In the beginning, medical history was written by doctors. Most 19th-century medical history was meant to illuminate scientific or professional issues, to encourage the profession, or sometimes to celebrate the traditions of particular localities. These writings are not all to be dismissed as special pleading or for undue reliance on present-day perspectives. At their best, doctors’ accounts add personal and technical insights to real historical awareness – the works of Christopher Booth and Irvine London offer good recent examples from Britain.(1) And in as much as medicine now comprises many professions, similar ‘insider’ benefits can be found in accounts of nursing history by nurses, or in the recollections of medical administrators, and so on.
This brief essay, however, is mostly about authors who were professionals in history, whether or not they were qualified in medicine. Here the beginnings are in the later 19th century, when ‘modern medicine’ was separating from the heritage of classical medicine. The medical heritage was ceasing to provide tools for medical practitioners, but it could be a laboratory for philologists, and for some positivist historians, as well as for erudite doctors. Littré and Daremberg were the key French examples around 1900.(2)
In Germany, in 1905, Karl Sudhoff became the first full professor of medical history. As a doctor turned philologist, he linked the powerful academic establishment of linguistic scholarship with a pragmatic approach to the medical profession. A great organiser and fervent nationalist, his politics were to pose problems for his intellectual descendants, some of whom preferred to draw on the cultural history of Lamprecht (which included social and economic history) – though this was also nationalistic. Julius Pagel (the father of Walter) stressed both science and cultural history, emphasising the culture of medicine as an antidote to the bureaucratic regulation of German insurance medicine.(3)
In 1925 Sudhoff was succeeded at Leipzig by a young Swiss doctor-historian, Henry Sigerist, whose associates and students included Owsei Temkin (who was also a friend of Norbert Elias). Temkin’s autobiographical sketch (4) powerfully evokes 1920s debates on the relations of science and history – which resonate now with debates from the 1980s. Sigerist was politically radical, Temkin less so; both moved in 1932 to Johns Hopkins University in Baltimore, invited by William Osler, the erudite physician who already personified for Anglophone doctors the humanistic aspects of scientific medicine.
For Sigerist, and especially Temkin, the new history of medicine was primarily a disciplined enquiry in the history of ideas, setting medicine in the context of wider culture histories. They founded the Bulletin of the History of Medicine, which has remained the leading journal. Their work has lasted well, and contrasts with the more positivist and progressivist history of science which the Belgian George Sarton was simultaneously trying to institutionalise at Harvard.(5)
After the Second World War, the history of scientific ideas gained backing from American educational establishments, and some history of medicine was written in this progressive mode. But ‘Baltimore’ history of medicine remained broader and more contextual, in part because of input from American social historians such as Richard Shryock, who focused on American practitioners and popular medicine rather than placeless science and national organisations.
Sigerist’s work was broader still, including medical sociology and ‘social medicine’ – often to support arguments for state medicine. His cause was not popular in Cold War America and he retired early to Switzerland, leaving Temkin as the sage of the field, greatly respected as a historian but keen that the discipline should continue to speak to doctors. He died in 2002, aged almost 100.
