History of Medicine A Scandalously Short Introduction 3rd

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For my students
past, present, and future
Contents

List of Illustrations
List of Tables
Preface to the Third Edition

Acknowledgments

1 Introduction: Heroes and Villains in the History of Medicine

2 The Fabricated Body: History of Anatomy

3 Interrogating Life: History of Physiology

4 Science of Suffering: History of Pathology
5 First Do No Harm: History of Treatment, Pharmacology, and Pharmaceuticals
6 On Becoming and Being a Doctor: Education, Licensing, and Payment

7 Plagues and Peoples: Epidemic Diseases in History

8 Why Is Blood Special? Changing Concepts of a Vital Humor
9 Technology and Disease: Stethoscopes, Hospitals, and Other Gadgets
10 Work of the Hand: History of Surgery
11 Women’s Medicine and Medicine’s Women: History of Obstetrics, Gynecology, and Women
12 Wrestling with Demons: History of Psychiatry
13 No Baby, No Nation: History of Pediatrics
14 A Many-Faceted Gem: The Decline and Rebirth of Family Medicine
15 When the Patient Is Plural: Public and International Health
16 ‘Slow as a Glacier, Equally Relentless’: Patient-Centered Medicine
17 Sleuthing and Science: How to Research a Question in Medical History

Appendix: Learning Objectives of This Book

Index
Illustrations

1.1 Medical students engaged in the Heroes and Villains game

2.1 Weighing the heart, ancient Egyptian Book of the Dead, ca. 1420 B.C.
2.2 Five-figure drawings, twelfth century
2.3 Fifteenth-century anatomy lesson, 1493
2.4 Zodiac man, from Johannes de Ketham’s Fasciculus medicinae, 1491
2.5 Wounds man, from Hans Gersdorff’s Feldbuch der Wundartznei, 1517
2.6 The écorché, from Vesalius’s Fabrica, 1543
2.7 The vagina and vulva, from Vesalius’s Fabrica, 1543
2.8 The Reward of Cruelty, by John Bell, ca. 1750
2.9 Queen’s medical class of 1920
3.1 The four humors and the four elements in Greek science
3.2 Schematic illustration of Galen’s physiology
3.3 Mouse in a jar, from John Mayow’s Tractatus duo quorum, 1668
3.4 Rising frequency of the word ‘neuroscience(s)’ in articles, 1967–2019
4.1 Disease game word-cloud responses, Queen’s University, 2021
4.2 Théophile Bonet, postmortem portrayal, ca. 1700
4.3 Hodgkin’s disease, by Robert Carswell, 1832
4.4 Phrenological comparison, 1859
5.1 Mandragora (mandrake root), mid-thirteenth-century illustration
5.2 The word ‘drugable’ in medical literature, 1977–2020
5.3 Phases in a drug’s use (graph), 1954
6.1 The Doctor, by Luke Fildes, 1891
6.2 A medieval hospital scene
6.3 Founding of British and American medical schools
6.4 The physician as angel and as devil, 1587
7.1 Woodcut depicting the burning of Jews in response to plague, 1493
7.2 The ‘French disease,’ from B. Steber’s A malafranzos, 1498
7.3 Young Woman Accompanied by Death as a Jester, by Hans Beham, 1541
7.4 Blue stage of spasmodic cholera, 1832
7.5 Cholera on the bowsprit, by Graetz, 1883
7.6 Smallpox vaccine riot in Montreal, by Robert Harris, 1885
7.7 Rate of decline in tuberculosis mortality
8.1 A direct transfusion from animal donor to recipient, 1671
8.2 An indirect transfusion using a gravitor, ca. 1829
9.1 Laennec practising direct auscultation, by Théobald Chartran, 1889
9.2 Number of publications on ‘sleep apnea,’ 1972–2020
9.3 Patients in the Hôtel-Dieu, Montreal, ca. 1710
10.1 Medical saints Cosmas and Damian, by Alonso de Sedano, ca. 1496
10.2 Cataract surgery in the sixteenth century, by Georg Bartisch, 1583
10.3 Lithotomy, 1772
10.4 A pre-anesthetic amputation, late eighteenth century
10.5 The Gross Clinic, by Thomas Eakins, 1875
10.6 Dr. Hingston operating, by F.C. Franchère, 1905
10.7 Mastectomy, 1772
11.1 The progress of obstetrics as viewed by a practitioner, 1960
11.2 Sperm cell, from Nicolas Hartsoeker’s Essay de dioptrique, 1694
11.3 Term infant in utero, by Jan van Rymsdyk, 1774
11.4 Woman inhaling chloroform, 1858
11.5 Hope I, by Gustav Klimt, 1903
11.6 The happy results of a family-centered birth, by Eleanor Enkin, 1977
11.7 James Miranda Barry with servant and dog, 1862
11.8 Joycelyn Elders, US Surgeon General, 1993
12.1 Pinel Delivering the Insane, by Tony Robert-Fleury, 1876
12.2 Mania Succeeded by Dementia, by Ambroise Tardieu, 1838
12.3 Design for the Provincial Lunatic Asylum, Toronto, ca. 1854
13.1 Enfance, by James Collinson, 1855
13.2 Arcutio, a device to prevent overlying, 1732
13.3 Enfants trouvés, by Henri Pottin
13.4 Tethered tree of orthopedics, from Nicolas Andry’s Orthopedia, 1743
13.5 La Goutte de Lait de Belleville, by Henri Geoffroy
13.6 Le tubage, attributed to G. Chicotot, 1904
13.7 Vivien Thomas, surgical assistant to Alfred Blalock
13.8 ‘Biological Study of the Dionne Quintuplets,’ 1937
14.1 The Country Doctor, by Paul Wickson, ca. 1905
14.2 Gavel of the Canadian College of Family Physicians
15.1 Kwashiorkor, from Williams’s Mother and Child Health, 1972
15.2 Cicely D. Williams, 1975
15.3 Henry E. Sigerist with his survey team in Saskatchewan, 1944
15.4 Founders of IPPNW receive honorary degrees at Queen’s University, 1985
15.5 J.T. Rothrock in the forest, 1919
15.6 Brock Chisholm, first Director General of the WHO, ca. 1947
16.1 Rise of the term ‘patient-centered medicine’ in journal articles, 1965–2019
16.2 Anderson Ruffin Abbott, 1861
16.3 Terry Fox, running the Marathon of Hope, 1980
16.4 Rick Hansen, carrying the Olympic torch, 2010
16.5 AIDS activists marching in the Gay Pride Parade, Toronto, 1989
16.6 New medical ethics journals, 1975–2020
16.7 Sue Rodriguez, ‘right-to-die’ advocate, 1993
Tables

