is also an art. Science is primarily analytic, art primarily synthetic. Medicine is likely to remain an art, however hard we may try to make it more and more scientific, and however much we may attempt to master its scientific contents. For medicine deals not with impersonal atoms, elements, plants with tropisms, or animals with instinct mechanisms, but with humans with a "soul" and "free will." In order to fulfill his mission, therefore, the physician has to be more than a mere technician and man of science. He must be a well-rounded human being, humane and humanistic. In practice he deals not with disordered metabolisms, specific infections, or neoplasms, but with sick human individuals. Even the effect of digitalis or antibiotics will partially depend on the human relationship between the doctor and his patient, not to speak of treatment of the "psychosomatic" diseases that will normally form from 50 to 70 per cent of the doctor's practice.