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SEVENTY-FIVE YEARS AGO IN THE ACADEMIC MEDICINE

The Historical Method of Teaching Clinical Medicine*

Emerson, Charles P.

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… This course in the history of medicine of 18 hours is not a course in medicine; we merely by means of it try to create in the student's mind an emotional attitude to which daily in the ward rounds we can appeal. We often refer to the course as one in the psychology of prejudice. We ask them why as students they accept without argument and with too much enthusiasm any new surgical operation, a new drug, antitoxin, serum, or vaccine, and yet are too “naturally” hostile to physical therapy, to dietetics, psychotherapy and other simple therapeutics. We warn them that unless they can appreciate, in part at least, their prejudices that they cannot maintain a safe position in the current of a rapidly progressing clinical medicine…. As teachers we should teach our students to recognize this fact, to evaluate their prejudices and so to compensate for them, and one of the best means of doing this is to emphasize the lessons taught by history.

With us the course of the history of medicine is not a course in ancient medicine but of the medicine of today interpreted by that of other ages and other people. We do not in the first lecture discuss the primitive medicine of uncultured races but the primitive elements in the practices of today….

… We describe briefly the few references to medicine and surgery on Egyptian monuments and in tombs which date prior to the 15th century B.C. That was quite good medicine what there was of it. Then follows a hard lesson. The students cannot understand how a medicine can be as old as that and be good. How can it be “good” without the aid of the premedical and preclinical sciences?

One of the first and most important lessons for students to learn is that the old may be “good,” it may be even better than the modern. That is “goodness” which is important is the intellectual honesty which it expresses; the reasonableness of it. We remind our students that the architecture of old Greece, developed without surveyors' instruments or steam winches, is “good,” is in fact an example of excellence for the ages; that the art and literature of Greece is “good,” is marvelous even today; and that the medicine of Hippocrates was a tiny stream but of crystal clear thought, in some particulars better in quality than the ocean of slightly muddy water which the mass of illy applied science (splendid, of course, as science) has made of the clinical medicine of today….

… But the most important lesson from Egypt is that after the 15th century came the domination of the priests and then came the Sacred Books of Thoth in which were written the dogmatic therapies which ruled for several hundred years. If a patient died and investigation showed that the doctor had not treated his patient in the way recorded by those books, then the doctor was subject to severe punishment. The priests had gained a strangle-hold on medicine and finally killed it by standardizing it….

… In modern medicine especially, we see clearly that medicine is and must be a reflection of contemporaneous culture. Each discovery of science, and each invention of the mechanical arts is likely sooner or later to find its application in medicine….

… By greatly increasing its benefits to humanity, medicine makes it also necessary that medical schools graduate better and still better trained general practitioners. Too great a loyalty to organization, too great a dependence on tools, too great a pride in quality production, is one reason why the American medical schools today are not producing their best product. Tools and organizations for standardized mass production is splendid, but we should teach our students, in light of history, that they must live up, not to the most conspicuous elements, but to the best that there is in their culture, should understand its weakness, and should try to correct some of the evils which too great loyalty to that culture may produce.

And finally, the lesson of history also suggests that American medical schools now should emphasize more not only greater accuracy in training but also the general culture of their graduates, their wider sympathies, in order to meet the wider social problems which medicine alone can answer.

*Round Table Conference: Thirty-seventh Annual Meeting, Cleveland, Oct. 26, 1926.

© 2000 Association of American Medical Colleges