The Historian’s Kaleidoscope – Making Sense of Medical History in Times of a Pandemic

In this blog post, Dr Claas Kirchhelle, Lecturer of the History of Medicine at University College Dublin (Wellcome Trust University Award) and Fellow of the Oxford Martin School, urges medical historians to critically reflect on the implications of the COVID-19 pandemic for their field.

Trying to make sense of COVID-19 is to look through a kaleidoscope. Within its brief existence, the virus has revealed the incredible complexity of interspecies relationships, economic interdependencies, health system designs, international relations, the many fallouts of the climate emergency, and differing cultural perceptions of disease and biomedicine. It has also unleashed a storm of attempts by historians, social scientists, and public commentators to make sense of the present against the backdrop of previous epidemics and pandemics.

From late January 2020 onwards, academic journals, websites, blogs, and media outlets saw a burst of contributions analysing the current pandemic in light of earlier ones, commenting on exacerbated social and racial inequalities, cultural biases in attributing causes and solutions, the biopolitics of lockdown, and hopes for a unified drive for a cure. Initial responses were soon complemented by a second layer of debates about how far one pandemic could be compared to another, ground-zero empiricism, and whether anything meaningful could be said before COVID-19 itself had become history.

As a medical historian, I followed debates with a mix of fascination and exhaustion. Holed up in my apartment, I was taking it in turns with my partner – also an academic – to care for our confused toddler while trying to meet funding and publication deadlines. In between writing, zoom calls, and potty training, I was, however, struck by the way that many exchanges were missing their mark. The version of history that was being debated was often too grand or too diminutive to adequately reflect the discipline’s value for public debates and decision-making.

Critics were of course right to highlight that it was too early to provide grand analyses and wrong to make facile comparisons to earlier pandemics. Nobody can accurately predict how interactions between this novel pathogen and its human hosts will evolve and it will likely take decades to retrospectively unpick the complex biosocial interactions that brought us here. However, history is also not as speechless as some seem to imply. While I would distrust anyone proposing a definite analysis of COVID-19, I would be similarly wary of those waiting for the elusive point when current events have ‘safely’ become history.

The COVID-19 pandemic is a biological and social event that is the result of contingent emergence. However, it is playing out within the structural constraints of a human and environmental playing field that was shaped over decades – if not centuries. Historians are uniquely placed to appreciate both the contingency of SARS-CoV-2 and to analyse its pandemic playing field. The relevance of such analyses for decision-making and public discourse is great. I have plenty of colleagues whose excellent work on vaccines, public and global health, infectious disease, mental health, and civil emergencies makes them ideally placed to provide critical context for varying policy responses. Scholars of the medical humanities can also highlight implicit biases and shaky data underpinning some of the epidemiological, behavioural, and economic models guiding current policy. By looking back at previous pandemic or epidemic events, some may even be able to make educated guesses about likely social flashpoints, governance problems, finance bottlenecks, and ethical dilemmata. None of the colleagues I know would make the claim that historical analysis holds universal answers. However, I think that many of them would be comfortable saying that decontextualized policymaking and public debates can be just as flawed – and that expertise from the medical humanities should be represented in official expert bodies.

Reflecting on my own work on antibiotics, laboratory surveillance, and infectious disease control, I have become keenly aware of the kaleidoscopic qualities of the current crisis. All of my research fields have been affected. COVID-19 has accelerated many of the structural constraints that have long prevented equitable and unbiased health provision, international coordination, and global solidarity. However, it has also provided interesting points of departure.

Writing about change, challenges, and prospects in the areas I know best has aided my own historical sense-making and prompted useful exchanges with other disciplines. Together with colleagues from the biomedical and environmental sciences, I have drawn on historical precedents to warn about the likely rise of antibiotic use to deal with bacterial superinfections and resulting selection for antimicrobial resistance (AMR). However, we were also keenly aware that the unprecedented global sharing of scientific information about COVID-19, formation of patent pools, and mobilisation of public funds may also point to new solutions for the long-standing ‘empty pipeline’ problem for antibiotic development. With collaborators from the social sciences, I have reflected on the chequered past of human infection studies in accelerating vaccine development but also exploiting marginalised and colonial populations. We warned that the race for effective SARS-CoV-2 vaccines and the growing tendency to ‘offshore’ trials necessitated a new international framework for infection studies. I was also honoured to reflect on how contagious disease can bring out the best and worst in societies with my former PhD supervisor. Interviews with talented and genuinely interested journalists have also allowed me to stress how the history of drug and vaccine development makes it clear that ensuring equitable access must be at the forefront of current decision-making.

