I’ve just spent 3 days at a conference run by the Australian and New Zealand Society for the History of Medicine, which was held this year at the University of Queensland. It’s been an interesting few days.
Unlike a lot of narrowly focussed conferences, this one brings together people from different disciplines – history and medicine – and from different ages and stages of life – postgraduate students, academics and doctors, including many who have turned to history in retirement.
This has both good and bad aspects. On the one hand, there’s nothing quite like the buzz of joining a group of like minded individuals, knowing that the room currently contains everyone who really knows or cares about – say – witch trials in Salem, or the architecture of early 19th century penitentiaries. (There’s also the buzz, for the postgraduates, of dreaming about that strategically placed bomb which might open up the job market to their advantage.)
You don’t get that at the ANZSHM. On the other hand, there’s a whole different buzz that comes from swapping ideas between different disciplines. I’m also struck by the similarity of what we do – as historians and as doctors. Both of us are trained to put together a coherent story from incomplete evidence, reading between the lines, making an educated guess where the patient, or the document, is silent.
One issue that always crops up is the idea of ‘retrospective diagnosis’. This is the appealing idea that we can look at the illnesses of people long dead, and with our greater medical knowledge, diagnose what ailed them. It’s seductive, and we all do it to some degree. Did Jane Austen die of Addison’s disease? Was the madness of King George caused by porphyria? Why did Charles Darwin become an invalid after the Beagle voyage – was he wrestling with psychological demons, or was he bitten by some mysterious bug in South America?
I’m an agnostic in these matters. As a historian, I’m wary of retrospective diagnosis, because I know how little we really know about the interior lives of the people we study – not just their thoughts, but their diet and bowel movements are usually hidden from us. And words change their meaning: gout has a specific meaning today, whereas once it was a generic term for many aches and pains. Similarly, what were the ‘tropic agues’ that afflicted so many settlers in North Queensland – dengue?
So generally, there’s not enough evidence to justify a retrospective diagnosis. Even when there is physical evidence, interpretation is a problem. A lock of Napoleon’s hair shows traces of arsenic – but how did it get there? Perhaps he was poisoned deliberately, but it’s more likely he ingested it accidentally, either from green wallpaper or because it was widespread in the environment in his day. According to the latest theory, he and his family all took arsenic as a general cure-all.
Sometimes there are medical notes about an illness. I gave a paper at the conference about Sir Walter Farquhar, the doctor who treated William Pitt, the British Prime Minister, in the years leading up to his death in 1806. Farquhar wrote a detailed if self-serving account of Pitt’s illness, and the treatments he prescribed for it. Pitt suffered some gut problem which brought on nausea and vomiting in the morning, and at various times diarrhoea, constipation, and severe pain. All this while he ran a country at war.
Nowadays he would be whisked off for a colonoscopy, endoscopy, and more. Without those scans, we are left guessing, just as Farquhar was, as he prescribed his laudanum, veal jelly and raw eggs beaten in brandy – and sent in a bill for 1000 guineas.
Finally, there is art. Occasionally a painting portrays the symptoms of disease. Perhaps the most famous example is the early 16th century Isenheim Alterpiece by Matthias Grünewald. This altarpiece was commissioned for a hospice, the Monastery of St Anthony, which treated skin diseases. The central image shows the crucifixion, while below, the dead Christ is placed in the tomb. In both, Grünewald has painted Jesus covered in suppurating, weeping sores. I remember how shocked and appalled I was when I saw the original, many years ago, for the images are truly gross. I know better now – the ugliness was intentional, a commentary on His shared participation in the suffering of the patients at St Anthony’s.
Perhaps a more ambiguous example of disease in art is Rembrandt’s painting of his mistress, Hendrickje Stoffels, Bathsheba at her Bath (1654). Bathsheba’s left breast is dimpled and lumpy, and this has often been interpreted as breast cancer. The painting was used some years ago in a campaign promoting mammograms, and Hendrickje has become something of a pin-up girl for breast cancer survivors.
Unfortunately (fortunately, from her point of view), Hendrickje lived for another 9 years before dying of plague. Another failure for retrospective diagnosis, it seems – or perhaps just one very lucky survivor.