By the late 1960s, American history of medicine and of science had become much more social and more critical – drawing inter alia on Thomas Kuhn, sociology of knowledge, the new social history, and Foucault. The key historian of medicine in this next generation was Charles Rosenberg, a disciple of both Temkin and Shryock, who taught at the University of Pennsylvania, where the Department of History and Sociology of Science was initially directed by the British social historian of science, Arnold Thackray; it also boasted Rosemary Stevens, a British historian of health policy, and Thomas Hughes, the leading American historian of technology. Their wide span and social approach tended to contrast with more intellectualist history of science, for example at Harvard.(6)
History of medicine grew rapidly in the 1980s and 1990s, in North America (and especially in Britain) coming to incorporate varieties of cultural history much influenced by literary studies. Rosenberg has remained the key American figure (though now at Harvard), but associates such as John Harley Warner and Allan Brandt have provided exemplary contextual histories of medical knowledge in practice.(7) Brandt has also demonstrated the utility and the problems of entering into policy and legal debates, such as those around smoking.(8) Feminist history has made major contributions (for example, by Judith Leavitt) and the tradition of American social history has been well maintained, not least by Ronald Numbers and his colleagues at Madison, Wisconsin.(9)
Medical history continues to thrive in the US, though some critics have noted a certain routinisation of enquiry which often accompanies established professional training,(10) while others have bemoaned a general failure to engage with the complex problems of American medical services since the Second World War.(11)
In continental Europe, the development of medical history has been very uneven. In general, younger scholars have incorporated recent Anglophone innovations in science studies, cultural studies etc., while also drawing strength from their own national traditions. Thus, the philosophical historical work of Georges Canguilhem and Michel Foucault has been internationalised but commands special attention in France. There are significant medical history groups in several non-Parisian Universities, for example in Lyon, and a continuing presence in the Paris School of Medicine and at Paris VII. But the productive and promising group at L’Hôpital des Enfants Malades, funded by INSERM (Institut National de la Santé et de la Recherche Médicale – the French Medical Research Council) and directed by Patrice Pinell, did not outlast the first 12-year contract. Its historians of medicine, however, continue elsewhere – notably at the CERMES centre where Ilana Löwy and Jean-Paul Gaudilliere work on cancer and pharmaceuticals. French historians have also contributed substantially to colonial history, especially where it concerned the Pasteur institutes. The work of Anne Marie Moulin is outstanding here, not least in its engagement with present-day medicine in North Africa.(12)
German universities have recently produced more good medical historians than they are prepared to employ. Their traditional pedagogical role of civilising medical students by explaining medical etymology has diminished, and in some medical schools history posts have been replaced by posts for medical ethicists. One consequence has been a migration to Britain, and especially to Newcastle and Durham, which now reflect the engagement with classics and with philosophy which was long characteristic of German medical history.(13)
In Copenhagen, the Medical Museion under Thomas Soderqvist brings science studies to the analysis and the public presentation of recent medicine. Traditions in demography and epidemiology seem to retain special strength in Germany and Scandinavia, while in Britain the influence of the Cambridge Group and the Liverpool school seems, regrettably, to have declined.(14) Cultural history does not (yet?) encourage the numeracy which might render it more social and testable.
But of all the countries in the world, it is Britain which from the 1970s has seen the greatest expansion of medical history, largely as a result of funding from the Wellcome Trust. To these intriguing developments we now turn.
As a professional discipline, British medical history was inaugurated at University College London (UCL) between the wars. The chief founder was Charles Singer, a medical scientist turned historian, with a secure private income. The immediate context was the UCL anatomy department, which under the Australian Grafton Eliot Smith spanned from radiology to anthropology. Eliot Smith had been professor of anatomy at Cairo and then Manchester. Through the massive ‘rescue archaeology’ of thousands of Nubian mummies, he became a leader of ‘diffusionist’ anthropology, which saw cultural innovations as rare, and mostly Egyptian. The rich bio-medical-historical culture of his UCL department provided a natural home for Singer – and a great attraction, too, for a wealthy pharmaceutical manufacturer from America who was building his own collection of medicine-related artefacts. When Sir Henry Wellcome died in 1936, he left his company to a research Trust, which was instructed to spend a proportion of the profits on the history of medicine and allied sciences. Like Cleopatra’s nose, the legacy was to change the world – albeit the small world of history of medicine.(15)
Until the 1960s most of the Wellcome Trust funds went into its London premises, to establish a marvellous library and a museum, and to store the huge collections amassed by Wellcome and his agents. Since the late 1960s, the spend in London has increased substantially, especially from the 1990s when the Trust sold the pharmaceutical company and derived even more money from other investments. It has funded the development of an academic unit for history of medicine in UCL, the Wellcome Galleries in the National Museum of Science and Industry at South Kensington, the continued growth of the Wellcome Library and Archives on Euston Road, and the recent creation there of major galleries and facilities for public engagement.
But some of the activities have also been spread across Britain. Various non-London museums gained material from the Wellcome stores, and some now benefit from the considerable recent growth in its ‘public engagement’ funding. For universities, the main ‘radiation’ was through the academic units set up between 1968 and 1986, first in Cambridge, Oxford and UCL, and then at Edinburgh/Glasgow and Manchester. All of these programmes were related to academic programmes in history of science. In a second wave of expansion, since the early 1990s, the Trust moved to five-year strategic awards rather than longer-term commitment, and spread funding across mainstream history departments. Groups at Warwick, Exeter and Oxford Brookes universities expanded notably under this second regime, while some of the earlier development was cut back – at Cambridge, Glasgow and to some extent the University of Oxford.