None of these points are particularly revolutionary and I do not pretend to be able to offer a comprehensive interpretation of an unfolding global crisis from the desk in my bedroom. It is, however, clear to me that COVID-19 is rapidly changing the fields I study and the way I see their history. Although I may only be able to see individual pieces of this vast kaleidoscope of change, the time to critically reflect on these changes started in January 2020. To publish these reflections is to stimulate debate, add a critical longitudinal and structural take to public sense-making, and – in my case – to optimistically push for some good things to come out of this global event.

Claas Kirchhelle

Dr Claas Kirchhelle is a Lecturer in the History of Medicine at University College Dublin’s School of History. His research explores the global history of antibiotics, infection control, and the microbial environment. Supported by a Wellcome Trust University Award, he is currently writing an interdisciplinary history of global infectious disease surveillance after 1920. Claas studied history at the Universities of Munich (MA, 2012), Chicago (MA, 2011), and Oxford (DPhil, 2016). He has published across the humanities and biomedical sciences and was awarded the University of Oxford’s 2016 Dev Family Prize for the best dissertation in the history of medicine and the 2020 ICOHTEC Turriano Prize for Pyrrhic Progress. Antibiotics in Anglo-American Food Production (Rutgers University Press). A new monograph on the history of British animal welfare science, activism, and politics is forthcoming with Palgrave Macmilan (2021). Claas has extensive experience in public engagement and broadcasting and co-curated the award-winning Back from the Dead (2016/2017) and Typhoidland (2020/2021) exhibitions on penicillin and the past, present, and future of typhoid control.

Conference report: Medical training, student experience and the transmission of knowledge by Anne Hanley

In the first blog post of 2015, Dr Anne Hanley reports on 'Medical training, student experience and the transmission of knowledge' - a conference which took place at the Centre for the History of Medicine in Ireland in October and which was funded by the Irish Research Council and the Wellcome Trust. Podcasts of papers from the conference were recorded by Real Smart Media and may be accessed here. 

I recently attended the conference, 'Medical training, student experience and the transmission of knowledge, c.1800-2014' (or #MTSE14 if you want to look over our live tweets), at University College Dublin. Needless to say its focus, and the discussion generated from its wide-ranging collection of papers, was excellent and very much overdue.

Students dissecting

Medical education

Despite an ever-growing interest in the history of medicine, the subject of medical education and student experience continues to be overlooked (the last international symposium dedicated to this subject having taken place in the early 1990s). Yet throughout the nineteenth century medical education was being increasingly formalized, centralized, and consolidated. It became the backbone of one’s medical career. Strangely, however, it has occupied the negative space in histories of clinical practice and patient care. This omission is incredibly problematic (but I digress…).

So, when Laura Kelly emailed to ask if I would give a paper at a conference devoted to the history of medical training and knowledge production, I sent back an immediate and unequivocal ‘YES!!’. (There were so many excellent papers about which I want to talk that my own paper, ‘Venereology at the Polyclinic’, will have to take a back seat for now.)

An important focus of MTSE was the centrality of pedagogy. Traditionally, histories of medical education have been written as administrative histories of major teaching hospitals. They have concentrated on the big names, significant infrastructural changes, and major medical developments that altered practice in these hospitals. Rarely have such histories considered in the implications of the big names and significant changes for the day-to-day learning and experiences of students. Happily, however, historians of medicine are beginning to recognize the importance of pedagogically-focused histories and MTSE really demonstrated this change. It brought a whole host of issues to the fore and, as those of you who follow me on Twitter will have gathered, I was rather excited by the rich collection of papers.

