Humanities in Medical Education: A Career Experience

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HUMANITIES IN MEDICAL EDUCATION: A CAREER EXPERIENCE GEORGE T. HARRELL* A Verbal Historical Picture of Medicine From time immemorial, a sick person has sought help from another individual on a one-to-one basis. The first physicians probably were priests. The relationship to religion has persisted in church-supported medical schools and hospitals. Rare dissections were the only exercises approaching a basic medical science. They often were related to art, as drawings, paintings of congenital defects, and self-portraits showing progressive aging. Art also reflected satirically on the doctor and society. Literature has recorded observations of society and cultures, of plagues, and of the reaction of individuals to their environment. To become a physician, a student apprenticed himself to a practitioner . The first universities with extensive libraries appeared in the East. All students studied the classics, and the medical faculty had students starting in it. Clinical teaching was done in hospitals for the aged and homeless by practitioners who saw their private patients in the homes. The physician had few effective drugs—foxglove, oleander, cinchona , ipecac, and opium. By the late eighteenth century, the sciences of chemistry and physiology were developing. Pathology early was restricted to gross autopsies. German universities promoted graduate education based on laboratory research. Bacteriology evolved from a chemist's studies on the fermentation and preservation of wine and epidemics of infection in farm animals . Medical education had a university base followed by clinical experience in cities. This paper is based on the John P. McGovern Award Lecture in the Medical Humanities, Galveston, Texas, May 24, 1984. ""Vice-president for medical sciences, emeritus, The Milton S. Hershey Medical Center, The Pennsylvania State University, Hershey, Pennsylvania 17033. Address: 2010 Eastridge Road, Timonium, Maryland 21093.©1985 by The University of Chicago. AU rights reserved. 0031-5982/85/2803-0442$01.00 382 I George T. Harrell ¦ Humanities in Medical Education During colonial times, rich students went to European universities. Others attached themselves to practitioners. Most schools were owned by practitioners who gave a series of lectures. Laboratories were primitive or nonexistent. No research was attempted, and libraries largely were limited to the practitioner's own books. For the few university schools, the professors in both basic science and clinical chairs practiced off campus . The development of anesthesia and aseptic techniques promoted the hospital as the dramatic focal point for care. The average doctor could only offer advice, sympathy, and support and wait for the patient to heal himself. The Flexner report made radical changes. It recommended the Hopkins model with its scientific base. The proprietary schools closed. Educational responsibility was transferred from the profession to universities , although the maintenance of standards of practice remained in the hands of practitioners. The great killers always had been acute infections. Most important were malaria and dysentery, which were responsible for the death of over one-half of all children before they reached age 5. Epidemics during or following wars resulted from disruption of living patterns. More people died from disease than were killed in battle. Endemic infections were tuberculosis and pneumonia—particularly pneumococcus in the elderly—and the childhood diseases of diphtheria, scarlet fever, whooping cough, and viral respiratory infections. In the absence of effective therapy, emphasis was on prevention. Vaccines for immunization were developed. Public health measures were enforced to ensure pure water, safe sewage disposal, and inspection of food supplies preserved by refrigeration and purified by pasteurization. Social changes resulting in better housing, reduction in crowding, and improved nutrition brought a steady decline in mortality without direct intervention by the doctor. During World War I trauma resulting from artillery and machine guns led to physiologic studies on shock. Psychological disturbances resulting from static trench warfare were recognized . A Verbal Picture ofMy Days in Medicine AS A STUDENT Chemistry had fascinated me in high school. I entered Duke while contruction of the medical school was under way. The great depression came the next year. I had no idea I could consider a medical career. Dean Davison, a student of Sir William Osier at Oxford, had an office near the college bookstore where I worked as night man. He encouraged Perspectives in Biology and Medicine 28, 3 ¦ Spring 1985 | 383 me. The...

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