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Clio in the Clinic

Clio in the Clinic: History in Medical Practice

Edited by Jacalyn Duffin
Copyright Date: 2005
Pages: 350
  • Book Info
    Clio in the Clinic
    Book Description:

    Sometimes, history can solve a medical mystery; at other times, it can point to the right treatment or console a despairing doctor by demonstrating a timeless connection to unchanging aspects of human existence. InClio in the Clinic, twenty-three doctors, each of whom is also an accomplished historian, write autobiographically about how they use history in their practice of medicine. Their stories of clinical experiences show that historical thinking can serve in the diagnosis and care of patients.

    These essays constitute new evidence for an old argument about the utility of history in medicine. They open an intimate window on how history informs and serves clinical practice and describe what life is like for doctors when they leave the history meetings and go back to the wards.

    The contributors to this volume hail from five countries and represent sixty years of training; the most senior completed medical school in 1943, the youngest in 2003. They include several internists, four pediatricians, two psychiatrists, two infectious disease specialists, one neurologist, one emergentologist, and one surgeon. Topics include: history in the service of patients, the doctor-patient relationship, disease causation, administrative dilemmas, and the use of history to reflect on current trends in the practice of medicine.

    Many books make claims for the value of teaching history to future physicians, but none have explored the clinical experience of those doctors who are experts in history.Clio in the Clinicshows how knowledge of history can shape a physician's view of the profession and how it can be a surprising asset at the bedside for diagnosis and treatment. Not all the endings are happy, but these tales of medical life are written with insight, honesty, humour, and great affection for medicine, its history, and its people.

    eISBN: 978-1-4426-7301-4
    Subjects: Health Sciences

Table of Contents

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  1. Front Matter
    (pp. i-vi)
  2. Table of Contents
    (pp. vii-x)
  3. Illustrations
    (pp. xi-xii)
  4. Acknowledgments
    (pp. xiii-xiv)
  5. Contributors
    (pp. xv-2)
  6. Clio in the Clinic: An Introduction
    (pp. 3-16)

    Medical history is familiar, but what is historical medicine? It is the kind of practice that emerges when Clio, the muse of history (figure 1), joins medical doctors in their work. The authors in this volume – each an accomplished historian as well as a practicing physician – tell tales from their medical lives about Clio’s contributions to the clinic.

    Clinician-historians are not new – far from it. One of the Hippocratic treatises of the fifth century BC is calledOn Ancient Medicine.

    Nor is medical autobiography new. It is an old and popular genre with many distinguished contributors from the second-century Greek...

  7. Consulting the Past

    • The Night I Fell in Love with Clio
      (pp. 19-26)

      I am an unreconstructed, old-fashioned historian-manqué,by which I mean that I see the saga of medicine with the eyes of an autodidact amateur, a clinician whose heritage can be understood best as a smoothly connected series of fascinating stories about doctors.

      Let me retract that word ‘autodidact.’ It is far too lofty for what I have been doing over these past four decades. Not only that, but it implies that the self-teaching has reached a level of completion that makes it the equivalent of the formalized education that might have been attained had I studied the subject systematically, as...

    • Speculum medicinae: Reflections of a Medievalist-Clinician
      (pp. 27-46)

      Soon after our meeting, a colleague who is both an expert clinician and researcher greeted me one morning with a look of concerned amusement. ‘I had a dream last night. Someone asked me to perform a stat historical consult on a patient, and I had no idea what to do.’ While the anxiety of this kind of dream is easily transferable into the realm of a kidney specialist being asked to act as an orthopedic expert or a neonatologist as an adolescent consultant, the specific anxiety posed by a lack of historical expertise is an uncommon experience for an academic...

