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About this book

This introductory textbook presents medical history as a theoretically rich discipline, one that constantly engages with major social questions about ethics, bodies, state power, disease, public health and mental disorder. Providing both instructors and students with an account of the changing nature of medical history research since it first emerged as a distinct discipline in 19th century Germany, this essential guide covers the theoretical development of medical history and evaluates the various approaches adopted by doctors, historians and sociologists.

Synthesising historiographical material ranging from the 19th to 21st centuries, this is an ideal resource for postgraduate students from History and History of Medicine degrees taking courses on historiography, the theory of history and medical history.

Table of Contents

1. History of Medical History

Abstract
What does medical history mean to different people? Who should write it – doctors or historians? Is it purely an academic exercise or can it have practical uses for doctors and patients? Since medical history first emerged as a distinct discipline in the mid-nineteenth century, these questions have been heavily debated. Issues of ownership and authority have permeated discussion on the purpose and function of analysing medicine’s past. In many respects, medical history differs from other types of history. Breaking beyond the confines of humanities research, medical history sits, sometimes uncomfortably, at the intersection between historical research and medical practice. It is actively pursued by historians, doctors and amateurs alike, researchers with different aims, needs, agendas and perspectives. This also raises questions about audiences. Who should medical history be written for? Whose needs should it serve: doctors, patients, policy makers, historians, the public?
Ian Miller

2. Disease

Abstract
What is a disease? On the surface, this might seem like a self-explanatory question. Surely, a disease is some kind of physical disorder with specific symptoms that normally affects a particular location of the body? From a clinical perspective, this is certainly accurate. But diseases are difficult to define and have meanings beyond their physical, biological existence. They can change biologically in response to environmental conditions while germs can evolve to protect themselves against threats, even man-made ones such as antibiotics. But humans also make sense of, experience and respond to diseases in strikingly different ways in different social and cultural contexts. Ideas about disease are highly context-dependent because human disease only exists in relation to people: people who live in varied cultural settings. Medical anthropologists and sociologists have shown that whether people consider themselves to be ill or not varies considerably due to factors such as class, gender and ethnicity. What constitutes a disease in one place might differ vastly in another, reflecting contrasting ecological or biological circumstances but also distinctive theoretical models about the body, cultural values, social and political constraints, technological capabilities and individual and collective expectations. In addition, what doctors choose to classify as a disease can regularly change. As an example, in 1994 osteoporosis changed from being considered an unavoidable part of normal ageing to being officially recognised as a disease by the World Health Organization, turning sufferers into patients. The historical contexts of disease therefore offer an important lens for further understanding how disease takes on various meanings in particular settings.
Ian Miller

3. Mental Well-Being

Abstract
Mental health is among the most debated themes within medical history. A standard historical account of mental health history looks something like this: in the medieval period, mental disorder was considered a fairly normal part of everyday life; mental distress could be understood in religious terms, a gift or punishment from God or as a problem of humoral imbalance, but not always as a medical problem in its more modern sense. However, between around the sixteenth and eighteenth centuries, Europe witnessed a Scientific Revolution in which traditional ideas about the world, rooted in religion, theology and superstition, gradually gave way to more secular outlooks. The emerging sciences valued facts, observation and scientific proof; scientific investigation began to replace theoretical speculation. In light of this, attitudes towards the body and madness changed radically. The new breed of scientists attacked traditional humoral medicine, based largely on the theories of Aristotle (384–322 bc). A fashionable view of the body as a machine ready for analysis and observation encouraged research into its solid, physical parts. Anatomists investigated the circuitry of the body - limbs, spinal cords, nerves and reflected upon the role of the nervous system in governing sensation and motion. A new mechanical view of the body was being forged.
Ian Miller

4. Health

Abstract
For those of us living in western societies, having good health is an important personal goal. Throughout the past two centuries, how we maintain health has been predominantly guided by medical science. During the Industrial Revolution, public health officials devised various new initiatives that targeted unsanitary urban and rural conditions. Sanitary conditions improved considerably in many towns, cities and rural areas. Notoriously high maternal and infant mortality rates dropped substantially. So too did death rates from infectious diseases such as tuberculosis and typhoid. For many of us in the twenty-first century, mostly living free from infection and poor sanitation, staying healthy still remains important, although we tend to achieve this by exercising, playing sports or eating a healthy diet. A lucrative industry has built up around health urging us to keep fit, although we also continue to benefit from state-supported public health schemes. It would appear, then, that health movements, public or private, have been a beneficial social force notable for the substantial improvement which they brought to the human condition.
Ian Miller

