This critique of medical education was recalled by Yale University historian Naomi Rogers at the 71 st annual meeting of the American Association for the History of Medicine (AAHM), held in Toronto from 7 to 10 May 1998. Rogers' talk, "Medical Students ‘Mad As Hell’: The Radical Health Movement in the Late 1960s," was one of 92 papers presented that explored provocative aspects of the history of medicine. Rogers' presentation addressed the now-forgotten role played by radical medical students in the 1960s and 1970s in challenging what they saw as paternalistic, sexist, and racist behavior among physicians.

Although not all of the papers presented in Toronto made explicit connections to modern medical issues, history has much to offer today's practicing clinicians and clinicians-in-training. First, it demonstrates the dynamic nature of scientific knowledge. For example, today's therapeutic interventions may prove to be as misguided as earlier treatments, such as routine tonsillectomy or gastric freezing. In addition, history reveals how the practice of medicine is a social enterprise: Cultural, political, legal, and professional factors influence how physicians and patients understand and respond to scientific information.

Profile of a Pioneer

A highlight of the meeting was the Fielding H. Garrison lecture, in which a distinguished medical historian presented original and previously unpublished research. Vanessa Northington Gamble, a physician and historian at the University of Wisconsin, Madison, presented a paper entitled, "Taking a History: The Life of Dr. Virginia Alexander." Alexander was an African-American physician who practiced in Philadelphia from the 1920s to the 1940s. Gamble elegantly described how Alexander confronted both racism and sexism in her efforts to provide medical care to the city's poor. In 1935, Alexander wrote that the staff of one Philadelphia hospital "seems unable to rise to the situation of having ordinary civil or professional relations with a colored doctor." Alexander also had to battle lupus, which ultimately claimed her life in 1949.

Medicine over the Years

Other speakers in Toronto dealt with historical topics ranging from sexual abuse of children in 19th-century America to the experiences of turn-of-the-century immigrants having eye examinations for trachoma (Figure 1). Physician and historian Howard Markel of the University of Michigan described how some Russian Jews were refused entrance to the United States at Ellis Island because of the contagiousness of trachoma and the concern that the eventual development of blindness would make them charges of the state.

View larger version (200K): [in this window] [in a new window]   Figure 1. Trachoma examination at Ellis Island, 1913.

Nancy Tomes, a historian at the State University of New York at Stony Brook, analyzed how public health propaganda and product advertisements came to resemble one another, beginning in the 1920s. Using attractive visual imagery and promises of improved lifestyles, health educators sought to sell the value of fresh air, healthy diets, and proper child care. In turn, manufacturers promoted such products as Fly Tox fly killer, Listerine mouthwash, and DuPont cellophane by emphasizing their supposed healthfulness. Today, Tomes noted, health advocacy and product promotion have become increasingly blurred. Examples of this trend include the sophisticated advertising campaigns to discourage smoking and unsafe sex.

Much of the work presented in Toronto had direct relevance to internists. Gerald Oppenheimer, a historian at the City University of New York, described oral histories that he and Ronald Bayer obtained from "plague doctors"-physicians who, in the early 1980s, chose to specialize in the care of people with AIDS. According to Oppenheimer, these physicians chose AIDS work on the basis of scientific fascination with the disease, personal political commitment, and an ethical obligation to treat patients who were being shunned.

Another paper of interest to internists was given by Jesse Ballenger, a graduate student at Case Western Reserve University in Cleveland, Ohio, who argued that the great attention given to Alzheimer disease in the 20th century has actually increased the stigmatization of the elderly. And University of Pennsylvania graduate student Elizabeth Toon provided a historical perspective on the health advice of Charles Atlas. Atlas, Toon explained, stressed 13 lessons of health that dealt not only with exercise and bodybuilding but also bathing, sleep, and the proper evacuation of waste.

Looking Ahead with the AAHM

Founded in 1925, the AAHM began at a time when most medical historians were either practicing or retired physicians. Indeed, the organization's third president was William H. Welch, the legendary pathologist of the Johns Hopkins University Medical School. Today, the annual meeting is attended by physicians, nurses, professional and amateur historians, librarians, archivists, students, and other history aficionados. The 1999 meeting of the American Association for the History of Medicine will be held in New Brunswick, New Jersey, from 6 to 9 May. For more information, contact Todd Savitt, AAHM secretary-treasurer, at 252-816-2797, or consult the AAHM's World Wide Web site, http://www.auhs.edu/aahm/.

Barron H. Lerner, MD, PhD