Why the history of medicine (part II)?

 I have gotten this question a lot, especially in connection with a second question of "what does a historian of medicine do?" While it is fun to tell people that we solved long ago deaths -you know as detectives would do!- it can  be a bit more 'practical' than that. Most historians of medicine, at one point or other of their career, will end up teaching first and third year medical students. These classes will be clinic-related, as in they are classes in medical terminology or the ethics of medicine or they will be that fun class that the medical student remembers in later years, ie the one on the actual history of medicine. To study physicians, especially at the height of the 19th century when medics were trying really hard to be hard-core scientists, can be a journey into the bizarre. There was that time that Robert Koch ( if I am remembering correctly) swallowed a sample of tuberculosis bacilli to test out whether in fact that was the way of transmission. This is one of those anecdotal examples of how for most of medicine's history medics, clinical or otherwise, have been fairly free to experiment as they wish, on themselves or others. Since the Helsinki convention on medical research practices on human subjects was only created in 1964 things such as testing out new vaccines on human beings in the then colonies was all too common. Or the more frightening, discovered while I researched about dengue fever, of the US military medics trying to figure out if dengue was mosquito transmitted by willingly infecting or trying to infect a whole score of local residents of the Philippines back in the 1930s. 

Teaching aside there are a few medical historians that end up in policy work or in NGO's. Some have become authors of medically influenced fiction. But I would hazard to say most stay in academia in some way or other. 

It is definitely a way of analysing reality, of viewing medicine more critically than most lay people do, and a way of seeing disease in society that is very particular. And this is because in studying the history of medicine we especially analyse how society reacts to both disease and medical interventions and discover that reactions are often much more subtle than  society is usually credited with. Pregnancy and childbirth, for example, are something that stand out in medically influenced literature and art.  Here the subject matter is what most people would call everyday but it is at the same time medical even though it is not a disease. The medical of course is not just curing the body but knowing the body intimately, both in illness and in health. And it is the body in health that reveals how very medicalised society has become. This began in the 18th century, something Foucault wrote about in detail in his book Birth of the Clinic, and which appears in my doctoral thesis on the reform of midwifery training in Prussia and Saxe-Weimar. In most western countries giving birth continued relatively untouched until well into the 20th century. The implications of this prolonged lack of change followed by what is now the overmedicalisation of birth, with the negative consequences it has for women, are illuminating. First, for a long time the medical community failed to recognise that the institutional measures, the entering of male medical practitioners into the birthing room, was causing more deaths than reducing them. It highlights how until fairly recently women were not thought capable of effectively practicing medicine of any kind leading to the sidelining of the traditional midwife and all those that did not support the figure of the male-midwife in the birthing room. Second, the overmedicalisation dominant today,  characterised by excessive instrumental intervention during pregnancy and childbirth, is the result of the same mentality whereby a controlled environment is the only guarantor of a good result. This mentality fails to recognise that pregnancy and childbirth, when not complicated by underlying diseases or complications that may arise, is a natural physiological process that has its internal mechanisms for working. Sometimes nature really does work out for the best. This excess intervention begun during the 19th century has not been able to change the main causes of maternal death: infection and haemorrhage. While haemorrhage is less easily prevented, a stuck placenta for example can happen no matter the intervention, infection is much more easily preventable. While death from both has decreased because of antibiotics and improved hygiene the fact that they continue to be the same main causes 200 years on should give pause for thought.