Why are there so few scholarly biographies in the history of medicine and public health?

A meeting like this is a welcome opportunity to raise historiographical questions, i.e., questions about the many assumptions (ontological, epistemological, cultural, or ideological) that guide professional practice in the field of history of medicine and public health.

One such set of historiographical questions has to do with the place and role of the individual in interpretations of the past. Is the individual subject just a social, cultural or linguistic construct? Are «agents» and «actors» primarily defined by webs of discourse? Or do individuals have a role as free and independent creators of society and culture, i.e., as sources of culture rather than its results? And if so, to what extent? Further (to raise the «utility» -question), is the ultimate purpose of interpretations of the records of the past to teach lessons for future collective action? Or is it also to emancipate the individual and to turn him or her into a morally competent global citizen? And finally (to raise the «reflexivity» -question), to what extent do such different opinions about the individual’s place in history, express different cultural and ideological assumptions, or even different personal life-experiences, among historians of medicine and public health?

In the wake of such questions and meta-questions about the place of individuals and their experiences in history, there is a whole set of issues concerning the role of biography in relation to other forms of writing about the past. The individual subject and its place in history is one of those historiographical topics we tend to repress, and biography is one of those genres of writing we tend to avoid. Why is this so?

Ten years ago, Ludmilla Jordanova pointed out in an essay review aptly titled «Has the social history of medicine come to age?» that she was struck by «the restricted range of genres and topics tackled» in the history of medicine and public health. She added that «one of the most dramatic examples of this is the almost total absence of scholarly biographies», and continued: «Even for the really big names celebrated by Whig history, few have been the recipients of sustained biographical treatment» (Jordanova, 1993, p. 438). In fact, not even Edward Jenner has received any substantial modern treatment.

I think Jordanova was right in 1993. And even though we have seen some rather impressive examples of scholarly biographical writing since then – consider, for example, works such as Patricia Spain Ward’s Simon Baruch: Rebel in the ranks of medicine (1994), Jacalyn Duffin’s To see with a better eye: A life of Laennec (1998) and Michael Bliss’s magisterial William Osler: A life in medicine (1999) – I am afraid that Jordanova’s observation is still valid. The absence of scholarly medical biographies, i.e., biographies about people who have been engaged in medical and public health activities in one way or the other, is indeed dramatic if you compare it with the interest in biographical writing in almost all other fields. General scholarly journals like the Times Literary Supplement and the New York Review of Books abound with reviews of biographies of all kinds: historical biographies, literary biographies, art biographies, biographies of philosophers, and so on. But rarely medical biographies.

The absence of medical biographies becomes even more dramatic if one takes a look at one of the neighbouring fields: scientific biography. During the last two decades there has been a swell of biographies about naturalists, microbiologists, biochemists, physicists, mathematicians, and geologists; whatever one desires. Books that have made their publishers happy and at the same time have received applause in the scholarly journals. In the last two decades, historians of biology, for example, have produced at least four major Darwin portraits based on meticulous archival research, one even in two volumes (Browne, 1996–2002). Historians of physics have produced several acclaimed studies of Newton and Faraday, and there have been marvellously written treatises of Lord Kelvin, Louis Pasteur, Thomas Henry Huxley, Fritz Haber, Lise Meitner and Rosalind Franklin, just to mention some random fine examples. In my view good biographies not only show how scientists were integrated into the thinking of their time, and how the life and work can shed light on the cultural, political and social context of science, but also investigate the mind and practice of the individual scientist, and even delve into their private lives and existential dilemmas.

Of course, there are many bad biographies as well; some would say too many. But this is what could be expected in global book market that absorbs around one hundred titles of scientific lives every year. Generally speaking, I think there is a general agreement among historians of science today that biography has become a quite respectable scholarly genre over the last two decades. The genre has blown new vitality into our understanding of science past.

If Academia in general and our disciplinary neighbours in particular, have taken biography to their hearts for some twenty years now, why is this not yet the case in the history of medicine and public health? Why are there still so few scholarly medical biographies?

The question becomes even more topical if one contemplates the fact that the medical-biographical genre has a much longer record than most other biographical genres, including scientific biography. Hippokrates, the celebrated, but elusive phantom figure of ancient medicine, had bioi written of him already in the Hellenistic period, none of which, unfortunately, is extant. A thousand years later, the miraculous healing powers of some of the medieval saints and their relics found the way into their vitae, a genre which later came to be known, somewhat condescendingly, as hagiography (literally saint-writing). And yet another half millennium later, Renaissance and early modern period medical doctors had their given place in the emerging secular biographical tradition, for example in funeral speeches of deceased university professors and in the collections of what was called, obviously by inspiration from Petrarch, «the lives of illustrious men». Medical biography is thus a very old genre, obviously reflecting the fact that medicine and healing is an old practice, whether pursued by hippocratic doctors, medieval saints or professors in the early modern medical faculties and it continues to be published in great numbers (Morton and Moore, 1994).

