Mind the gap! – or mend the chasm?

Most papers in the Journal of Medical Biography are written by medically qualified authors who have had no structured training in historical methodology, whereas most authors who publish in Medical History or in the Social History of Medicine are professional historians with no medical qualification. Similarly, most delegates at meetings of the British Society for the History of Medicine are medically qualified, whereas most of those who attend the meetings of the Society for the Social History of Medicine are not. The dichotomy is striking and not so much a gap as a gaping chasm. It is also to be found in the meetings of the American Osler Society and the American Association for the History of Medicine and has become a long-standing subject for debate. ¹ Why should this be, does it matter and, if so, is there a remedy?

Papers on biography or medical equipment certainly lend themselves to the unfunded (except from the author’s own pocket) amateur historian who pursues his hobby in relative isolation. Given the nature of most medical work, it is not surprising that some doctors become fascinated by human nature and hence with biography. For some, it can provide an artistic refuge from the scientific component of medical practice, just as music does for many others. Much of what is written by medically qualified historians often reflects the Oslerian tradition of seeking lessons from the past to inform current clinical practice.

By contrast, and particularly when dependant on externally funded grants, professional historians of medicine are expected to paint on a much broader canvas and to reflect the interests of their own lineage from the realms of social and cultural history by framing their subject matter within that context. As Howard Kushner has observed, both groups use the word ‘history’ to describe what they do but what they do is not the same. They even use different vocabularies, and the ‘references’ at the end of a paper in the Journal of Medical Biography reflect a different thought process from the ‘footnotes’ in Medical History. ¹

That the study of medical history has been split by two separate traditions and cultures might not matter if each group (I nearly wrote ‘each side’ with its implications of contest and rivalry) were to interact from time to time and to listen to and to learn from each other; but, apart from an occasional and highly successful collaboration such as the James Lind Library, ² such contacts are infrequent and limited in scope. In consequence, elements of suspicion and even of antagonism sometimes creep in. For example, editors of most history journals aimed primarily at professional historians are extremely reluctant to accept papers which use biomedical data to challenge historical claims ¹ as Iain Chalmers discovered when he tried to challenge a historical claim in Isis. The editor rejected the paper by Chalmers ² not on the grounds that the factual content was incorrect (improbable as Chalmers is one of the founders of the Cochrane Collaboration) but because it lacked a discussion of historiographical issues. The paper was eventually published but not in a journal where it was likely to be seen by historians of medicine, professional or otherwise.

When praising a book on the history of anaesthesia by a fellow professional historian in 2007, Richard Barnett described the historiography of anaesthesia as

 … one of the last outposts of unreconstructed medical triumphalism. Titles such as Milestones in anesthesia and The battle for oblivion reflect a general unwillingness amongst writers on this subject (frequently senior or retired anaesthetists themselves – plus ça change) to go beyond an uncritically deterministic narrative … ³

As an avid reader of all material on the history of anaesthesia, I am not aware of any such triumphalism in recent years although it was sometimes to be found in the work of earlier generations. Indeed, it is significant that both of Barnett’s examples had been published 40 years earlier, the first being an edited collection of works published between 1665 and 1940 and the second a book written by an economist and intended for a lay readership.

Other professional historians are more aware of the potential benefits of cooperation. When comparing Bad Medicine: Doctors Doing Harm Since Hippocrates by the professional historian David Wootton with Science and the Quiet Art by David Weatherall of the Oxford Institute of Molecular Medicine, Anne Hardy suggested

It is tempting to suggest that the experienced clinician, thoughtfully considering medical history in the light of deficiencies he acknowledges in clinical practice, offers a valuable corrective to the historian whose only experience of medicine is as a patient and not as a practitioner. ⁴

Of course, it must be intensely irritating for the professional historian to find papers written by amateurs whose work betrays a total ignorance of historical methodology. Kushner relates the possibly apocryphal but all too plausible conversation between a surgeon and a professional historian. The surgeon announces that he plans to become a medical historian when he retires from medicine and is then struck dumb with incredulity when the historian says that he intends to practise as a neuropathologist. ¹

If untrained historians like myself wish to be taken seriously by the professionals, it is sensible and also courteous that we should at least take the trouble to learn the rudiments of historiography. Those who have yet to take their first tentative steps in this direction could do worse than study What Is History? by EH Carr and The Practice of History, the response which Carr’s work drew from GR Elton. Both are very readable and, although written more than 50 years ago, are still to be found on student reading lists. Those seeking a modern alternative might prefer What Is Cultural History? by Peter Burke. For a longer work which deals specifically with the historiography of the history of medicine, there is the multi-authored work Locating Medical History: The Stories and Their Meanings edited by Frank Huisman and John Harley.

There is also much that we can learn from the cultural and social lineage of the professional historian of medicine. For example, when writing biography we should aim to set the facts of our subjects' lives in the context of the times and the places in which they lived and worked. Contextual biography is never only the life of John Smith but always the life and times of John Smith because, with the rare exception of the true visionary, we are all creatures of time and place, moulded by our heritage and by those around us. Placing John Smith in his context need not entail a detailed study of weighty academic tomes. Popular works suffice provided that we choose those written by authoritative and respected authors, preferably those who also write well. As I write mainly about people and events in the second half of the 19th century, I read, re-read and always enjoy the wonderful trilogy of Victorian People, Victorian Cities and Victorian Things by Asa Briggs. It is also prudent to read what the professional historian may have written about the broader aspects of my topic. As I am currently researching the history of military anaesthesia, I am reading what Mark Harrison has to say about the militarisation of medicine and the medicalisation of war. ⁵ As clinicians and medical researchers, we have been spoilt by the availability of PubMed to help with our literature searches. There is no direct equivalent in the field of historical research but Google Scholar often turns up trumps and it is always worth a digital search of back numbers of the medical history journals and the publishers’ databases.

It takes two to tango but somebody has to make the first move. Rather than continuing to ‘mind the gap’, let us all start to ‘mend the chasm’. To do so will be to everyone’s mutual benefit.