Is the history of medicine worth your while?

Rebecca Lester makes a case for her one year intercalated degree in the subject

Aristotle 384-322 BC

Hippocrates probably never wrote his famous oath; nor, it is likely, did he ever swear it

Having completed my medical studies via an intercalated bachelor of science degree in the history of medicine, I am often asked to justify and explain my interest in the subject. "How is that going to help with your career?" and, "Sounds easy, did you just doss around all year?"

I don't necessarily think everyone should do a medical history degree, but I urge you to read about things other than medicine. Before doing this degree, my narrowly focused mind was invited to join a pub quiz team only on the off-chance that there would be a question such as, "What is the medical term for a nosebleed?" I felt ignorant compared with my arts student counterparts.

Providing a context

The history of medicine isn't just history. Every fact we learnt was put in context, and I broadened my knowledge in several different and fascinating directions. Yes, I now know about Pasteur and his germ theory, about Darwin and evolution, about Hippocrates and his oath, but I also know about the societies in which these men lived and about why they thought the way they did. In learning about Ancient Greek medicine we learnt philosophy; through studying the history of the NHS we studied British politics; and through reading about cholera and smallpox epidemics we read about geography and international politics. In other words, the course turned me into a more rounded person.

A young Charles Darwin

A particular emphasis of the course was to understand why the so called "great men of medicine" faced untold difficulties in introducing their theories and concepts. Germ theory, for example, was no overnight revolution, and Darwin struggled with the implications of his heretical theory. Moreover, Darwin was not the sole protagonist of evolution, and Florence Nightingale was not the only nurse to travel to the Crimea. Sometimes we link historical theories and discoveries with particular names without knowing why. Pasteur, for example, was an excellent publicist, and Darwin had better social standing than Alfred Russel Wallace, the often forgotten co-discoverer of natural selection.

Alfred Russel Wallace, the often forgotten co-discoverer of natural selection

I also learnt not to take knowledge for granted. Did you know, for example, that Hippocrates probably never wrote his famous oath; nor, it is likely, did he ever swear it. Although the oath later became a paradigm for our profession we know little about its origins, other than the dates it was written (fifth to third centuries BC). Also, did you know that surgeons were firmly at the bottom of the medical hierarchy until relatively recently.

Beyond memorising facts

The degree was not just learning facts and concepts. History of medicine taught me to think for myself. I have developed ways of examining and critically evaluating sources and thinking about the reliability and accuracy of historical evidence and historians' commentaries. These transferable skills help me when reading medical research. It was also in this year that I really learnt to read: reading a dozen books and not a dozen pages to write an essay took some getting used to. When I returned to revising for medical finals I could read more and for longer than before. I developed my writing skills: my style improved and my vocabulary increased. Being able to communicate well in writing is important in medical practice and is a vital skill for doctors to acquire. I'm not only talking about research papers, but referral letters or job application forms are less daunting after a 15,000 word dissertation.

Learning the history of medicine is humbling and not just in the sense of realising that, until relatively recently, medicine was not a respectable job and doctors were low down on the list of respected members of society. Not that long ago parents would be embarrassed if their son went into the medical profession, and they would try to steer him instead in the direction of the clergy. Learning the history of our science and profession has taught me how fragile our knowledge is. Everyone from the Ancient Greeks to the Victorians thought they were getting it right, so there is no reason why we shouldn't be proved wrong about aspects of our practice in the future. I no longer, for example, scorn the Hippocratic doctors for believing that imbalance of the four bodily humours led to disease. Everything makes sense if placed in context. And some things haven't changed. Hippocratic doctors put particular emphasis on clinical history taking and observation skills. A doctor in 400 BC believed a diagnosis could often be made by simply looking at and talking to a patient, a skill that many physicians pride themselves on today.

What was the course like?

The course included a number of core modules spanning a long time period, beginning with ancient Graeco-Roman medicine and ending with wartime medicine and the development of national insurance and the NHS. Optional modules included the history of madness and psychiatry, Asian medicine, and the history of evolution. These modules enabled us to study particular areas of interest. An individual research dissertation gave us the chance to develop an in-depth knowledge on almost any aspect of medical history.

I attended Sheffield medical school and ventured to University College London for the course between my fourth and fifth years. It is based at the Wellcome Trust buildings, and sharing an environment with doctor of philosophy students, lecturers, and international researchers was both sociable and stimulating. We also had the opportunity to go to northern Italy to visit Renaissance medical schools.

Was it an easy year? I'm afraid not. I don't think I ever worked that hard at medical school. There were constant essay deadlines, a 15,000 word dissertation, and end of year exams. Unlike much assessment at medical school we had to be on the ball for the whole year and not just for the few months in the run-up to exams. My ability to study consistently and organise my time improved dramatically.

In today's climate that emphasises the sparkling CVs and dazzling application forms required for Modernising Medical Careers you might be forgiven for thinking that intercalating in a scientific discipline such as physiology or biochemistry would be more worth while than studying an arts subject. It might be. History of medicine would not suit everyone, but history is as valuable as any other intercalation. I owe much to my intercalated year. I didn't spend it looking down a microscope, but I did spend it opening my mind. It was difficult to go back to studying medicine proper, but I did not, as was suggested to me before I left, forget what a stethoscope was. And what's more, I can even tell you when it was invented.

Competing interests: None declared.

Provenance and peer review: Non-commissioned, externally peer reviewed.

1 Porter R. The greatest benefit to mankind. A medical history of humanity from antiquity to the present. London: Fontana Press, 1999.

Rebecca Lester, foundation year 2 doctor, Hope Hospital, Salford, Manchester
Email: rebeccalester@doctors.org.uk


Student BMJ 2007;15:427-470 ISSN 0966-6494 | December

       

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