The first Wellcome Units were major centres of innovation, directed by charismatic, radical historians with a strong sense of intellectual purpose. Directing the Unit at Cambridge helped Robert Young to build a group of young scholars who have played major roles in the history of medicine and several related disciplines, including Karl Figlio, Ludmilla Jordanova, Roger Smith and Edward Yoxen.(16) But Young was also seminal for the ebullient cockney historian, Roy Porter, who moved over from 18th-century social history to the history of geology.
It was Bill Bynum, in the new Unit at University College London (housed alongside the Library in the Wellcome Building), who brought his friend Porter back to London, where he did so much to develop the social history of medicine – initially a contested venture.(17) Bynum, like Young, had trained in America in bio-medicine, and then worked on history in Cambridge UK. But intellectually, Bynum was much closer to the American traditions of history of medicine, not least to Erwin Ackerknecht, a member of the Sigerist generation who had returned from the US to teach at Zurich. The publications of the London Unit included excellent edited volumes, the many books of Roy Porter, the work of Chris Lawrence, especially on surgery, and of Vivian Nutton on classics. Ongoing work includes the Witness Seminar volumes arranged by Tilli Tansey, Anne Hardy on public health, and Stephen Jacyna on neurology. (18)Under Hal Cook, the redevelopment of the Unit has emphasised colonial and post-colonial medicine.
Bynum, in the 1970s, was also close to the émigré Walter Pagel, the son of Julius Pagel, who worked as TB specialist at the Medical Research Council laboratories at Mill Hill in North London. Pagel’s house was an intellectual centre for several historians of early modern medicine (and science) who fought against the positivism of much post-war history of science. The Warburg Institute (especially Frances Yates and D. P. Walker) was another pillar of this crucial development, as was the innovative History and Philosophy of Science department at Leeds University established by the Wittgensteinian philosopher Stephen Toulmin with help from the social historian Asa Briggs.
It was from the Leeds circle that Charles Webster moved to Oxford to direct the new Wellcome Unit. His books on the 17th-century English millenarians, and then on the National Health Service, are products of monumental scholarship, colossal range and strong political commitment (a new book on Paracelsus is about to appear).(19) Of his Oxford associates, Margaret Pelling moved from key work on 19th-century cholera to studies of the early modern medical professions and markets; and Paul Weindling from 19th-century German biology to the politics of inter-war medicine, including fascism and the holocaust – work he continues at Oxford Brookes.(20)
For all their achievements, neither of the Oxbridge Units proved secure. Young resigned and was succeeded by Roger French, but by the 1990s, the leadership of the Wellcome Trust was impatient of French’s relaxed style – in spite of the considerable amount of quality work, from medieval to modern, which had been produced in Cambridge, largely by Andrew Cunningham and latterly also Harmke Kaminga.(21) The Trust closed the Cambridge Unit in 1998, establishing a new Unit in the History department of the University of East Anglia at Norwich. It was directed by Roger Cooter who had been at Manchester since 1984, but it fell victim to local academic politics and Cooter moved to London in 2002.
At Oxford, Webster’s relations with the Trust were always problematical. When he moved to All Souls College in 1988 to focus on the NHS book, the new Director, Richard Smith, shifted the emphasis towards demography, and then Jane Lewis briefly tried to develop social policy. But in 1998, the Trust closed the Oxford Unit, to reopen with a new and rather narrow brief. The focus has widened again under Mark Harrison, one of the historians who have successfully developed historical studies of colonial and post-colonial medicine, inspired in part by Michael Worboy’s pioneering study of imperial science, but also using approaches from cultural history, subaltern studies, etc.(22) David Arnold’s work on colonial India – in Lancaster, London and now at Warwick – has been especially notable.(23)
The Wellcome Unit in Edinburgh was established under a historian of science, Eric Forbes; the historian of biomedical science was Malcolm Nicolson – a recent product of the Edinburgh ‘Strong Programme’ in the Sociology of Science. After Forbes’s early death, the Unit moved to Glasgow in 1985, under the clinical historian David Hamilton, who was succeeded in difficult circumstances by Johanna Geyer Kordesch, known for her work on German medicine. In 2001 the Unit was demoted, but has now regrown thanks especially to Nicolson and its long-serving social historian Anne Crowther.(24)
In all these sites, much excellent work was produced, establishing Britain as a major creator of medical history. If Manchester proved more stable it was in part because of better University support, and because the Unit developed incrementally. At UMIST from the mid 1970s, I built a team which focused on medicine and medical science since the industrial revolution. After the History of Science and Technology department at UMIST was disbanded in the early 1980s, most of the group moved to the Victoria University of Manchester (with which UMIST has since merged) to establish a Wellcome Unit, and the Centre for the History of Science, Technology and Medicine (CHSTM).