  8. Facing Epidemics

    • A Wartime ‘Plague’ in Crotone
      (pp. 49-55)

      I had just qualified in medicine at King’s College Hospital in the midst of the Second World War. I was twenty-three years old, a Welsh boy ‘from up the Valleys,’ where my ancestors had farmed in Cwm Rhondda before the collieries came. I had already been exposed to precocious experience because senior medical students had been elevated to the posts of unqualified house officers in order to make up the deficiency in staff caused by the ‘call-up’ for active service of fully qualified doctors. I had worked briefly as an unqualified casualty house officer during the blitz on London. My...

    • Plagues and Patients
      (pp. 56-72)

      When I entered Dartmouth Medical School in 1971, two friends gave me classic texts from medicine’s past: the Loeb Classical Library translations of the Hippocratic writings from the fifth century BC and Danie Defoe’s fictionalized account of the London epidemic of 1665-6,A Journal of the Plague Year.Later, during my residency in San Francisco, another friend made a present of historian William McNeill’sPlagues and Peoples.As I went through training and afterward, I have dipped into these books in quiet moments. Although they differ markedly, each has echoed in my medical imagination since my first reading. The following...

    • Coping with the HIV/AIDS Epidemic
      (pp. 73-86)

      In 1960, someone on the faculty of Harvard College assigned our entering freshman class a summer reading list that included C.P. Snow’s classic,The Two Cultures and the Scientific Revolution.I read the book but doubt that I grasped what I now perceive to be its message: science should always be informed by values derived from the humanities. I went off to college listing geology as my intended major, but was in reality quite undecided about what to study.

      My father was a physician, and I had seen him have a heart attack at a relatively young age. I was...

  9. Reviving Defunct Diseases

    • ‘La Crise’
      (pp. 89-91)

      I remember a forty-year-old man who was admitted to Paris hospital, where I was working as a resident back in the 1970s. He had a high fever and a bad cough. The chest X-ray displayed a ‘white out’ in a part of his lung, the classic textbook image of acute lobar pneumonia of the type usually caused by thepneumococcusgerm (as it was called back then). I immediately started an intravenous line for treatment with penicillin and then chatted with him for a half-hour or so as he lay calmly in his bed. The man was otherwise healthy, but...

    • Floating Kidneys
      (pp. 92-104)

      In the 1990s, I worked in the employee health office of a community hospital in New Jersey. The capable nurse did most of the work and was not particularly dazzled by physicians. Most of the pre-employment examinations, annual physicals, and ‘clearance’ visits were routine. There were the usual sniffles and back strains and latex glove sensitivities and tuberculin skin tests to be read, and the increasingly ominous needle sticks with their attendant protocols. I even did some good. Did the hard-working medical records technician have repetitive strain injury from pressing a hole puncher all day? Yes; she improved when the...

    • Historical Adventures in the Newborn Nursery: Forgotten Stories and Syndromes
      (pp. 105-115)

      One of the more depressing moments during my career as a pediatrician and medical historian came during a conversation in which I was trying to convince one of the medical school deans of the utility of history. ‘The basic problem with history’, he announced with a dismissive sweep of the hand, ‘is that it’s retrospective.’ His point was true enough in one sense. For most physicians, history brings to mind lists of names and dates, arranged in neat timelines culminating in the present. This style of history is fundamentally apologetic; its purpose is to confirm, not challenge, the authority of...

    • Susan and the Simmonds-Sheehan Syndrome: Medicine, History, and Literatures
      (pp. 116-128)

      I was a third-year medical student when I met Susan, a gentle 54-yearold lady from a traditionally Italian-American, working-class part of South Philadelphia. She had been sent to the hospital by her primary care doctor, whom she had gone to see for routine follow-up after a bad bout with pneumonia. When she presented to the hospital emergency room, she had a low plasma sodium level of 111, with the normal range being 135–145. The numbers suggested an imminently life-threatening condition, but she had no symptoms at all.

      Susan was quite puzzled by all of the fuss, since she felt...

  10. Recognizing New Diseases

    • The Histories of a History: The Boy, the Baron, and the Syndromes
      (pp. 131-145)

      My encounter with a clinical Clio took place in October 1998, as I was delivering a paper at the fifth Mexican Congress of History and Philosophy of Medicine. We were meeting at the old university in the elegant eighteenth-century city of Querétaro, and I was at the podium.