1.1 ‘Heroes’ and ‘villains’ in medical history – game worksheet

2.1 Anatomy legislation in Europe, thirteenth to sixteenth centuries
2.2 Anatomy legislation, nineteenth and twentieth centuries
3.1 Early national periodicals and societies in physiology
4.1 Nosological classifications of disease by six eighteenth-century medical writers
4.2 Organizations formed by pathologists
4.3 Examples of clinical problems linked to chromosome abnormalities
5.1 Top drugs/treatments used or sold in various practices, 1795–2018
6.1 Founding of Canadian medical schools and their predecessors
6.2 Early milestones in the medical professionalization of Europe
6.3 Founding of health-care systems
6.4 Doctors’ strikes or threatened strikes – a partial list
9.1 Advent of some diagnostic technologies
9.2 Advent of some therapeutic technologies
10.1 Professional organizations for surgery
12.1 Successive name changes in Ontario hospitals for mental illness, 1850–2000
13.1 ‘Classic’ descriptions of childhood disease from the seventeenth century
13.2 Milestones in vitamin history
13.3 Estimates of percentage of children living in poverty
14.1 Some first-hand accounts of general practice
14.2 Some milestones in general/family practice
15.1 ‘Trades’ in Ramazzini, On Diseases of Workers, 1700 and 1713
15.2 Some milestones in public health institutions
15.3 Number of articles on hunger, starvation, and food supply, 1950–2020
Preface to the Third Edition