The members during the 1990s included Roger Cooter, Steve Sturdy, Mark Jenner, Mary Fissell, David Cantor, Stephen Jacyna and Mark Jackson. When, however, the Trust began to establish permanent posts in other universities, but not in Wellcome Units, some staff migrated to help build groups elsewhere. That twist of policy was reversed around 1996, and since 2002, CHSTM has been directed by Michael Worboys. It has developed additional strengths in infectious diseases, animal histories, contemporary history and public engagement – alongside its longstanding interests in medical sciences and technologies, medical services and regional history.(25)
Of the former Wellcome Units, only UCL and Manchester remain as substantially larger than the newer centres in History departments which have been funded over the last decade. A strong group developed at Warwick, including Colin Jones and Hilary Marland, focusing on French medical professions, women’s history and psychology.(26) At Exeter, under Joe Melling and Mark Jackson, the strengths include occupational history, asylums and asthma and allergy.(27) At Oxford Brookes, under Anne Digby and Steve King, foci include British social history and economics of medicine, together with pharmaceuticals and Weindling’s work.(28) Generally, the shift to History departments emphasised social and cultural history rather than history of science and technology, health services, or demographic/epidemiology. An exception is the group developed by Virginia Berridge at the London School of Hygiene and Tropical Medicine, with its strong focus on recent health policy.(29) Happily, as noted, the geographical focus has widened, with many more studies of colonial and post-colonial medicine; and the chronological median has moved towards the 20th century.
What was less predictable, even 10 years ago, was the scale of the widespread growth of cultural and historical studies of the body and its diseases. In Britain, this growth has benefited from Wellcome funding; but the increase is world-wide, with major inputs from literary studies, a populous field characterised by rapid changes of fashion – now sometimes recreating the history of disembodied ideas. In some quarters, concerns with representations seem to have substantially replaced concerns with knowledge and power, and the death is announced of social history. (30)
To my mind there is a paradox here. Of all historical disciplines, that which fought best to bridge between the cultural, social and material is the history of science and medicine. If medical historians downplay the technical aspects, the economic, the socially positioned or the explicitly political, they reduce their potential relevance to our contemporary debates about medical knowledge and medical services. They risk becoming defined as part of the ‘cultural industries’ – as intriguing and amusing, rather than challenging. They join a fashion for relaxing into the past or ‘theory’, while living in a world which is aggressively unhistorical.
Of course, there are gains, especially in our grasp of popular cultures of medicine, where literary studies can be wonderfully convergent with historical studies founded on sociology of knowledge; and these tools can, indeed, be turned on to present debates about genetics or germs. The worry is that fewer medical historians can now address question about research policy and practice, medical industries or service development, even for the West. It is not hard now to find good undergraduates in cultural history who will carry its concerns through graduate work to employment. It is much harder to get an education in science and history, and to add to your history of science the skills of demographics, business history and political history – but how else will you be best equipped to analyse recent medicine in the West or anywhere else?
There are issues of historical research policy here which need adjusting – not to diminish the thrust of cultural history, but to embed it in wider problematics of contemporary importance; not to diminish the expansion of historical studies towards studies of less wealthy countries, or indeed of animals, but to connect them with more penetrating studies of medical ‘centres’, including the dismantling of simplistic centre-periphery oppositions.Present-day medicine is endlessly fascinating, as the media well know; but it is also problematic. Some areas of cultural history now seem overpopulated, even as many contemporary medical issues cry out for historical exploration. Britain has dozens of historical experts on 18th-century sensibilities, and scarcely any on late 20th-century medical industries. Is it time for some rebalancing – to find ways in which young historians can better engage with more technical and contemporary histories? But note that ‘contemporary’ here does not necessarily mean recent – it means of relevance to present day debates, whatever the period studied.(31)
Professor John V. Pickstone is Wellcome Research Professor at the Centre for the History of Science, Technology & Medicine, University of Manchester