      In that paper, called ‘A Travesty of History’ (Shein, 1999), I was arguing against what I believe to be the unjust use of the name of Baron Münchhausen as an eponym for two syndromes that do not correspond to his history; nor does this name reflect the bizarre etiology of either condition....

    • Who Says You Have to Crawl before You Walk? Sudden Infant Death Syndrome, Crawling, and Medical History
      (pp. 146-158)

      Although I began my career as a pediatrician at the age of twenty-six, I did not gain the critical

      ‘hands-on’ experience of being a parent until I was forty. Fortunately, both for my daughter, Bess, and for my patients, I learned a lot of medical history in the years between. I often tell my students that I like to think I am a better historian of medicine because I am a practicing physician, but the reverse is equally true: I am a better physician because I am an actively practicing historian. This essay is one attempt to explain why.


  11. Making a Diagnosis

    • An ‘Appallingly Sudden Death’ Explained Seventy-Six Years Later
      (pp. 161-169)

      My story of how history can inform the present is circular rather than linear. It began with a plaintive request of a surgeon in 1909 asking if any doctor could help him explain why his patient unexpectedly died while being prepared for a surgical procedure. No one responded. My publication of a response seventy-six years after the original question was posed solved two recent unexplained deaths.

      But I am getting ahead of myself.

      Historians are used to noting connections from various projects on which they are working, and this happened in this case. About twenty years ago, I was interested...

    • One Blue Nun
      (pp. 170-186)

      On a day in May 1986, I was seated in a vast conference room of a Rochester, New York, hotel, about to make my speaking debut as a historian at the annual meeting of the American Association for the History of Medicine. A stylish woman leaned across the row of besuited men to hand me a message and murmured, ‘It’s urgent, doctor.’

      I went cold. My children? My husband? What could have happened? Getting paged at a meeting is a fairly regular occurrence for a physician – but not when she is scarcely in practice and far from home. I could...

  12. Prescribing the ‘Right’ Treatment

    • William Withering’s Wonderful Weed
      (pp. 189-200)

      Almost thirty years ago I attended a postgraduate course at Pennsylvania Hospital, arguably the first hospital in the United States. The original 1751 section of the hospital was undergoing renovation, and the old medical library, which had opened in 1762, was closed. I was so disappointed

      that the librarian took pity on me and let me use the library (figure 25). The door closed behind me, and I was alone with the ghosts of people like Benjamin Franklin and Benjamin Rush. I scanned the

      shelves, chose an original edition of William Withering’s 1785 book,An Account of the Foxglove,and...

    • Dr Heisenberg, Are You Certain about the Diagnosis?
      (pp. 201-210)

      History entered my medical practice by a circuitous route. I grew up in the household of a physician: my father was a clinical professor of surgery. When teaching his residents, he frequently spoke of John Hunter’s philosophy of being a nonoperating surgeon first. It was making the diagnosis that was most important, for without that, surgery would be difficult and possibly dangerous.

      I was trained as an internist and entered private practice in the late 1960s. My younger brother became a surgeon, and I use to joke with my father that I went into internal medicine because we needed at...

  13. Explaining Differences

    • Trust and the Tuskegee Experiments
      (pp. 213-225)

      I grew up in the American South. The Deep South. Mississippi, a land of hot, humid summers, exuberant Kudzu vines, beautiful, red soil, and a place where the world has long been defined in terms of race. In the South, along with knowing that one is white, as I am, comes the constant awareness that many others are not. Race usually trumped the other great divider of persons – religion. My mother is Jewish, but there are simply not enough Jews in Columbus, Mississippi, for that to be a major issue. Catholicism was another story – about 10 percent of the population...

