Reading Medical History: Much More Than Inspiring Stories

Adam Rodman

As the host of Bedside Rounds, a medical history podcast, book recommendations are one of my most frequent queries. I've been asked many times to recommend one single book that sums up the history of medicine. However, I’m largely skeptical of books that give a general overview of the history of medicine. While they can be good jumping off points, these overarching narratives can give the false impression that one innovation clearly follows another in an unending chain that leads to modern medicine. If working on Bedside Rounds has taught me anything, it’s that the history of medicine is far messier than this. That said, if you must read one overview, For the Greatest Benefit of Mankind by Roy Porter is a good starting point. Medical history is so much more than the content—the who, what, where. My goal here is to give a miniature curriculum of sorts on how to approach medical history and conceptualize our own place in it, rather than to actually teach the content.

I’ll start with the Birth of the Clinic by the postmodern philosopher Michel Foucault. This book is about arguably the most important period in the development of modern medicine, the Paris Clinical School. That being said, as for its historical content, it doesn’t really stand up to modern historiographical standards (and if you’re really interested in the period, I’d recommend Ackernecht’s Medicine at the Paris Hospital, or Duffin’s To See with a Better Eye). But what Focault masterfully does is describe the ending of one medical episteme (that is, the unconscious approach to knowledge that constrains our approach to the patient and disease) and the dawn of another -- pathological anatomy, which we’re arguably still in today. In many ways, the medical world at the beginning of the 21st century looks a lot like the beginning of the 19th -- a potent mixture of new technology and new ways of defining and categorizing disease threatening the traditional order. Postmodern philosophy gets a bad rap these days, for being overly obtuse and unreadable (of which Foucault has been guilty), or for supposedly supporting extreme relativism, but Birth of the Clinic still remains readable and relevant in 2019. If you’re still skeptical, just try the introduction, which is the most memorable introduction that I’ve ever read, and that I occasionally pull out for my trainees.

Next I’ll recommend The Ghost Map by Steven Johnson, a popular science author. This is about the context surrounding John Snow’s famous study of the Broad Street pump during the 1854 cholera epidemic in London. Johnson is more interested in the granular details of Snow’s study than the scientific and medical milieu in which he was operating (which would be my main complaint, that he dramatically oversimplifies the arguments of Chadwick and Farr in regards to miasma). This is also the book’s strength, as he dramatically shows the advantages of a new type of “knowing,” that of epidemiology, which would soon come to dominate medicine. It helps that the book is structured as a mystery and is a real page turner.

I’m skeptical of overarching narratives of medical history, but Thomas Dormandy’s The White Death is the finest example of a biography of a single disease that I’ve ever read. Dormandy, who was both a chemical pathologist and an historian, paints a picture of tuberculosis intimately tied to the human condition for thousands of years. As such, his story references literature, art, and popular culture just as much as it does with epidemiology, pathology, and pharmacology. Muhkerjee’s Emperor of all Maladies is usually given as the example of a disease biography, and while that’s an excellent book as well, I still have to recommend Dormandy’s tome.

Finally, everything that we do—and that includes my lecturing and podcasting on medical history and philosophy—we do for our patients. The final two essays focus on how medical perception, even when well-intentioned, can have serious effects on how we approach our patients. The Disappearance of the Sick-Man from the Medical Cosmology by Nicholas Jewson famously describes the loss of patients’ involvement in their own health over the dawn of modern medicine. Jewson is an academic, but his writing is engaging and generalist. The second essay is Illness as Metaphor by Susan Sontag, and its follow up AIDS and Its Metaphors. In these essays, Sontag deconstructs the language we’ve used to understand disease, starting with tuberculosis, extending to cancer, and finally to HIV/AIDS. Her arguments are made more powerful by the fact that she was undergoing treatment for breast cancer during her writing. I don’t always agree with her analysis, but her message -- that the stories we tell about disease to both ourselves and our patients have real effects on medical treatment treatment -- is as relevant today as it was in the 1970s, or the 1810s.

Ultimately, the importance of medical history is not simply that there are interesting, crazy, heart-breaking, and inspiring stories—it’s that an historical perspective can make us more introspective physicians, and help us take better care of our patients. I hope that this collection of books and essays can help you on your way—and if you have any other questions, you can always feel free to ask me @AdamRodmanMD.

Adam is a general internist, academic hospitalist, and Director of the Center for New Media at Beth Israel Deaconess Center in Boston. He completed his residency in internal medicine at Oregon Health and Science University and his fellowship in global health at BIDMC in Molepolole, Botswana. He is the host of the medical history podcast Bedside Rounds, produced in partnership with the American College of Physicians (CME/MOC credit available at www.acponline.org/BedsideRounds; website www.bedside-rounds.org), as well as the podcast Origins. He lectures nationally on medical history and philosophy, as well as the use of new media in medical communication. You can find him on Twitter @AdamRodmanMD.