Professor John Harley Warner delivering his keynote.
Image courtesy of Real Smart Media

John Harley Warner keynote address

We began with the keynote address from John Harley Warner, who introduced us to his most resent and gruesomely fascinating work on the photographic history of dissection in American medical schools. As Warner observed, nineteenth-century medicine was often a solitary occupation and so medical schools provided an important opportunity for group learning and for developing a collective professional identity. And this is particularly well-evidenced in the strange collections of photographs in which groups of students posed around tables upon which they were dissecting cadavers. One particularly interesting aspect of Warner’s keynote was the figure of the medical school porter who often appeared in these photographs and who Warner identified as playing a key role in the facilitation of medical education (but I’ll return to this shortly).

Attendees at MTSE.
Image courtesy of Real Smart Media.

Microbes to matron

Many fantastic papers followed, including Claire Jones’s presentation of her most recent research on the ‘Microbes to Matron’s’ project. Her focus on the pedagogy and practice of infection control in British nursing between 1870 and 1900 offers an important counterpoint to what have traditionally been male-focused accounts of medical education. It is very easy to forget that there were (and continue to be) other groups of trained medical professionals beyond doctors who provided care to a wide cross-section of the population. What also interested me about Jones’s paper were the types of sources she and her fellow project investigators are drawing upon. By using surgical nursing examinations, Jones demonstrated the increasingly active role of nurses in their own education, and in surgical practice more broadly.

Dollhouse diorama

Crime scenes and dollhouse dioramas

Similarly, Neil Pemberton’s paper on teaching crime scene investigation through dollhouse dioramas also prompted us to reconsider the role of women in medical and scientific training. By appropriating the traditional female practice of miniature making, women like Frances Glessner Lee created a new way of thinking about crime scene science. Nathalie Sage Pranchère also looked at the important role of women in medicine, speaking about the development of nineteenth-century French midwifery training. Importantly, she also described how obstetric teachers used models to develop the anatomical and obstetric knowledge of their midwifery students. As we saw with Pranchère’s paper, the role of material objects in medical training and practice is becoming an increasingly central focus of historical scholarship and this was reflected throughout MTSE. For example, Jenna Dittmar used the collections from Cambridge’s former Anatomical Museum to demonstrate how human remains allow biological anthropologists to examine the historical tools and techniques of dissection.

Speakers Greta Jones, Anne Hanley,
Nadav Davidovitch and Victoria Bates.
Image courtesy of Real Smart Media.

Spaces of medical education

Another important theme to emerge from MTSE was the different spaces of medical education. Warner described the dissection room as a space for developing collective professional identify. Michael Brown spoke about the dynamic space of the nineteenth century lecture theatre, in which students and their lecturers were appealing to culturally resonant sets of values. Clare Hickman presented eighteenth-century botanic gardens as important spaces for thinking about the material culture of medical teaching. Hickman’s paper, like Warner’s keynote, also demonstrated that the history of medical education is never simply about those who learned the art of medicine but also those in the background. Like the African American medical school porters who procured cadavers for students, gardeners were important (but silent and overlooked figures) in the maintenance of teaching spaces and the facilitation of teaching practices.

Attendees at MTSE.
Image courtesy of Real Smart Media.

MTSE demonstrated how the nature of medical training has changed over time and within distinct national contexts. Through an excellent collection of papers we explored the emergence of centralized and consolidated systems of medical training. We looked at the development of new tools of training and the different spaces in which these tools were employed. And we looked at how medical knowledge and codes of professional identity were being assimilated by medical and dental students, nursing probationers, midwives, and qualified practitioners seeking further education.

I came away from MTSE with a new appreciation for the diversity of student experiences and systems of knowledge dissemination, and will certainly be drawing upon these ideas in future. With any luck, events like MTSE will slowly begin to generate greater interest in the important place of medical training in wider narratives of medical history.

Dr Anne Hanley is an LHRI Research Fellow at the University of Leeds with particular expertise in the history of modern medicine, medical education, health policy and the history of science. She recently completed her PhD at the University of Cambridge on the development and dissemination of venereological knowledge among English medical professionals, 1886-1913. She writes a blog Clinical Curiosities and tweets at @annerhanley.

