History of medicine: read past ideas in their evidence and context
The history of medicine examines how people understood health, illness and care in earlier times. It includes patients, communities, institutions and scientific work, not only famous discoveries. Reading it well means asking who created a record, what it can show and which experiences may be missing.
Start with the record and the question it can answer
Historical sources include letters, clinical records, laboratory notebooks, photographs and institutional documents. Primary vs secondary sources: a source created during the timeframe studied is often described as primary while analysis made later may be identified as secondary. However, whether something was generated originally during the timeframe studied or not does not automatically make it complete, accurate, or representative of everyone's experience.
Let us imagine a hypothetical hospital report from an older era. Before summarizing any claims, we must determine who wrote it, when it was written and to whom it was written. For example: a fund raising report may include different information than that which would have been found in a patient diary. Both can be useful but they answer different questions. Clearly separate the record from your own interpretations based on its silence.
Words and practices need to be understood in their own setting
Words and practices used to describe diseases, professionals, and explanations of illnesses may have different meanings now than they did at the time they were used. The knowledge base available to them, their social environment, and the organizations they worked within affected their decision-making processes. Knowing this context will help you understand why a particular practice was utilized without necessarily agreeing with it. Additionally, knowing this context allows you to avoid using an older term automatically as if it is an exact equivalent of today's diagnostic terms or services.
Examine two hypothetical accounts of similar symptoms written decades apart. Identify any differences between them in vocabulary; identify any differences between them in what each writer could have observed. Do not assume that similar phrases in the writing prove that the authors were identifying exactly the same disease. Explain what other evidence would need to exist prior to drawing this conclusion. Using this methodology allows you to retain the historical detail of these documents while maintaining the uncertainty associated with making retrospective assessments.
A new practice and proof of benefit are different claims
Historical accounts may help identify how an idea or practice was disseminated among practitioners; who provided and who opposed it; and, the number of practitioners who ultimately adopted it. However, simply because a practice has been widely accepted does not mean that it has provided better healthcare. To evaluate a claim regarding benefit, you must pay close attention to the type of evidence that existed at the time; the types of comparisons that were made; and, possible alternative explanations. A compelling narrative account of an individual’s experience related to an intervention; and a carefully documented comparative study of outcomes are very different types of studies.
For an illustrative example of how to teach these distinctions, identify the first known instances of an intervention; and evaluate whether there exists sufficient documentation that demonstrates that the intervention actually resulted in better outcomes. Also, determine how the outcomes were evaluated and whether changes in other areas of care could impact the results. Avoid telling a complex developmental process as a story with one person and one predetermined outcome; when the records support a more uncertain sequence.
An archive preserves some experiences more clearly than others
What exists to survive depends upon what was recorded; what was collected; and what was preserved. Therefore, official accounts typically reflect institutions more thoroughly than the experiences of either patients or staff. Consequently, researchers evaluate gaps in documentation and evaluate multiple types of evidence. Although absence of a specific document does not refute that an event occurred, other evidence may still exist or need to be sought. Similarly, having only one example of an occurrence does not demonstrate how frequently it happened.
When completing a historical reading, state what evidence exists to support what conclusions can be drawn; and, what is left unexplained. Ensure that you correctly attribute any direct quotations; and, maintain a distinction between your explanations and the quotation itself. Historical accounts describing treatments serve as evidence regarding previous eras' health care systems, not as directions for contemporary health care. A valuable way to begin to synthesize your research findings is to develop a study note that describes why a particular account is historically important; without suggesting that an earlier treatment should continue to be employed today.
Check your understanding
A short quiz, with an explanation after each answer.
What should be identified before interpreting a historical record?
Go back through the most difficult area for you and write out an explanation for the example without referring to the page again. Evaluate your explanation prior to revisiting the quiz. Learning to articulate your thought process is more beneficial than memorizing where the right answers reside.