In a way, it’s appropriate to end this blog with an entry from a medical historian. Guldi and Armitage will find a receptive audience among this group of specialists, or narrow minds. Medical historians in the UK are ahead of the pack when it comes to public engagement, collaborating as they do with museums and theatre groups, speaking in schools and retirement homes (partly because of nudges from the Wellcome Trust, the go-to funder for scholars in the field). Despite such encouragement and the support of a wealthy benefactor, medical historians have lately been on the defensive, at least since July 2014, following comments by Richard Horton, editor of the medical journal The Lancet, who declared the history of medicine to be a ‘moribund body’.
As you might expect, medical historians have responded to Horton’s challenge, but, more importantly, they have long pre-empted aspects of Guldi and Armitage’s Manifesto. Most undertook graduate research over a relatively short durée (my study covered a measly 44-years and addressed innovations at a single Warwickshire brewing firm), and, unlike an earlier generation of historians of medicine, few have medical qualifications. My doctorate, however, has been my driving licence, allowing me to follow new roads and interests into the 18th century, and others into more recent decades. Based in a medical school, I’ve become familiar with both the challenges and opportunities facing medical practitioners and witnessed the proliferation of short-term thinking in a sector overlooked by Guldi and Armitage. As in politics, institutional memories in the NHS rarely extend back more than five years. But some people appear keen to travel back further, not least because the buildings in which they work are historical artefacts. So, too, are the big datasets employed by many medical researchers. Those used in childhood cancer and longitudinal epidemiological studies often incorporate cases from the 1940s, a world that is vastly different from ours. Inevitably, historians will be consulted to provide valuable context to guide those using data created in this ‘world we have lost’.
Unfortunately, Guldi and Armitage miss such opportunities to link directly with medical historians. One of few references to medicine is to chronic diseases, versus acute infections, because the former are of ‘long duration’ (there they go again). The distinction between chronic and acute conditions is, in this case, little more than semantics, not to say clumsy. Though often shorter in duration, infectious diseases have long plagued societies and historians have consistently discussed and debated the impact of short-term illnesses, including smallpox, measles and diphtheria, on long-term trends, such as population growth. Acute illnesses can also breed chronic conditions and thereby become ailments that require long-term management. Medicine, like history, is complicated, as others have repeatedly suggested.
Although I didn’t count references to ‘long durée’ (Simon Yarrow did), I knew there were more than a hundred in this book. By the tenth iteration, however, I had already begun to question the relevance of the long term to the ‘call to arms’ manufactured by these authors, especially as it applied to my field. While I remain convinced, like many others in these blog posts, that history does not need to be instrumental to be of value, I will indulge Guldi and Armitage, if simply to test their argument further. In the realm of medical history, I would suggest that any attempt to ‘speak to power’ does not necessarily depend on adopting a broad timescale. Guldi and Armitage argue emphatically that micro-histories that fail to engage and reconnect to larger narratives may indeed court antiquarianism, but what about the long durée narrative that fails to connect with current debates and issues? Many important questions in medicine about how we might reintroduce care and compassion into medicine will inevitably take us back to the micro-, not the macro-level, nor do we need to go back far to consider scandal and abuse in healthcare. Such lessons readily arise only out of local studies and investigations into micro-dynamics between individuals, patients, families and carers. My own limited policy work does not necessarily depend on taking the story of healthcare back much further, and far more on closing that short, yet crucial gap between the first half of the twentieth century and the present day in order to ensure relevance, if not some emotional power. Think only of the recent Labour party conference in Manchester, where nonagenarian Harry Leslie Smith reminded his audience of a world before the National Health Service in a talk that brought many delegates to tears.
My most recent involvement at a policy workshop may not have brought my audience to tears, but it left me with some final lessons. In 2013, I attended a dermatology seminar hosted by England’s Chief Medical Officer, Professor Dame Sally Davies, to consider the economic and social impact of skin diseases. Davies herself is no stranger to history, having employed historical arguments recently to drive home claims that microbial resistance to antibiotics, unless addressed, will take us back to a ‘dark ages of medicine’ (how’s that for long durée Simon Yarrow); she also regularly uses big data to good effect in her talks on the subject. Unfortunately, I didn’t possess the ‘visualisations’ to steal the show at this dermatology forum. However, to suggest that historians can lead such discussions, as Guldi and Armitage do, is more than a little arrogant. On this occasion, as so often in team teaching at my medical school, I was scheduled to speak first, and, not surprisingly, failed to connect with all of the points raised in subsequent talks and discussions. Nevertheless, participants’ presentations converged on certain points, not least the importance of stigma. I was pleasantly surprised that many of the talks were already somewhat historically informed, in some cases due to the medical history teaching participants had received as a result of reforms to the medical curriculum in the 1990s. Many of the civil servants in the building on the day were also historians by training. Clearly, history can make a difference. We might comprise an important part of policy-making teams, but other times we might impact policy through our teaching. That said, I felt my contribution on that day could have been improved had I been scheduled at the end of the session and been able to speak directly to the issues raised by others presenting on the day. If that was not to be, I am grateful to my colleagues at MBS for at least indulging me on this occasion and allowing the medical historian to have the last word.