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"By the historical method alone," remarked William Osler in 1901, "can
many problems in medicine be approached profitably."1
By the time I started medical school, my program had abandoned its history
of medicine course for a monthly lecture series. This made sense. Faced with
the explosion in knowledge of molecular and clinical science, there was not
enough time in the day to study the past. After all, history is not essential
to the day-to-day practice of medicine. And, given that physicians used to
treat fever with leeches and hysteria with surgery, our history is often embarrassing.
Yet I wonder if I would have been better served had I studied history
in my preclinical years. Like most physicians, I have used the phrase "the
patient is a poor historian." I wonder if we should more accurately admit
that we "took a poor history."2 According
to one poet, "One might say, though we are told not to, that the patient is
a poor historian/We are told instead that we are the historian, and that if/A
poor historian is present, he is often wearing scrubs or a stethoscope."3
One could argue that patients are never poor historians, only more or
less reliable sources of information. It is the role of the physician to be
a historian—to collect evidence and weigh competing sources of information
against one another. The historical method is part of the craft of medicine.
As Sapira4 puts it, "Simply to write down
or to recite a gaggle of true statements is not to compose a history. The
facts must be placed in a form that makes them informative. Many medical schools
‘teach' by having the students memorize a large number of facts. But
these schools do not teach the students how to decide what a fact is, or how
to collect facts in a useful and informative manner." The purpose of this
issue is to demonstrate the importance of the historical method in understanding
current clinical problems.
In this issue of MSJAMA, David
Schuster reviews the history of the diagnosis of neurasthenia—an illness
that reminds us that medical diagnoses are shaped by cultural factors as well
as by science. In an account that resonates with our current dilemma over
vaccination against bioterrorism threats, Elise Lipkowitz describes the smallpox
vaccination debate in 18th-century France. Continuing this discussion on the
balance between public health and individual choice, George Joseph tells us
about the legacy of the 1905 US Supreme Court case Jacobson
v Massachusetts, which upheld the right of the government to order
compulsory vaccination. All of these authors teach us something about how
to interpret and narrate history.
Rajkumar R. History of Medicine. JAMA. 2003;290(17):2326. doi:10.1001/jama.290.17.2326-a
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