I wrote the first edition of this book in the late 1990s because my medical
students repeatedly asked me to publish my lectures. I hesitated for a long
time because of my limited expertise. They argued that it could serve as a
guide for students, interested practitioners, and nonhistorian instructors
wishing to incorporate history into health-care teaching. I hoped that it
might also demystify medicine for students in other domains, such as
history, philosophy, and sociology – although the thematic structure is
unusual for a humanities course. But as soon as I began trying to turn those
comfortably private, oral presentations into public print, I ran up against my
own lack of erudition (as predicted) and was humbled by the numerous
places where I risked falling into the very traps described in chapter 17.
Without the security of fudging footnotes and scholarly apparatus, I began
to feel exposed on alien turf – every sentence, a minefield; each choice of
word, a little bomb waiting to explode. This feeling has not diminished.
Reviewers were kind, and Scandalous enjoyed more success than I had
imagined. Several readers wrote to suggest additions or correct errors.
Although it had originally been unabashedly aimed at Canadians, I was
surprised (and perhaps the publisher was too) to discover that it found
readers, course assignments, reprintings, and translations in the rest of
North America, Europe, and Asia. Therefore, the second edition of 2010
aimed to serve a wider audience with a new chapter on public and
international health, while the examples from Canada were joined by many
more from other places, especially but not only Britain and the United
States. The suggested readings were placed online. Nevertheless, some
reviewers quipped that the book was no longer ‘scandalously short,’ though
it was and still is shorter than most comprehensive histories. What had
Scandalous become if not short? Scandalously clinical? Political? Personal?
 For this third edition, the title remains, although the length has
expanded yet again. It has been a busy decade in medicine and in its history.
Revising a medical history during a pandemic has been a quixotic task.
Numbers, information, and rules keep changing, and I am haunted by a
strange impression of déjà vu blended with hubris that it is too soon to be
writing about something that is, as yet, incomplete. We cannot see over the
edge to the other side. Journalists are constantly pestering historians for
‘lessons learned’ and for reassurance about our relative safety now
compared to distant times of plague, influenza, or polio. On the other hand,
the continuities with the past are striking, and at any given moment, our
human trajectory is never really over.
In dealing with the updates and suggestions, a hundred new names or
topics are mentioned – some from well before the twenty-first century. A
new chapter on the rise of patient-centered medicine emphasizes the
influence of rights movements for race, Indigenous peoples, disability, and
sexual orientation. And, of course, COVID-19 demanded changes in almost
every chapter.
Some students do not like this book because it is, well, a book. Teaching
methods of lectures and readings, where my work originated, are now
called ‘traditional,’ even passé, and in pandemic times, online learning has
become the norm. Library stacks are echoing and empty, and shelves of
books and journals have been replaced with computer terminals. Scholars
and medical practitioners – including me – conduct their research through
the instant gratification of wondrous Google and burgeoning databases;
information comes in concise bullets, and attention spans are growing
shorter.
But electronic versions of this book are now available, and the updated,
much expanded Suggestions for Further Reading persists open-access on
the web (at http://www.histmed.ca). Whether it be on paper or online, this
not so scandalously short book was never intended to be read all at once, or
in sequence. Each (relatively) brief chapter can be selected in any order at
any time. The goal is to spark questions, stimulate curiosity, and orient the
search beyond these pages. And if the chapter subjects do not satisfy,
perhaps the index will.
Being a historian as well as a physician, however, I happily draw your
attention to the remarkable, venerable technology of print on paper.
Diverse, durable, portable, and lovely to hold, touch, and smell, books can
go with you on canoe trips, or into the bath, without electricity or fear of
shock. And in the end, unlike the disposable flux of a website, they stand as
testimony to a moment in time and space, becoming historical sources
themselves. Books may be an endangered species, but for nearly 600 years
they conveyed so much medicine that it seems only right that a book should
be the vehicle for its past.
Acknowledgments

Historical ideas, like diseases, can be both hereditary and communicable.

