A better reading

What is medical history? John C. Burnham Cambridge, UK: Polity Press 2005 163 pp $26.95 (paper) ISBN 0-7456-3225-4

Figure. Photo by: Fred Sebastian

In our ordinary experience of time we have to grapple with three dimensions, all of them unreal: a past that is no longer, a future that is not yet, and a present that is never quite. We are dragged backwards along a continuum of experience, facing the past with the future behind us.

— Northrop Frye

The first task of the doctor is … political.

— Michel Foucault

Truth be told, I probably enjoy medical history more than I enjoy medicine. The notion of being dragged unseeing into the future, as so cleverly described by the often impenetrable Northrop Frye, is not always appealing, especially in an age of self-determination and autonomy, but there is solace in the old saw about those ignorant of history, etc., etc. But what is history? And, more importantly in the present context, what is medical history? John C. Burnham, professor of history at Ohio State University's Medical Heritage Centre, asks just this question, and answers it in a fashion reminiscent of Michel Foucault, whose The Birth of the Clinic (Naissance de la clinique, 1963) is subtitled “An Archeology of Medical Perception.” Foucault famously chronicled the “access of the medical gaze into the sick body” and suggested that by the late 17th century the “medical gaze was organized in a new way … . [I]t was no longer the gaze of any observer, but that of a doctor supported and justified by an institution, that of a doctor endowed with the power of decision and intervention.”

Whereas Foucault's “archeology” addressed “the gaze” — the power and politics of seeing — Burnham's examination of the state of the art of medical history necessarily involves an attempt to make his readers better readers, in part by pointing out the power and politics of writing. His concise book demonstrates that medical history itself has a history, and that the evolution of the genre corresponds to, causes, and is a result of its sociopolitical context.

Locating the beginning of medical history at around the time the classical texts of Hippocrates were compiled (and noting en passant that “the ‘Hippocratic corpus’ of writings was a collection of not necessarily consistent texts by numerous different authors, mostly from the fifth and fourth centuries BC”), Burnham traces a lineage wherein the goals of writing changed from the Galenic/Hippocratic desire to pass on then-current and useful medical knowledge, through the 18th and 19th centuries, when medical history became a “narrative in which one idea progressed to another, presumably better, idea.” In this transition, Burnham sees the insertion into medical history of a political agenda: the idea of progress had taken hold, and with it the tendency on the part of historians to project “backward onto earlier times a course of steady improvement.” Burnham suggests that it “would be an error to lose sight of the continuing centrality of this narrative [of progress] and the subplots associated with it.”

Much of this book is devoted to showing how the notion of progress has translated into medicalization, and Burnham writes using a general “medicalization versus demedicalization” dichotomy. His chapters deal successively with a number of “dramas,” beginning with those that focused on, or were seen from the perspective of, the healer. There is a helpful discussion of biography, “a special category in and of itself, different from history,” as well as observations regarding “case histories,” the “traditional ceremony of diagnosing” and “the sick role.”

Although he cannot but comment on matters medical, as Burnham shifts his gaze in subsequent chapters to “The Sick Person” or “Diseases” his focus nevertheless remains less on the details recorded than on the implications of their being recorded. His observations, if not completely novel, are important, and he raises a number of simple yet vexing questions. What is a disease? Indeed, what is “a body?” Noting that a “great deal of what started out as histories of ideas of illness and health … ended up as histories of ideas about the self,” Burnham goes on to explore how the notion of progress has tended to make historians and others more or less paternalistic and arrogant, inasmuch as it tends to make many of us see those who came before as backward, dull, or simply in error, rather than as people who “just viewed the world differently.”

It is important to reiterate that Burnham appears to want from those who read his book not a re-understanding of medical history and facts, but a re-invigorated ability to read. That is, he attempts to provide both the impetus and the skills to look beyond and behind the printed page. Although he outlines a genealogy of medical history, and although his perspective is that of an historian, he deliberately cites only minimally the works on which he bases his ideas, preferring rather to provide a wonderful collection of “suggestions for further reading.” In this way we are given not only a way to look, but places to look, should we be so inclined.

It ought not to go unsaid that this book is first and foremost an historian's examination of history; which is to say that it is in many ways a work of theory. As such, and notwithstanding its numerous valid and important arguments, it may not be for everyone. Those many of us whose reading in medical history is as diversionary as didactic, and whose disposable reading time continues to dwindle, probably can ill afford to read this book; all the more so since reading it almost certainly will force us back into books with which we thought ourselves long finished.