History of Science, Technology, and Medicine

The image of Sir Luke Fildes’ famous painting The Doctor (1891, The Tate Britain, London) transported us—twenty rising Duke sophomores aspiring to become leaders in science and society—to the world of medicine during the early 19th century.

The painting depicts a physician observing a sick child while the parents look on helplessly. The setting is the interior of the family’s humble cottage rather than that of a hospital. The patient, a young girl, lies on a makeshift bed of two chairs pushed together, as the doctor, dressed not in a white lab coat but in an elegant black suit, observes her intently in the process of “watchful waiting.”

“If you were diagnosed with a terminal illness, would you rather die in the present day or in the 1830s?” asked Dr. Jeffrey Baker, a general pediatrician in Duke Children’s Primary Care and a professor of Pediatrics and History.

Who wouldn’t choose the present over the 1830s? Today’s cutting edge technology and advanced treatments guarantee the ability to provide a level of care and comfort that would be impossible to achieve in the 1830s. Directing our attention back to the painting, though, Dr. Baker then prompted us to think about the question in a more abstract way. In the painting, the concentrated focus of the doctor on the child emphasizes the patient as an individual person and the doctor as a compassionate caretaker. The doctor is paying single-minded attention to the patient, displaying genuine concern for the patient’s suffering. He is being there for the patient. He is fully present. So often in today’s medical profession, with the increasing predominance of the scientific medical model and technological advances, crucial features of the provider-patient relationship get lost. Qualities such as patient-centeredness and empathy are frequently overlooked in the need for efficiency.

Yet, we all agreed that the quality of care in the present is overall much better than of that in the past. It’s crazy to think that almost two hundred years ago, it took only one year of schooling to become a doctor. As two Huang Fellows read aloud the titles of typical classes that medical school students took in the 1830s, Dr. Baker explained how medical education in that time period consisted mainly of lectures and reading. Back then, medical students didn’t complete any of the practical real life training that aspiring doctors undergo today. The most “hands-on” learning—if it can even be called as such—took place in the field of surgery, in which a student would watch a practicing clinical surgeon perform a live surgery on a stage in the center of a huge amphitheater among a crowd of other students.

However, doctors were not accessible to everyone. People usually only turned to doctors in absolute medical emergencies. Most of the time when family members fell ill, their first instinct was to consult an almanac-like book about health care that basically every family owned at home. As I listened to Dr. Baker read off the book’s outrageously long title and skim through its index of ailments and symptoms, which included things as ambiguous as “anger,” and different modes for treating them, I couldn’t help but laugh at how ridiculous it all was. But upon further reflection, I realized that there are significant similarities between today and then. Wasn’t the book Dr. Baker showed us kind of like “the Google” of the 1830s? Don’t we all look for remedies online before we head to urgent care?

In early 19th century, when a family did decide to call in a doctor, the doctor would most likely administer “heroic medicine”. This was a form of rigorous treatment based on bloodletting and purging to restore the body back to its healthy, natural state, or homeostasis. According to heroic medicine, the body consisted of four humors—black bile, yellow bile, phlegm, and blood—, and illness was caused by an imbalance of these humors in the body. Doctors sought to cure these imbalances with various tools, such as a bleeding bowl used during bloodletting (which I had foolishly assumed to be some sort of small metal hat), jagged knives, and terrifyingly large applicators. I found myself cringing at the severity of such methods. Listening to Dr. Baker describe how George Washington bled repeatedly and was given several blisters to induce sweating before dying shortly after such rigorous heroic treatment filled me with a whole new appreciation for modern medicine.

Not surprisingly, heroic medicine soon fell out of favor. This gave rise to homeopathy, a medicinal practice based on the doctrine that “like cures like”, still practiced worldwide and quite popular in several European and Asian countries. In fact, one of the Huang Fellows’ family owns a homeopathy kit at home. As I struggled to wrap my head around the concept and the controversy surrounding its effectiveness, I realized more than ever how narrow and limited my understanding of different historical and diverse cultural practices of medicine was. Nonetheless, Dr. Baker’s talk reminded me of how much we can still learn from the past. Ultimately, it is only by studying history that we can truly appreciate the present and progress toward the future.

Sophia Li, Huang Fellow ’18

Sophia LiSophia is pursuing a double major in Neuroscience and Political science with a certificate in Science & Society.