My mentor Mirko Grmek, just before his death, could see in the first edition
of this book how he had passed on his historical and medical instruction; I
am a grateful heritière. The infectious enthusiasm and unfailing patience of
my editors and their confidence in the outcome were essential catalysts for
turning ideas into a book: at the outset, Gerald Hallowell, and since, Len
Husband, who launched me on second and third editions. Nor would there
have been a book without the support of Queen’s University and the unique
teaching opportunities of the Hannah Chair, generously endowed by
Associated Medical Services.
I am indebted to many predecessors, whose far more ambitious works
resolved numerous problems, and to several practitioners, medical and
historical, who were pestered to read portions of the work. They corrected
prose, answered questions, offered creative suggestions, and helped with
illustrations.
For the first edition, Hannah Professors Paul Potter and Charles G.
Roland, Cherrilyn Yalin, Martin Friedland, and an anonymous reviewer for
the University of Toronto Press kindly commented on drafts of the entire
manuscript. For excellent advice on specific issues, I thank friends and
colleagues Ian Carr, the late Peter Cruse, Dale Dotten, the late Eleanor
Enkin, Murray Enkin, Anita Johnston, and Felicity Pope. For similar help, I
gladly acknowledge the generosity of Queen’s colleagues: the late Alex
Bryans, Prakash Burra, Gerald Evans, Pamela Frid, Charles Graham,
Charles Hayter, R. Neil Hobbs, Steve Iscoe, the late Gerald Marks, Steven
Pang, Terrie Romano, Joan Sherwood, Duncan G. Sinclair, Lucinda Walls,
James L. Wilson, the team at the Kingston’s Museum of Health Care, and
the wonderful staff of Bracken Library.
 Over the years, reviewers and colleagues described their uses of the
book and their expectations of future editions. In particular, I thank Jayne
Elliott, Heiner Fangerau, Delia Gavrus, Mary Hague-Yearl, Bert Hansen,
Jenna Healey, Joel Howell, Geoff Hudson, the late Ross Kilpatrick, Joel
Lexchin, Susan Lamb, Susan Lederer, Beth Linker, Christopher Lyons,
Heather MacDougall, Shelley McKellar, Suzanne Maranda, Laurence
Monnais, Pamela Miller, Sheila Pinchin, Steven Peitzman, Susan Phillips,
the late Roy Porter, Paul Potter, Anne Smithers, Meryn Stuart, Mindy
Schwartz, Lewis Tomalty, and once again, as always, Robert David Wolfe.
My students are my teachers too, and the toughest critics. Their
persistent requests for an introductory text made me finally decide to do
what I had long resisted. For the first edition, several cheerfully read
chapters in a test-drive exercise that shaped the finished version. They are
former medical students, now doctors all, Hershel Berman, Matthew
Bowes, Ruttan Bhardwaj, Darryl da Costa, Leigh Eckler, Kymm Feldman,
Diana Fort, Fiona Mattatall, and Matteus Zurowski; and former graduate
students Elaine Berman, Jennifer Marotta, and Megan Nichols. Without
their firm belief in its future utility, the first edition would never have
appeared.
For the second edition, another intrepid gang of Queen’s students and
young doctors offered thoughtful suggestions, criticisms, and ideas, or they
patiently read updated chapters. They include Courtney Casserly, Melanie
Colpitts, Dan Finnigan, Rebekah Jacques, Raed Joundi, Ahmed Kayssi,
Jessica Liauw, Melissa Pickles, Paul Uy, Mary-Clair Yelovich, and Julia
Cameron Vendrig.
For the third edition, the test-drive exercise exploded. A few former
readers returned from the first, in particular Cherrilyn Yalin and
physiologist Steve Iscoe, as well as some seasoned practitioners who had
once read chapters as students: internist Hershel Berman, pathologist
Matthew Bowes, and obstetrician Fiona Mattatall. Historians Geoff
Hudson, Casey Hurrell, Susan Lamb, and Lucy Vorobej and law student Pip
Swartz also agreed to read chapters and make constructive suggestions.
Recent graduates and students of Queen’s medical classes from 2015 to
2021 stepped up eagerly: Ashna Asim, Andrew Belyea, Sarah-Taïssir
Bencharif, Maximilien Boulet, Hissan Butt, Michael Chaikoff, Harry
Chandrakumaran, Maggie Hulbert, Yannay Khaikin, Palika Kohli, Adam
Mosa, Kate Rath-Wilson, Hollis Roth, and Victor Tang. The intrepid Paul
Istasy, entering Schulich medical school at Western University, gave
feedback on the entire book. Then he recruited an extraordinary number of
as-yet-unknown people from his new class of 2024, who quickly
volunteered to help too, despite their complicated, socially distanced lives:
Alveena Ahmed, Elnaz Assadpour, Ayushi Bhatt, Judith Kecskemeki,
Ayesha Kalim, Amrose Khaira, Ashvent Malek, Donna Mofidi, Penelope
Neocleous, Joshua Neposlan, Jarrett Noakes, Arjun Patel, Samaunus Safa,
Adeel Sheikh, Devanshi Shukla, Yifeng Song, Zahra Tabouin, and Snow
Wangding. Following their contributions, Carolyn Zapf, Robin Studniberg,
and their colleagues at University of Toronto Press thoughtfully fixed the
manuscript and made the book beautiful.
Beyond the welcome corrections and insights, this wealth of genuine
curiosity for medical history from students was an inspiration in itself. May
they all find the new version useful in their studies and their careers –
despite being a book! It is for them with my gratitude.
Some readers will continue to notice errors; others will complain that I
still ignore their favorite topics. I thank you in advance for letting me know
and helping to make the next edition better.

Kingston, Ontario, January 2021