Leave a comment

The Value of an Education in the History of Medicine

In 1913, nine years before his death, the physician and medical historian Eugene F. Cordell gave his presidential address to the Medical and Chirurgical Faculty of the State of Maryland. His topic was the The Importance of the Study of the History of Medicine. Dr. Cordell was known to hold strong convictions with little tolerance for differing viewpoints, and he lambasted the state of medical education at the time. Specifically, he criticized the lack of any formal teaching on the history of medicine. Relying on over two thousand years of examples, he explained why physicians at all stages of training should have working knowledge of the expansive field of medical history. A century later, this sentiment still rings true. As I trudged through my medical school curriculum, I dismissively labeled conditions such as Cushing’s disease, Charcot joint, and Boerhaave’s syndrome as diseases with a “dead man’s name,” without a passing thought of the life of the man or woman responsible for its discovery. However, once I began researching the historical significance of these diseases, a vast world of medicine opened up before me. I remembered these conditions more vividly than before, I gained an awareness of the importance of medical and social ethics and the subsequent harms caused by certain actions or beliefs, and I developed a deeper appreciation for the noble profession I am to embark upon soon.

Though my experience may be anecdotal, research corroborates that reading or listening to a story helps people recall its details. A 1980 study performed by University of California researchers reported a higher correlation between narrative scripts and the amount of information recalled from the narratives than material remembered after exposure to expository texts such as an encyclopedia article. One possible explanation is the mystic connection between human emotion and memory — stories tend to provoke an emotional response. The account of the sixteen-year-old New York teenager, Minnie, who developed symptoms representative of an adrenal tumor is one such example. She sparked the intrigue of the famed neurosurgeon, Harvey Cushing, who postulated, even before the discovery of the hormone ACTH, that this clinical picture may have resulted from a pituitary basophilic adenoma. This narrative contains a human emotional element not present in First Aid’s page on Cushing’s disease. Another illustration is the detective tale of multiple sclerosis, which spanned from the earliest recordings of the disease during the Middle Ages to an exponential increase in knowledge of the mysterious disorder due to rapid biological advancements after World War II. A curious case of slurred speech, abnormal eye movements, and an unusual tremor in a young woman was noted by the “father of neurology,” Jean-Martin Charcot, in the middle of the 19th century. Because of each story’s emotional underpinning, I could more quickly recall symptomatology manifested by these disorders and gained a more thorough understanding of their recommended treatments. As a result, I noticed my patient histories were more comprehensive and my differential diagnoses expanded for each patient I encountered.

While studying the history of medicine can lead to improvements in the context of clinical healthcare, it also teaches valuable and timeless lessons in the realm of medical ethics. As future and current healthcare professionals, we should follow the ancient adage of learning from mistakes to avoid repeating them. This was noted by Dr. Cordell: “that we may profit by its lessons, both of success and of failure; for what others have done or have failed to do should point the way to their successors, whether in search of individual, social or national guidance.” During my second-year medical humanities course, I read about the life of Henrietta Lacks, a poor, black woman in Baltimore and the victim of one of modern medicine’s grave ethical mistakes. Her story was detailed in the investigative work,

During my second-year medical humanities course, I read about the life of Henrietta Lacks, a poor, black woman in Baltimore and the victim of one of modern medicine’s grave ethical mistakes. Her story was detailed in the investigative work, The Immortal Life of Henrietta Lacks, by Rebecca Skloot, which told of the harvesting of Henrietta’s cervical cancer cells by the predominately white and male doctors at John Hopkins University without acquiring informed consent. The cells would become the ubiquitous HeLa cell line responsible for medical and scientific research advancements worldwide. However, neither Henrietta nor her family were given any form of compensation for the use of her cells, and the origin of the HeLa cell line was cast aside for decades. After reading about this dark chapter in American medical history, we learned the danger that medical assumptions based on race, gender and socioeconomic status can pose on the assurance that everyone is given human dignity. A more well-known example of the harm resulting from the lack of ethical concern for all patients is the dehumanizing scientific experiments performed on Jewish detainees in Nazi Germany. These events that resulted in the Nuremberg Code of Ethics and the story of Henrietta Lacks serve as a reminder to remain vigilant of ways the medical profession might infringe upon basic human rights.

In his presidential address, Eugene Cordell noted another benefit of learning the history of medicine — an appreciation for the profession. Although this value may sound esoteric, I realized the truth he was espousing when I immersed myself into the stories of the giants of medicine’s past. From the “father of medicine,” Hippocrates, to the “father of modern medicine,” William Osler, reading about these pioneers has given me a deep respect for the tribulations and successes of those who shaped our current medical education system, health care delivery system, and diagnostic and therapeutic techniques. Most of our modern ideas and techniques were developed and altered through the millennia. Countless unnamed heroes served the destitute suffering from the bubonic plague during the Middle Ages. Centuries later, the renowned Rudolf Virchow articulated this noble calling of the doctor, stating that he or she is “is the natural attorney for the poor.” Lithotripsy, which is still utilized today in the form of extracorporeal shockwaves for the treatment of kidney stones, owes its origin to Ammonius of Alexandria around 230 B.C. and was improved upon throughout the centuries by Middle-Eastern and European physicians. Our current understanding of bacteria grew from exhaustive experiments and theories, from the microscopic observations of the curious “father of microbiology,” Anthony von Leeuwenhoek, to the antiseptic procedures instituted by British surgeon Joseph Lister. As Maximilien Littre stated, “There is nothing in the most advanced contemporary medicine whose embryo cannot be found in the medicine of the past.” As I learn these stories, I am encouraged to try my best to uphold the virtues of the profession and become the best physician for my current and all future patients as a means of showing my appreciation for these historical figures.

Education in these stories must become an integral part of our curriculum and can be achieved without drastic changes. Techniques such as presenting the historical background of various diseases and treatments during their respective clinical lectures would serve a dual purpose of respite from physical scientific knowledge and implementation of medical history education. Until that curricular reform occurs, students must take the initiative to self-learn about the history of a frequently-encountered disease or treatment, even if it is only a cursory Wikipedia search. The benefits are far-reaching.

Ryan Yarnall (2 Posts)

Contributing Writer

Oklahoma School of Community Medicine

Medical student at University of Oklahoma School of Community Medicine in Tulsa, OK.