In spite of being old and venerable, however, the genre has lagged behind its sister genre, scientific biography, for the last three hundred years (the history of the genres of scientific and medical biography remains to be written; see, for example, Söderqvist, 2002a). The first vitae of the pioneers of the so called scientific revolution, including Copernicus and Kepler, came in the first part of the seventeenth century. As natural philosophy, astronomy and physics, and later chemistry and the biological sciences, advanced toward the top of the academic pecking order, so did biographical portraits of what gradually became known as scientists, whereas the lives of medical men (and later a few women) were gradually assigned a more humble place in the genre spectrum, compared to the lives of the new revolutionary scientists. Consequently, one of the few medical doctors who repeatedly received biographical notice in the eighteenth and nineteenth centuries was Hermann Boerhaave. Of the approximately 1200 medical-biographical essays and monographs published in the three hundred years between 1550 and 1850, almost all were singletons (Oettinger, 1854); Boerhaave, however, received a top score of seven, the most famous of which was that of his admiring English student William Burton, whose Account of the life and writings of Hermann Boerhaave (1743) came only a few years after the great master’s death. The fact that Boerhaave towers higher than any other in the Enlightenment medical biographical tradition confirms the impression that he was, in the eyes of his successors, the man who brought the scientific revolution into medicine (Cook, 2000).

The triumphs of scientific medicine in the late nineteenth and early twentieth centuries were, of course, reflected in medical lives, too. But they still lagged behind their more illustrious scientific colleagues. Scientists were conspicuously present in the Lives and Letters-tradition; these spectacular and detailed compilations about the great luminaries of the Age of Imperialism, tomes packed with excerpts from letters, often in two, sometimes three volumes. Datwin, Pasteur, Kelvin, Wallace and the other great stars of nineteenth century science all got their tributes. The mathematician William Rowan Hamilton was the subject of 2100 pages in three thick volumes (Graves, 1882–89); the physicist and physiologist Hermann von Helmholtz was memorised by three volumes in German (Koenigsberger, 1902–03). But there were not many great medical doctors among them. And when authors of medical lives eventually adopted this grand format, the era of Lives and Letters had already ebbed out, not least thanks to Lytton Strachey’s and André Maurois’s attacks on what they regarded as biographical dinosaurs. Harvey Cushing’s two-volume Life of Sir William Osler in 1925 was one of the most celebrated medical biographies of the interwar period and was indeed a great tribute to the man. In form and outlook, however, it came almost a quarter of a century too late. It was out of fashion before it was even conceived.

I will not try the reader’s patience by going into the medical biographical tradition of the rest of the twentieth century, but will hasten to my conclusion of this look-back on the record of the genre, viz., that one reason why there are so few scholarly medical biographies today, compared to, for example, scientific biographies, is that even if medical biography is a very old genre, it never really has had a strong presence as a scholarly genre. True enough, tucked away on the shelves here and there are some extremely well-written and thoughtful studies. But, with the risk of sounding contentious, there have indeed been a lot of bad medical biographies. The Biography Room of the Welcome Library in London contains every possible variety of eulogistic, panegyric, hagiographic, badly written, badly organised, badly contextualised biography, in all major languages: English, French, German, Spanish, Italian, Russian, Danish, Swedish, etc. Biographies written by admiring colleagues, devoted students, faithful wives and proud daughters and sons; biographies written out of duty, or as labours of love; biographies that wanted to set the record straight, and so forth, but very few good scholarly biographies.

This lack of a strong scholarly medical biographical tradition may partly explain the absence that struck Ludmilla Jordanova in 1993. But there is also another, and probably more important, reason which has to do with the strong impact that social history has made on the field of history of medicine and health in the last three decades.

If one goes back to the programmatic manifestos of the social historians of medicine in the 1970s and 1980s, one will note the extent to which they were fighting against the biographical genre. They probably did not do so because they were trying to defend a scholarly space of their own against the dominance of scholarly medical biography (because, as we have seen, there was hardly any such tradition), and their fight against biography was probably not driven by a virtuous wish to combat the many bad medical biographies (because there were bad biographies in all possible areas, including lousy art biographies, literary biographies and scientific biographies, now filling dusty shelves in remote library stacks). Neither did the social historians of medicine fight so fiercely against biography because they were influenced by the vague anti-biographical sentiments fuelled by positivism, Marxism, structuralism, new criticism etc., that hovered all over Academia during most of the post-war period (because art historians, literary historians, historians of science etc., continued to produce scholarly biographies apparently without being affected either by the marxist denouncement of individualism, by Roland Barthes’s call for the «death of the author», or by the young Michel Foucault’s attempt to eradicate the subject (Burke, 1998)).

