Monday : History of medicine in Boston

This day was mainly dedicated to history and philosophy of medicine. Three important themes emerged :

1)      Architecture as a source for history of medical practices

2)      The use of bio-medical innovations to build the self-representation of an american medicine

3)      The distinction between science, anti-science and pseudo-science.

 

A)     The MGH and the Brigham and Woman’s Hospital

Founded in 1811, the Massachusetts General Hospital, with 240 patients by day in the Emergency Room and 1500 volunteers (students, retired people…), is the most important hospital in New-England and the third oldest in the United States. This long history is emphasized by the new Russell Museum, which presents a lot of old instruments, and by the complex architecture of the building, reflecting the evolution of the patient’s status in medical practice. The MGH is indeed a patchwork of several buildings constructed in different periods: the oldest one was not conceived as a place for care, but only as an official building; on the right side of the main entrance, a red bricks building shows the dehumanizing aspect of the technical medicine during the 1970’s, whereas, in the other side, the glass walls of the most recent building reveals a patient-centered medicine.

The Brigham and Woman’s Hospital, heart of the medical district of Boston, near the Harvard Medecine School (separated from the MGH in the beginning of the XXth century), is the main academic hospital. It is built on a linear model, with detached houses (separation between men and women, infections and non-infectious diseases). This architecture reflects a hygienist conception of medicine, even if the theory was already abandoned since several years, and shows the delay between scientific paradigm shift and architectural transformations. Two other features of this building are interesting : the round central tower, conceived as a panopticon (the nurse office in the center and the patients rooms all around), and the distinction between the basement dedicated to medical research and the upstairs to the clinics, which can be seen as an architectural integration of translational medicine.

 

B)      Bio-medicals innovations and the construction of “American” medicine.

In the MGH, in 1846, took place a decisive evolution of surgery: the first public demonstration of the use of anesthesia, in the amphitheater now called the “Ether Dome” (built on the model of European surgery and anatomical theater), by a surgeon, John C. Warren, and a dentist, William T. G. Morton, to perform a tumorectomy on Edward Abbott’s neck.

We can notice that this event is known as the first American medical discovery which crossed the Ocean, to Europe. That’s why this discover is presented as one of the ground of American surgery and celebrated in Boston through a memorial in the Public Garden as a symbol of the scientific influence of the city.

There is two other examples of the use of history of medicine to celebrate ”a  glorious past”, root of a prestigious present of Bostonian medical research: the bicentenary of the famous New England Journal of Medicine (on this occasion, the journal invite his readers to vote to choose the most important publication of each decade) and the two paintings, in the hall of the Countway Library, contrasting the two most important events of Bostonian medicine : the first anesthesia and the first kidney transplantation, in the Brigham Hospital.

But this construction of an American science was also influenced by the choice of an European model: a French one in the Harvard Med School and a german one in Johns Hopkins, as suggested by Jeremy Greene.

 

C)      Science, pseudo-science and anti-science in a medical context

During our visit, our “guide”, Jeremy, emphasized the importance, in the XIXth century, of a case of strong anti-medical skepticism, represented by a movement created in 1866, the Christian Science Church, by Mary Baker Eddy, which assumed that every somatic disease was the result of a perverted state of mind. Then a medical science was necessarily useless, because the only way to cure a disease was faith in God and a Christian behavior.

But unlike such an anti-scientific assumption, an other kind of non-scientific position is also possible: the pseudo-sciences. It is well illustrated by the opposition between phrenology and neuro-psychology in the XVIIIth and the XIXth centuries, as presented in the exhibition of the J. Warren collection. Next to the phrenological representation of human mind faculties, we saw the skull of Phineas Gage, wounded in 1848 by his iron rod. It destroyed his brain frontal lobes and, as a result, his behavior radically changed and became completely disinhibited. It was the first case of a “frontal syndrome”. This case reveals the thin border between neuro-psychological explanations and phrenological descriptions, in the sense that both of them try to localize human faculties in the brain. Unlike anti-scientism, pseudo-sciences try to adopt scientific norms and not to challenge them.

 

In the Countway Library (the largest academic medical library in the World), Scott Podovski presented us some amazing items, from the Harvard History of Medicine resources, like an incunable (1491), a copy of the Nuremberg Chronicles, one of the oldest Newton’s manuscripts (1669), “touch pieces”, a Waterhouse’s box for vaccines against smallpox, the scalpel used by Warren in 1846, and a letter from Erwin Schrodinger.

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