In our new ‘MedHums 101’ series exploring the key concepts, debates and historical points of the medical humanities, Kate Errington gives a general history of the subject: it’s been around longer than you might think.
When I use the term ‘medical humanities’ I’m often met with blank stares. For many this is a new subject – none of us had Med-Hums on our timetable in school. And how can something be both medical and humanities focused? That’s an oxymoron – right? In reality, though, the humanities and medicine have always been linked. Although the term ‘medical humanities’ was first used in 1948 by historian George Sarton, we need to go further back to explain how the field emerged. Much further back.
During the classical period (between the 5th and 4th centuries BCE) doctors had a more holistic view of medicine than they do today. When someone was sick, doctors understood the condition as relating to the whole person. As such, treatment also involved caring for the whole person. Hippocrates, a physician of the classical period, and the ‘Father of Modern Medicine’, believed in humoural medicine. According to this model, good health reflected the four humours – black bile, yellow bile, phlegm, and blood – being kept in equilibrium (Jouanna and Allies 2012). If you became sick, this indicated that your humours were imbalanced, to which a doctor might suggest an intervention – like blood-letting – or prescribe a lifestyle change such as an alteration in diet or occupation. This is all to say that, in the time of antiquity, health was understood as a balancing act of internal and external components, and that it existed within a wider environmental and sociological context.
A doctor’s education
The influence of humourism on western medicine persisted for over two millennia (Lagay 2002). The oldest, and perhaps most prominent, medical school in modern civilisation, the Schola Medica Salernitana, based its curriculum around Hippocratic medical doctrine (de Divitiis et al. 2004). Based in Salerno, Italy, this school was at the forefront of medical education in Early Modern Europe. In addition to anatomy and medical theory, students learned Greek, Latin and Philosophy in order to appreciate classical texts in their original language. Later, in the 12th century, students were also taught grammar and rhetoric (Kristeller 1945). The fame of the Salerno School of Medicine meant that it served as a model for other educational institutions at the time. As a result, doctors throughout Europe studied the humanities as an integral part of their medical training.
Medicine as science
With greater understanding of the body, and of the origins of disease, the study of medicine became a science. By the 19th century, the work of Giovanni Battista Morgagni, Xavier Bichat and Rudolf Virchow had developed pathology as a specialism, locating disease within tissues and cells (van den Tweel and Taylor 2010). Microbiology also became prominent, with Louis Pasteur’s germ theory, published in 1861, and advances from Robert Koch (Opal 2009). Our understanding of disease became far more localised – we could now pinpoint specific organs, tissues, even cells, causing illness. Consequently, the study of medicine also became highly specialised. Physicians could devote themselves to the mastery of a particular medical discipline, dividing labour among specialists, and advancing knowledge and medical teaching.
However, specialisation was not without its opponents. In his editorial preface to Dictionnaire de Médecine (1832), French physician Raige-Delorme lamented what he saw as a harmful division of practice (Weisz 2003). Medical history was also being introduced to the curriculum to counteract this specialisation: in Prussia, by Kurt Sprengler and Emil Isensee; and across the pond by John Shaw Billings and William Osler (Doria 2016).
“the so-called Humanists have not enough Science, and Science sadly lacks the Humanities” (Osler 1919, 18).
Despite its opponents, medical specialisation continued to progress into the 20th century. This was, in part, propelled by the Flexner Report in 1910. This American report transformed the landscape of medical education in the US, advocating a biomedical model of education, inspired by the successes of German institutions. It prioritised scientific knowledge and advancement in the education and ethos of the physician. This approach galvanised medical science in the US, but its detractors feared that the primary role of the physician was being lost; Osler, again a significant opponent, believed that the care and welfare of the patient was being decentred from the aims of the medical profession (Duffy 2011).