5. Eating

Abstract
Medical professionals play an important role in advising us on food-related matters: dieting, good nutrition, eating disorders, links between foods and illness, levels of carbohydrates, cholesterol, fats and protein, and so on. In the twenty-first century, efforts made by medical communities to promote healthy eating are often supported by government initiatives. Indeed, the imperative to eat well and be healthy has emerged as a central personal goal within the broader nexus of health initiatives outlined in the previous chapter. Since the late eighteenth century, scientific perspectives on food have informed how doctors have advised us on what to eat. In the nineteenth century, Canadian surgeon William Beaumont (1785–1853) elucidated the workings of the digestive system by examining a patient, Alexis St. Martin (1802–1880), who had been shot in the abdomen. As an example, in 1994 osteoporosis changed from being considered an unavoidable part of normal ageing to being officially recognised as a disease by the World Health Organization, turning sufferers into patients. The historical contexts of disease therefore offer an important lens for further understanding how disease takes on various meanings in particular settings.
Ian Miller

6. Global Health

Abstract
In 1961, Martinique-born Afro-Caribbean psychiatrist Frantz Fanon (1925–1961) published The Wretched of the Earth. In this, he provided an account, from psychiatric and psychological perspectives, of the dehumanising effects of colonisation upon people and nations.1 An active supporter of the Algerian war of Independence (1954–1962), Fanon asserted that French colonisation had caused a serious decline in Algerian mental health and highlighted how colonists had used particular forms of language and vocabulary to help establish imperialist and native identities (e.g. coloniser, colonised). Fanon worked in a colonial hospital in Algeria, an experience which radicalised him and catalysed one of the most searching critiques of the late-colonial social order. For Fanon, to be colonised was to be alienated from oneself and ones environment, in just the same way as a person suffering from psychiatric illness could be considered alienated from his or herself. In his account, colonialism itself was pathological. Colonialism was synonymous with violence and racism and inflicted profound psychic damage. The colonised subject suffered from a profound maladjustment to modernity and the civilisation presented by colonisers.2
Ian Miller

7. Patients

Abstract
If modern medicine has become predominantly hospital-based and technological in recent centuries, then it follows that patient experiences must have changed dramatically. Today, the majority of us will experience serious illness, and often death, in a hospital. However, this tended not to be the case until fairly recently. It would be tempting to presume, if we consider the radical changes in medicine since the late 1700s, that patient experiences of illness and institutionalisation are now vastly superior to their historical equivalents. However, the situation is not that simple. While diagnosis, treatments and medical technologies are undoubtedly more technically precise, the quality of the doctor - patient interaction declined in the nineteenth and twentieth centuries to the point where patients claimed to feel marginalised and deeply alienated during impersonal clinical encounters. In response, patient rights movements emerged in the late 1960s and 1970s and dovetailed with other emancipatory left-wing movements including feminism, gay rights and civil rights. All of these movements strove to tackle social discrimination and the inequitable workings of existing power structures. Those who advocated patient rights challenged a perceived paternalism in medical care and discriminatory medical attitudes towards women, ethnic minorities and gay communities.
Ian Miller

8. The Limits of Medicine: Ethics and Technologies

Abstract
This chapter examines some of the key ethical issues raised by modern biomedicine, with a focus on activities which tested and pushed the boundaries of what we consider acceptable for doctors to do to us. In doing so, it highlights deeply problematic interactions between modern medicine, the human body and western societies. It was English physician Thomas Percival (1740–1804) who, in 1803, first introduced the term medical ethics after being asked by Manchester Infirmarys medical staff to compile a list of hospital regulations. For the next century, Percivals book was widely used internationally as a code of ethics, part of the broader process of physicians and surgeons demarcating themselves from irregular healers as orthodox medicine first professionalised. Remarkably, Percivals work formed the basis of the American Medical Associations Code of Ethics, adopted in 1847. However, Percivals ethical codes were very much a reflection of nineteenth-century professional politics. Their introduction was, at least in part, an effort by the emerging breed of middle-class doctors to present themselves as gentlemen with enshrined duties and responsibilities, individuals who could be entrusted to act decorously and professionally towards patients and other medical practitioners unlike their unscrupulous quack counterparts.
Ian Miller

9. Conclusion

Abstract
Admittedly, the current landscape of the social history of medicine project looks very different from that of the 1970s and 1980s, a period when there was no firm separation between the intellectual and the political, when contemporary political concern with health inequalities was reflected in an egalitarian social approach to the medical past.3 Cooter was perhaps also correct to lament the relative lack of methods or theory in medical history, often celebrated by its practitioners as a positive intellectual pluralism. And his scepticism about the constant borrowing from sociologists, anthropologists, psychologists and scholars of gender, cultural studies and subaltern studies was perhaps not entirely unfounded. Nonetheless, I would profoundly disagree that the discipline is politically and intellectually sterile, to borrow Cooters phraseology. This book has attempted to synthesise a rather vast amount of literature to produce a concise, accessible overview of the basic themes, methodologies and theories that have underpinned medical history research over the past few decades. It proposes no overarching theoretical framework; it contains no all-embracing methodological approach; its thematic structure favours no key intellectual thinkers.
Ian Miller
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