Learning from history: the value of a BSc in the history of medicine

"Can anyone tell me who invented the stethoscope?" The consultant peered over his half moon lenses, from beneath a pair of bushy grey brows, surveying the medical students shuffling awkwardly in front of him. We were silent. We could not tell him. We were soon dismissed as heathens and our education slandered by the ageing clinician

When I returned to his ward a year later not only could I have provided that consultant with the answer, but I could have offered him a lecture on the subject. Between my third and fourth years at medical school I interrupted my clinical studies to cross the borders of discipline and nation; from medicine in Scotland to history in England. It was the most enjoyable and exciting year of my life and the lessons I learnt will benefit my clinical career.

1

A Wellcome break

The Wellcome Trust offers one year intercalated BSc programmes in the history of medicine in London and Manchester. Medical students from all over Britain are eligible to apply for places. Becoming a historian at one of the Wellcome units is a unique opportunity to experience a new vocation in a new location. You can also engage in some serious thinking and theorising in the company of enthusiastic tutors and a diverse mix of students.

The BSc programmes intend to impart more than knowledge of great medical figures and events: they offer an understanding of the role of medicine in society and how this has been shaped over time. The programmes do not pursue a chronological study of medicine's progress, but a range of courses cover particular periods in history and particular themes in medicine. The "antiquity to renaissance" course includes various topics from the healing art's relationship with the philosophies of Plato and Aristotle to the association of medieval anatomical texts with emergent artistic trends. "Colonial and empire medicine" examines how medicine and disease have helped and hindered European expansion and empire building, from early settlers in the New World, to British rule in India. Topics in other courses include the forces that brought the NHS into existence and the dynamics for change within it that exist today.

2

What value?

Those who see science as the sole basis for medical practice are likely to question the value of a year spent studying history. Such perspectives are discredited, however, by evidence from medicine's history: the determinants of present day practice are often more historical than empirical. In other words, current medical practice is based on many factors other than the idealised "evidence base."

The history of medicine offers an understanding of the nature of science and medicine. This understanding fed my scepticism, and I lost a degree of naivety. Objective science does not exist: politics, economics, and chance have all influenced not only what we perceive today as scientific truth but also how this truth has been translated into medical practice. Scepticism of present practices forces us to acknowledge that better ways of doing things may exist: it is vital in today's medical world that we keep our minds open to new ideas and to change.

3

Empathy

Perhaps the greatest benefit from my historical studies was the experience and practice of empathy. Empathising--understanding another person's thoughts and emotions--is the key to history. Only by stepping into the shoes of the people of the past and adopting their perspectives can we understand their thoughts and actions.

As an example, it is not obvious why, up until the late 1800s, doctors and patients continued to resort to liberal "purging" with laxatives, diuretics, and emetics, in cases of diseases as diverse as gout and pneumonia. To understand this practice we must remember that theories of the body and of disease were still based on ideas of a balance of fluids. Also, people could reasonably perceive a treatment as "working" so long as it had some action on the body, whether this be curative or merely purgative.

Empathy is a skill as vital to the historian as it is to the doctor. The study of history provides an education in the necessity and method of empathising. Clearly, history has many valuable lessons for doctors of the future.

Other benefits?

Students of medical history are never stuck for dinner party conversation: knowledge of trivia ensures that they will always be capable of serving up a delicious array of anecdotes to friends. This might be of value on the wards too. Who was the inventor of the stethoscope? It was René Laennec, who in 1816, was visited at his Paris clinic by a young woman with symptoms of heart disease. The woman's "stoutness" prevented palpation and Laennec described how her "age and sex" prevented him from placing his ear directly to her chest to listen to the heart. The inventive doctor rolled up a piece of paper, applied one end to the woman's precordium and his ear to the other, creating a stethoscope. With luck, this sort of story might just pass me off in the eyes of a consultant or two until I have time to relearn the names of all the drugs and bugs that I have forgotten during my year of historical studies.

4


5