Articles
by Dr. Leslie Hall and Dr. Harriet Deacon
Overview of Medical History
The world of the history of medicine is currently in mourning for its most distinguished contemporary practitioner, Professor Roy Porter. He had recently retired after over 20 years at the Wellcome Institute for the History of Medicine, London (now the Wellcome Trust Centre for the History of Medicine at University College London) and his enormously productive career was by no means over (shortly before his untimely decease he had handed in manuscripts of two new books, and a television programme on the English Enlightenment was posthumously broadcast). Roy's huge output included several works which have become classics in the field, and his career demonstrates the enormous developments within the history of medicine and its engagement with the wider questions of history over the last few decades.
Medical history can surely no longer be dismissed as an antiquarian pursuit suitable for retired medics, involving the reiteration of Whiggish tales of professional triumph and the production of internalist institutional histories, or else the retrospective diagnosis of what ailments famous names of the past 'really' suffered from. It has become theoretically and analytically sophisticated with a field of activity which extends well beyond the stories of a narrowly-defined medical profession, the 'great men of medicine' performing the Wonderful Onward March of Medical Progress. The history of medicine now includes not merely non-elite medics, but other practitioners, from formally regulated 'ancillary' professions to alternative and informal 'healers', and (as Roy Porter was one of the earliest to demonstrate vividly) the point of view of sufferers and patients themselves. Indeed, it interrogates the whole idea of a straightforward onward and upward march of unproblematic progress.
A lengthy tradition of scholarly interest in the history of medicine dates back to the beginning of the twentieth century, in Europe and in North America, associated with such names as Karl Sudhoff, Henry Sigerist, Owsei Temkin, George Rosen, and Charles Singer. Initially this was very much the purlieu of medical men (and most of them were, indeed, of the masculine persuasion, though female scholars such as Kate Hurd-Mead demonstrated the long historical presence of women as practitioners), as one can see from the early volumes of the relevant journals in the field, where nearly every contributor had an MD or equivalent qualification. Many of them had an exalted belief in the importance of medical history to the contemporary profession, and the standards of scholarship were high. They laid significant foundations for the discipline. The relevance of an understanding of the history of medicine is currently being recognised once again with the increasing inclusion of modules on the subject in the medical curriculum. Practising doctors continue to make important contributions to our understanding of the history of the discipline.
However, Sir Henry Wellcome, whose legacy is one of the major reasons for the current efflorescence of medical history in the UK, did not see the history of medicine as merely of interest to medical professionals. When establishing his Historical Medical Museum he believed that the history of medicine could illuminate the whole of human life. In his evidence to the Royal Commission on National Museums and Galleries he stated that 'in all the ages the preservation of health has been uppermost in the minds of human beings'. (1) He therefore saw it as a central theme whereby to understand society as a whole in historical context. This extremely broad vision is illuminated by the copious archives of the Historical Medical Museum (even though the actual artefacts are now dispersed, mostly to the Science Museum, South Kensington). The Wellcome Trust has continued his legacy through ongoing support for the library of the Wellcome Institute for the History of Medicine, now the Wellcome Library for the History and Understanding of Medicine, and by funding research and teaching.
To further the latter aim, the Wellcome Trust established History of Medicine Units in several UK universities from the 1960s, and there are now a number of Wellcome Trust Centres for the History of Medicine within academic institutions as well as individual teaching and research posts supported by the Trust. Largely as a result of this initiative the history of medicine and health has become of increasing interest to scholars with a background in history rather than medicine. This development has enabled the linking of medical history to many wider historical concerns, ranging from the political processes involved in the development of welfare states to gender attitudes within society and popular beliefs about health and the body. The history of medicine has also become much more widely disseminated in the history teaching curriculum at all levels.
While these exciting intellectual developments are to be welcomed, the continuing advancement of the discipline is enabled not merely by new readings of the materials already known and accessible but the identification and preservation of, and making available to researchers, of new sources. There are perhaps particular problems arising with records of medical practice, especially for the more recent period. Records of institutions such as hospitals are often very bulky, and issues of Data Protection for documents containing sensitive information about individual patients may necessitate restrictions on access or periods of closure, factors which are often a deterrent to repositories which might be suitable places of deposit. The complex legal status of (to take a specific problematic example) the records of general practitioners means that an extremely important element of medical care may be vastly under-represented, or represented only in a very sporadic and idiosyncratic way. For the more recent period, oral histories can reveal much that the written record could never touch, but cannot replace more traditional sources.
The Wellcome Library has continued to build upon the diverse strengths of the materials brought together in Sir Henry Wellcome's lifetime, which cover a much broader range than many people understand under the rubric of 'history of medicine'. A major new initiative was the decision in 1978 to make a specific effort to identify and preserve archives relating to medical developments in the twentieth century. Much material relating to medical and public health administration activities of central and local government agencies was being preserved but it was already apparent that valuable resources for the future historian were slipping through existing nets. The initial assumption was that the focus would probably be on the papers of individual medical scientists, and a number of important collections in this area have been acquired (mostly recently negotiations have been concluded for the transfer to the Wellcome of the papers of the Nobel Prize-winning pioneer of DNA research, Francis Crick). However, an area of concern which became apparent very early on was that of the archives of non-governmental, voluntary, organisations. Records of these bodies, which played a significant part in the British system of health and welfare provision whether as regulating bodies for particular professional groups, philanthropic service providers, or campaigning societies lobbying for change, are particularly at risk (something which is true not only in the medical and health field). Important archives of many voluntary bodies have been acquired and the archivists are always happy to survey records still held on site by creating bodies and to advise on their preservation.
There has also been growing awareness of the plethora of material relating to the history of medicine which cannot feasibly be accumulated within any one single institution. Over the years major surveys have been undertaken to identify records in other repositories, resulting in the joint Wellcome/Public Record Office Hospital Records Database (now online at http://hospitalrecords.pro.gov.uk/) and the Medical Archives and Manuscripts Survey, 1600-1945 (MAMS). The results of the first phase of the latter, ongoing, survey, relating to London repositories, are also available online at http://library.wellcome.ac.uk/node265.html. The importance of primary sources for the historian of medicine and healthcare achieved further recognition from the Wellcome Trust with the launching of the joint Research Resources in Medical History initiative with the British Library in January 2001. This supports projects that improve the preservation of or access to medically important collections, by enabling conservation, cataloguing, the creation of databases, etc. Many hitherto unthought of possibilities for research have been opened up by new technology, but it should not be forgotten that the prospects which, for example, digitisation and web access offer, still require a sound foundation of traditional archival skills and activities to make them accessible and meaningful.
This is - in spite of the grief that historians of medicine are feeling at the extinction of the brightest luminary in the field at the peak of his powers - an exciting time in the history of medicine, as Sir Henry Wellcome's vision of medicine and health as central to understanding the past is increasingly embodied in ever-expanding research and publications andthe making available of additional resources for its study.
Notes:
- Cited in Helen Turner, Sir Henry Wellcome: the Man, his Collection and his Legacy (The Wellcome Trust and Heinemann, 1980), p. 38. back to 1