    • Beware the Poor Historian
      (pp. 226-235)

      Physicians are all familiar with patients who tell incoherent stories about prior illnesses, or know nothing of surgeries made obvious by the scars on their bodies. When their stories do not make sense, we dub such patients ‘poor historians,’ inadequate witnesses to their own health histories. Whether due to failing memory, ineffective communication with past medical care providers, or the intrusion of alternative modes of understanding illness, these narratives do not provide the information sought by the practitioner for clarifying present health status.

      But yet another kind of ‘poor historian’ can be found in the clinic: those very practitioners who...

    • We Are All Historians: Thoughts about Doing Psychiatry
      (pp. 236-248)

      We are all historians. We place ourselves within a set of stories, a train of prior events and purposes, of which we wish to be a part. As physicians, the skills, roles, and knowledge we labor to learn, endlessly update, maintain, and consequentially wield, are set within a story or stories, fundamentally historical, within which they make sense and gain legitimacy. This historical work is so ubiquitous and so basic as to be invisible. The question is not about history’s utility to medicine: any physician moves surely, boldly, and even skeptically within medicine because some historically sensible purpose is woven...

  14. Confronting Futility

    • Timeless Desperation and Timely Measures
      (pp. 251-268)

      ‘What use,’overworked medical students and psychiatry residents often ask me, ‘is knowing the history of medicine?’ This question is not due to lack of intellectual curiosity, as most of these students are passionately caught up in their medical studies. Instead, it reflects their urgent desire to care for and treat their suffering patients in immediate and practical ways. By way of response, I tell them that what we do as physicians is shaped not only by the nature of illness but also by historical, cultural, and social circumstance: rather than part of the natural world, clinical practices are historical products...

    • A Brief History of Timelessness in Medicine
      (pp. 269-282)

      The power of time and history to shape medical encounters is widely acknowledged. Here I want to consider the opposite, the power of timelessness. By timelessness I mean to suggest more than simply the quality of being unrushed or unharried in the work of doctoring. Contrary to my assumptions as a historian, I have sometimes felt immersed in medical practices that seem essentially human and freed for the moment of their particular, local constraints and expectations – freed, that is, of historicity and more a part of medicine in alongue durée.To act in this capacity as a physician is...

    • How Medical History Helped Me (Almost) Love a V.A. Hospital
      (pp. 283-296)

      In this essay, I shall try to show how working as a house officer, then junior attending physician, on the Medical College of Pennsylvania service at the Veterans Administration Hospital in Philadelphia (hereafter ‘the V.A.’) in the 1970s helped nurture my then budding infatuation with medical history, and how an appreciation of history helped accommodate to the vagaries of the V.A. Unflattering observations the V.A. will necessarily appear, so I need to declare early on that of my most gratifying and meaningful medical work occurred By ‘meaningful,’ I simply refer to efforts that helped patients to recover or to avoid...

  15. When Clio Falters

    • What Do You Know? Cancer, History, and Medical Practice
      (pp. 299-307)

      My work as a historian and my work as a physician vividly merged one day in 1995. I was making weekend rounds for the Division of General Medicine, seeing my colleagues’ inpatients. I entered the room of a seventy-eight-year-old woman, Grace, who was recovering from pneumonia. When she opened her gown to permit me to listen to her lungs, I must have looked startled.

      ‘I see that you can tell that I have had breast cancer,’ Grace remarked. ‘I had it twice, first on the left and then the right.’

      ‘Yes,’ I replied. ‘And I can tell you exactly when...

    • Seeing through Medical History
      (pp. 308-318)

      In medical history, probably about as much as in any other kind of history, there is a lot to be said for a ripping yarn. I thought I was never very good at ripping a yarn. I studied the history of medicine for more abstract and abstruse reasons than that, I told myself; something about plumbing the ‘structure of medical knowledge.’ That was a high-sounding notion, and one that perhaps became much less fashionable for historians to explore. Maybe such a notion seemed to presuppose some acceptance of a ‘truth value’ in various groups’ practices or habits of mind. An...

  16. Index
    (pp. 319-334)