Workshop report: Soviet healthcare in the comparative perspective by Susan Grant

In this month's blog post, Susan Grant reports on the recent 'Soviet healthcare in the comparative perspective' workshop which took place at UCD in May 2014.

Historians of Soviet and medical history met in the UCD Humanities Institute May 29-30 to discuss Soviet healthcare in comparative perspective. Generously supported by the Wellcome Trust, UCD Seed Funding, and the Irish Research Council, this workshop represented an important international gathering of scholars from Ireland, the UK, Canada, and the United States.  The inter-disciplinary nature of the workshop meant that there was much debate and discussion among participants (the programme is available on the CHOMI website here).

Nursing in the Soviet Union

The overall aim of the workshop was to analyse the history of Soviet nursing and healthcare in comparative perspective, and to critically examine issues such as professionalization, gender, and care. The workshop mandate was to evaluate Soviet nursing relative to international nursing and healthcare, and to explore how nursing in the Soviet Union developed in relation to other medical professions. Participants were asked to consider the development of Russian healthcare and to compare the Soviet healthcare system to that of other countries.

Comparative aspects of Soviet healthcare

The workshop was a great success, particularly in facilitating cross-disciplinary discussion about the comparative aspects of Soviet healthcare. Panels focused on three key aspects of Soviet healthcare: professionalization, gender and care. The issue of care and the idea of the ‘virtue script’ (as conceptualised and explained in the work of Prof. Sioban Nelson, University of Toronto) fostered a particularly engaging dialogue about how nursing care is conceived and understood. This fed into discussions of what constitutes a ‘good’ and ‘bad’ nurse, as well as patient perceptions of ‘good’ and ‘bad’ nurses.  Nursing care, whether in the Soviet Union or elsewhere, depends on a variety of factors and an individual’s experience of nursing care. Studies of Soviet nursing are limited and probing expectations of care from an international perspective proved very productive in thinking about approaches to Soviet nursing and healthcare practices.

Panel on gender

Papers that focused on gender were particularly helpful in illuminating the difficulties and challenges of dealing with source material such as memoirs, interviews, etc. Prof. Dan Healey, Dr Laura Kelly, and Prof. Christopher Burton shared their experiences of working with memoir literature and the problems this can raise in terms of medical history. This was very informative for everyone, and especially instructive in highlighting the similar experiences of scholars who focus on different periods and countries. Indeed, scholars of medical and nursing history, and also the history of Russia, Ireland, Great Britain, etc., found that they had much in common. Participants specialising in Soviet history were surprised to learn of the liberal aspects of medicine in Ireland at the turn of the century. Cross-disciplinary dialogue here proved fruitful and underlined points of intersection and diversion between Russia and the West.

Transnational healthcare

The comparative dimensions of international healthcare were underscored in the panel featuring Prof. Susan Solomon, Prof. Paul Weindling, and Prof. Anne Marie Rafferty. Papers here focused on the transnational aspects of healthcare, dealing with Soviet cultural diplomacy in the 1920s, continental nurses in the UK  1933-1945, and nursing and decolonization during the second colonial occupation of Malaya, 1946-1955.

Round table on professionalization

The issue of professionalization was discussed in the opening and round table discussions. Scholars of Russian history, including Prof. Donald Filtzer, Prof. Benjamin Zajicek, and Dr Susan Grant presented their papers on professionalisation and practice in Soviet healthcare history.  Discussions about professionalization were elaborated on in the roundtable session, with participants Prof. Susan Solomon, Prof. Sioban Nelson, Prof. Dan Healey, and Prof. Anne Marie Rafferty contributing to a lively debate. It was questioned whether or not theories of professionalisation and histories of the professions are helpful as methods in analyzing both healthcare history and the Soviet case. Findings here were inconclusive, with some scholars acknowledging the merits of professionalisation literature in their work on the Soviet Union or healthcare, and others noting that they found this literature less useful.

The workshop proved that healthcare history continues to be a vibrant field and one that has much value when considering comparative international experiences. We look forward to more discussion of these debates in the future.