Descendants of the Serpentine: Stars In The History of Medicine
[America] By Sherwin B. Nuland
I wrote this book in the library. Among the libraries of educational institutions in the world, there is no one quite like it. I like to think of it as my personal domain, even though there are hundreds of people like me who share it. We’re all hovering in the middle of our studies, but none of us are holding back.
My large, comfortable, book-filled room was a medical “sanctuary,” filled with scripture and reminiscences about the therapeutic art of medicine. It’s a museum, a portrait gallery, a treasure trove of medical historical documents, a refuge from the hustle and bustle of modern technology. For those of us who care for patients or engage in medical research, the Yale Library of the History of Medicine is a safe place from the hustle and bustle of everyday life and a nurturing fountain of scientific innovation and development.
All the LABS and patient-care areas at my medical center were just a few minutes’ walk from the tall, veranda reading room and its medical treasure trove. And the library is two football fields away from the operating room where I spend most of my time every day. Thirty years ago, I could cover the distance in 25 seconds, but even now, middle-aged and slow, I can reach my destination in three minutes, including the stairs.
It is so convenient because of the vision of the library’s donors. The three avid booksellers wanted to “travel around and through the ages”. They jointly created this bibliotheca paradise in the 1930s, incorporating their personal collections for use by everyone who wishes to learn about medical history.
John Fulton, one of the most productive researchers in the field of neurophysiology in the United States, also known as the “human dynamo,” whose tireless work led to many major projects in medical science and humanism; Harvey Cushing, who came to Yale shortly after retiring from Peter Bent Brigham Hospital at Harvard, where he established the specialty of neurosurgery; Arnold Klebs, a Swiss doctor and bibliographer, wrote the words about navigation. In honor of their public projects, they call themselves the Trinity.
Since opening in 1941, the library built by the three friends has grown faster than even their most optimistic expectations. The Yale Library of the History of Medicine has become one of the few places in the world where medical workers want to make an annual pilgrimage. If we accept the Lord Macaulay’s standard, that is, the “perfect historian is his work shows the characteristics of an era and the epitome of the spirit of”, so I call my private areas of the library is the perfect “historian” of western medicine civilization, does not have painstakingly impossible to reach such a height. It fits Macaulay’s definition of historical writing as “the fusion of poetry and philosophy.”
In the end wall of the reading room is a huge fireplace, and above it a large plaque with a thought-provoking inscription for those who can make the most of the collection. Visitors wander through the collections, listening to their “narratives” and appreciating the wisdom of the inscription: “Here, keep silent and listen to the great works of other ages.”
This book is based on a lot of listening. The subtitle of this book is “Stars Shining in the History of Medicine” because I have chosen to tell the history of healing in the form of biographies of some of the landmark contributors. But I’ve been wondering, especially as I’ve been writing the last chapters, whether the word “autobiography” would better convey what I meant. What I have tried to do in this book is to describe the developmental stages that each of today’s physicians went through in forming their own basic ideas about medicine, and the ideas that we all have about how disease occurs. So more than anything, the medical story is the story of my career.
As I sat at the patient’s bedside and tried to reconstruct the sequence of pathological events that led to his illness, I was using a method of reasoning that originated in Greece 2,500 years ago. At the same time, when I trace the development of a disease I have encountered, I am also following the development of the theory on which modern medicine rests. I will to check, all the cases to find out the primary cause of disease, and I adhere to the principle: only in my doctor understand the cause of certain patients, the source of the disease and its prognosis and the body’s internal damage process (whether or not to take treatment), can effectively treat the disease. With this understanding, I can make a diagnosis, determine treatment and predict the outcome.
Hippocrates, the father of medicine, greatly influenced every step of the Greek doctors’ procedure. The history of medicine is a process of continuous improvement by generations of practitioners who passed on their staffs and sought ways to perfect the whole process. It was not until the 16th century that the internal anatomy of the human body was truly understood; In the 18th century, as people began to understand the damage that disease could do to these anatomical structures, doctors began to develop physical diagnostics that could trace symptoms and signs to their organs of origin. They can then assess the accuracy of the diagnosis by examining the victim’s anatomy.
With the invention of diagnostic tools such as the stethoscope, the identification of disease sites became more and more accurate. With the help of the modified lens system, it was realized that the disease states of organs were caused by tiny cells within the organs. Having identified the microscopic origins of the disease, doctors then turned their attention to a new question: what causes normal physiology to go awry. That’s what happened in the mid-19th century.
Over the decades, the whole process of diagnosis and treatment has become increasingly dependent on the objective study of organs, tissues and cells, and therefore on the scientific method. As a result, doctors have had to focus in what historians call a reductionist way, sometimes ignoring the patients they need to treat right now. Although the best doctors always try to focus on the overall health of their patients, the precise demands of science prevent doctors from caring about the “whole”.
It is not, of course, that “holism” (or holism) is inconsistent with scientific medicine. In fact, in the last years of the 20th century, as we gathered more information about what happened to healthy people, we began to become more fully aware of the complexity of the factors involved.
Today, we rarely look for a single cause of disease, but rather for every factor that makes a patient sick. There must be a number of reasons for a person to become ill, and it may be different for each person. For example, while we may all harbor streptococcus bacteria in our bodies, your sore throat and mine may be caused by different causes, and the pathogenic bacteria “play havoc” in different ways at different stages.