The emergence of the ‘medical humanities’
Fast-forward to the 1960s and 70s, we begin to see humanities disciplines re-enter medical curricula. In 1967, Pennsylvania State College of Medicine opened the first Department of Humanities in a US medical university. In the UK, there was a drive for medical ethics to be reintroduced to MD education, through forums such as the London Medical Group (Shotter et al. 2013). A confluence of factors and events beckoned the return of the humanities to medicine at that particular time (see Reynolds and Tansey 2007 for detailed discussion in the UK context). There is not the scope in this article to go into depth, but here are a few headlines:
- In the aftermath of the Second World War, the Nuremberg trials revealed evidence of human experimentation by Nazi doctors. Repeating these atrocities was to be avoided at all costs.
- After the atomic bombings of Hiroshima and Nagasaki there were debates about the social responsibility of science and the potential perils of new technology.
- With other conflicts such as the Korean War, and particularly the unpopular Vietnam War, there was a feeling that leaders and institutions should be made accountable for the consequences of their actions.
Social activism and political debate
- Social movements such as the civil rights movement, feminist movement, and gay liberation movement marked this period as one of great social change. Previously established social hierarchies were being challenged, and with this the traditional deferential attitude to the doctor.
- Public debates on abortion in the UK and US raised moral issues with the procedure, as did attempts to legalise euthanasia.
- Medical and technological advancements such as organ donation, genetic coding, and reproductive technology, pushed the limits of science and introduced new moral debates, including concerns that medical technology further dehumanised medical practice.
- Institutionalised medicine had changed the doctor-patient dynamic.
Many of these concerns were raised by Edmund Pellegrino in his 1973 ‘The Hippocratic Ethic Revisited’. In this piece – a sort-of manifesto for the medical humanities – Pellegrino described how the complexities of modern life required a renewed consideration of medical ethics and the importance of humanistic medical training. Society had changed. What it meant to be a doctor had changed. Professional ethics needed to change as well.
Pellegrino became a pioneer for the medical humanities. He led the Society for Health and Human Values, at Texas University, helping him to articulate a vision for medical humanities (Engelhardt 1990). In 1976 he founded the Journal of Medicine and Philosophy, which allowed for scholarly debate and a definition of disciplinary standards and issues. This was followed by the Journal of Medical Humanities in 1979, marking the critical expansion of the health humanities in the United States.
By the 1990s the term ‘medical humanities’ was beginning to take hold in the UK (Evans and Greaves 2010). The University of Wales, Swansea, launched its Medical Humanities MA in 1997, and in 1999 Durham University opened the Centre for Arts and Humanities in Health and Medicine (now the Institute for Medical Humanities). In 2000, the Medical Humanities journal launched, marking the subject’s increasing credibility and influence. Today the medical humanities may no longer be considered niche: you can study it at university (like me), there’s a vibrant research community, multiple journals and conferences, all devoted to its study and development.
Futures in the critical medical humanities
As you’ve probably gathered from this whistlestop tour of the medical humanities, much of its history has primarily been concerned with medical ethics and education. Similarly, conversations have revolved around how the humanities can be used to enhance medical practice and patient experience – how we can ‘humanise medicine’. But through the 21st century the scope of medical humanities research has expanded to include new disciplines, perspectives, and directions.
The current wave, dubbed the critical medical humanities, was marked by the publication of The Edinburgh Companion to the Critical Medical Humanities (2016), edited by Anne Whitehead and Angela Woods. The companion argues that the critical medical humanities blurs the disciplinary lines between medicine and the humanities (Fitzgerald and Callard 2016). It embraces the messiness, with the humanities no longer posed in service of (or opposition to) the biomedical, but endlessly entangled with it (Viney, Callard, and Woods 2015). The interdisciplinary nature of critical medical humanities makes it dynamic, with infinite opportunities for collaboration, whilst its contemporary commitment to including diverse perspectives critically disrupts and expands the experiential lens through which we ask what it means to be human.
About the author
Kate Errington is a PhD candidate at Birkbeck and the London School of Hygiene and Tropical Medicine, studying the cultural history of pregnancy in the 20th century. She is available to contact on Twitter @KateErrington3.
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