From the Princeton Weekly Bulletin, October 20, 1997
Medicine in modern West
By Caroline Moseley
Diseases
are more important than doctors," declares Professor of History
Gerald Geison, whose course on Diseases and Doctors in the Modern
West examines disease patterns and the role of healers in Western
Europe and the United States since the 17th century. The course
thesis ("with occasional digressions," Geison admits) is that
prevailing disease patterns influence medical theory and practice
rather than vice versa.
For example, he says, in the mid-19th century, as tuberculosis became "the disease that killed most people who died of diseases," the practice of bloodletting was abandoned "because it didn't help the patients." French physician R.T.H. Laënnec and others "began redefining the nature of the disease, saying that urbanization had simply enfeebled people," making them too weak for bloodletting. Physicians substituted "supportive care, such as stimulants," administering alcohol, mercury and a remedy still in use today -- soup.
Bloodletting had been practiced since ancient times and was, says Geison, "a perfectly rational approach to disease" when people believed in the concept of the four "humors" or body fluids -- blood, phlegm, yellow bile and black bile -- which could make a person sanguine, phlegmatic, choleric or melancholic, with concomitant mental and physiologic disturbances.
"Though bloodletting is now seen as barbaric, at the time it seemed reason-able to deplete what there was too much of, to deplete the `humor' that was making the person ill," Geison points out. In any case, he observes, "the average amount of blood let was about nine ounces -- that's less than would be drawn for tests in any hospital today."
Less idolatrous attitude
"No doctor ever saved a life," Geison tells students. "At best he or she prolonged it." This is by way of making students aware that "determinants of health and longevity are extremely complicated and change over time." However, "if you talk about quality of life, doctors matter immensely," Geison asserts. "The functions doctors perform that are most powerful are not the ones we think of immediately, like saving lives or prolonging them. Rather, by relieving the physical and emotional stress of illness, they can make life worth living--or more worth living."
The course, History 394, begins with Greek physician Hippocrates (c. 460-377 BC) "because ancient medicine was at the base of so much that followed" and because Geison believes that "there have been some very smart physicians over time, who just didn't know as much as we know now." Indeed, one of his aims is "to convey a greater sense of respect for the healers of the past and a less idolatrous attitude toward the medicine of today."
Students read textbooks such as Logan Clendenning's Source Book of Medical History and William McNeill's Plagues and Peoples, as well as essays and articles from a variety of secondary and primary sources, from Boccaccio's "Plague in Florence" (c. 1348) to William Harvey's De Motu Cordis (1628) to Lewis Thomas's "How to Fix the Premedical Curriculum" (1978). There are two lectures per week and one precept; the precepts are led by Geison and three doctoral candidates in the Program in the History of Science -- David Attis, Jordan Spellman and Marwa Elshakry, "whom I could not do without," Geison says.
While constantly revising and developing this course over the two decades in which he has taught it, Geison has introduced a number of innovations this semester. The 250th Anniversary Fund for Innovation in Undergraduate Education supported a major infusion of visual materials: Geison has purchased approximately 800 slides from the Slide Archive of Historical Medical Photographs of the State University of New York, Stony Brook, and from the collection of the National Library of Medicine in Bethesda, Md., among other sources.
Iron lung, formal dress suits
Thus, students this term will view illustrations from Flemish anatomist Andreas Vesalius's 1543 De humani corporis fabrica [On the Structure of the Human Body] -- illustrations that, says Geison, "are influenced by Renaissance artists and are truly beautiful." They will also see "images of victims of prevailing diseases of the past, such as cholera; they will see an iron lung and lots of other machines and equipment no longer used. And they will see images of the physician over time: for example, wearing a white lab coat today rather than the formal dress suit of the 19th century."
The 250th grant has also allowed Geison to expand his own background in and course coverage of chronic and degenerative diseases, such as diabetes and arthritis. It has been difficult to find material on the history of such afflictions, he says, because "most scholarly attention has been focused on epidemic or infectious diseases." It is important to learn more about chronic and degenerative diseases,
he feels, because "they dominate the disease pattern in the modern industrialized world. Indeed, some acute diseases have been transformed into chronic diseases: that is, they can't be cured but can be managed--like diabetes with insulin or AIDS with protease inhibitors."
Geison's most recent book is The Private Science of Louis Pasteur (1995).
His path to professorship was not typical. Born in Savanna, Ill., he was a star basketball player for his high school. Athletic prowess won him a scholarship to Beloit College in Beloit, Wisc. The first person in his family to attend college, he was introduced to the history and philosophy of science at Beloit -- "a place where ideas mattered a whole lot."
When a professor told him it was "possible to go to graduate school, learn a lot more and even receive a stipend to do it," the young Geison was amazed--and convinced. He went on to earn a PhD in Yale University's Department of the History of Science and Medicine in 1970 and joined the Princeton faculty the same year.
Geison is gratified, if somewhat bemused, by History 394's consistently high enrollments (115 this term). Only about a third of the class, he says, is considering medical school. "It must be the current debates about medical costs and medical ethics," he suggests. "Perhaps that's why they're so intrigued. Or perhaps, like me, they simply find the material unbelievably interesting."
Then again, it could be because History 394 is, according to its professor, "the only Princeton course that offers a magic formula for living long and living well." The secret?
Says Geison, "Choose your ancestors wisely."
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