This new way of looking at disease was articulated by w. JeffreyFessel, who was both a physician and a prophetic philosopher of medical theory:
In most cases, disease is not the inevitable result of a single event occurring at a point in time, but is often the probabilistic result of many events, each of which acts on the organism at different times, each of which produces a unique set of biological responses. The sum of these events is enough to make the patient feel unwell enough to be diagnosed with a disease…
Different patients may end up with the same tissue response that leads to the same clinical manifestations, that is, they have the same symptoms, which means they may have the same disease. However, it can also be inferred that each person’s disease is unique, based on the assumption that the syndromes, progression patterns, and chronology of the disease are difficult to be completely consistent. In this sense, every disease consists of syndromes; In other words, there is no single disease, just the sick person.
This was a view shared by Hippocrates and every doctor in charge after him. So Jeffrey Feissel and I and all of the physicians who have tried to make a diagnosis, implement a treatment plan, and try to predict the prognosis, are all descendants of the staffs, and have benefited from the inheritance of the great healers described in this book. Therefore, this book represents the “autobiography” of all of us physicians.
For this book, I make the following points. First, I ask readers to forgive me and not to question my selection of outstanding contributors to this book (as is necessary for anyone who writes history in biographical form). There are a few other stars in the medical galaxy that shine as brightly as they do, and that fit my definition of contributors, even more so than the people I earn in my book. But I don’t base my choices on that. I choose people I’m interested in to tell the story I want to tell.
I may also be criticized for adding narrative anecdotes and colorful plots, which professional historians may dismiss as pointless, since they are always dedicated to uncovering milestones in the lives of “heroes.” I found some theoretical support for this in Macaulay, who said, “The perfect historian… He believes that anecdotes, strange methods, and familiar aphorisms help to draw attention to the focal points of history: the operation of the law, religion, education, and the signs of human spiritual progress. These are people who will not only be written about, but become our close friends.”
But while I am grateful for these words, and would obviously not hesitate to quote them, they do not entirely apply to an imperfect (and very amateur) historian like me. Moreover, my motives were less pure, probably in line with a niche historical perspective, and had to do with one of my dark secrets: I confessed to being a “voyeur” and a “gossip.” I like to peer into the lives of famous doctors and write down what I see. The perfect historian has not yet been born. Until he or she laughs at our pretentiousness, we can all assume that we are the great storytellers in these books.
One final point. A colleague who I admire for his sharp words points out some of the book’s potentially fatal flaws — an excessive “wow” style of writing. “I’m impressed by all the characters,” my friend said, “and I really can’t be as surprised by some of them as you are.” Well, that’s certainly an accurate view, but I make no apologies for it. I was not only impressed by their talent, hard work, and accomplishments, but frankly, I was amazed by most of them. They were, after all, the greatest medical innovators of all time. William Osler, a great medical teacher, once said (see, I’m marveling again) that when we study history and events themselves, we experience what he calls “the influence of the people.” We learn history, and the people pass it on. As I learned about the lives of my chosen healers, MY faith in the future of our civilization grew.
In these days, when the future of humanity seems bleak and predictions seem unrealistic, I find something hopeful in my role reversal. What you will learn in these chapters is a reverence for life, a passion for learning the mysteries of nature, a vision of sacrifice for progress, these characteristics are inherent to our species, even though our century has also witnessed a great deal of human self-inflicted tragedy.
Further: I firmly believe that there are biological determinants of human will — genes, just as there are one or more genes that determine the color of our eyes or the length of our fingers. I don’t know if it’s called the power of God or the power of chance, but it proliferates within us as predictably as the sun rises and sets. Neither our intelligence nor our physical structure is a measure of what makes us human.
On earth, human beings are more happy than other animals, because we contain in our hearts the power of human spirit and civilization. It gives us the ability to think bravely, to do courageous things, and to give our peers courageous support. I anticipate that one day it will be the subject of scientific research and confirmative experiments. While such studies may start with soft science such as sociology, they eventually move into the realm of quantification and analysis. I believe that in the near future, those who can solve the mystery of DNA will be able to solve the incredible mysteries that are now considered part of human nature. As Goethe told us, there are no miracles; There are only mysteries of nature waiting to be solved.
By understanding the biological basis of the human spirit, we can explain many human qualities, such as altruism and a person’s so-called “nature”, such as caring for others to restore them to health. Although similar abilities have been observed in other animal species, they are not as highly developed as they are in humans. They form the basis of many of the relationships that we think are uniquely human. One is the eternal foundation of the doctor-patient relationship.
I am encouraged by this, too. Unlike so many doomsayers of our time, I am confident in the future of medical care, if only because it expresses something I call the biology of the human spirit. I use the word “eternal” deliberately — I don’t think it will ever go away.
More than half a century ago, Dr. Francis Verde Peabody gave a speech to a group of Harvard Medical School students in which he said of the dangers of allowing medical research into the techniques of interventionology: “They are not antagonistic, but complementary.” The three lines in the inscription of my introduction conclude his speech. Since then, the conclusion of the speech has been repeated by countless students, as they are convinced that it is both the secret and the greatest blessing of being a good doctor.