So why then did historians of medicine in general and social historians of medicine in particular, try to root biography out? Susan Reverby and David Rosner’s influential anthology Health care in America: Essays in social history from 1979 gives a clue. In their introductory chapter, the editors questioned medical doctors’ definitions of health and disease and hegemony over history; they wanted historians to take over professional ownership of the medical past. But there was more at stake. Reverby and Rosner had a much more far-reaching political goal than control of the past: they evidently wanted to have a say about who should control the contemporary medical system. The new social history of medicine was thought to be a weapon that would unmask «the pervasive societal faith in the potential and efficacy of medical science» (Reverby and Rosner, 1979, p. 4). Historians were thought to help break doctors’ control over the health system. Reverby and Rosner took the side of patients against powerful doctors, and in doing so; they particularly questioned biographies of «great men», because they believed that biographies were an expression of false consciousness. In their view, medical biographies made the presumed real forces in history – social and economic forces, political discourses, ideologies, patients, nurses, etc. – invisible. In short, biographies upheld the power relations in the medical system.

Confirmed social historians of medicine were not alone in attacking biography as an expression of a deplorable «great doctor» -perspective in history of medicine. With very few exceptions, most professional historians of medicine in the 1980s and 1990s have been hostile, or at best indifferent, to biographical writing (Linker, 2002; Söderqvist, 2002a). This is remarkable, because it was in the same period that Academia in general began to shake the ban on biography imposed by Marxism and structuralism off their shoulders. (Indeed, literary and art historians never found it necessary to fight the art establishment and have therefore apparently not felt any strong need to attack biographies of artists. In fact, it seems as if art historians still feel rather cosy with the idea of the «great artist»; more critical approaches to art biography, like Christie and Orton (1988), have not had much impact).

Likewise historians of science have not felt any strong urge to combat the «great men» of science for political reasons; the idea of «great scientists» has just been considered a trifle unfashionable, so it has rather been a question of moving biography out of the «great man» perspective instead of attacking and denying the genre of biography altogether. As Thomas Hankins wrote in an influential article titled «In defence of biography» published in 1979 (the same year as Reverby and Rosner made their attack), the genre could in fact be used productively to show how the political, social, cognitive, philosophical, etc. aspects of science were working together. Hankins did not see biography as the expression of a suppressive professional ideology, but as a useful methodological tool for exploring science in its wider context.

Hankins’s 1979-article announced the come-back of biography as a scholarly genre in the history of science. For the next two decades there has been a surge of scholarly scientific biographies, many of them written with the Hankinsinian purpose in mind. Adrian Desmond’s two volumes about Thomas Henry Huxley (1994–97) is a telling example. «This is a story of Class, Power and Propaganda», Desmond announced in the preface: this is «a contribution to the new contextual history of science». And he continued: «Isn’t it the modern function of biography to carve a path through brambly contexts? To become a part of history? … And isn’t that our ultimate aim, to understand the making of our world?» And again:

«Huxley is part of the new contextual history of science. This itself is a reaction to the old history of ideas, which displaced the person, made him or her a disembodied ghost, a flash of transcendent genius. Only by embedding Huxley can we appreciate his role in the vast transformation that staggered our great-grandfathers» (Desmond, 1997, p. 235).

Desmond and other historians of science have thus given good arguments for not setting social history up against biography and the individual. So it may be time for historians of medicine and public health to begin to reconsider the genre of biography. The omnipotent doctor is not the major culprit any more; today the medical system is in the hands of politicians, health administrators, insurance companies and pharmaceutical multinationals as well. Patients’ lobby groups and nursing organisations are beginning to have a say as well. The «great doctor» of the past is largely gone. There is no need to flog dead horses and therefore there is no need to combat biography, because it supposedly obscures power relations, social forces and cultural influences in the medical system.

To use the individual as a lens, as it were, into the larger social and cultural context of philosophy, or science, or art, or literature, or, in this case, medicine and health – i.e., to use biography as a microcosm of history at large, or as an ancilla historiae (a servant of history), as I have called it elsewhere (Söderqvist, 2003) – is probably the most common argument among historians today for the use of biography. It is an important role indeed, which, as I have just tried to argue for, makes it more profitable for historians to work with biography rather than against it. Recent developments in historiographical thinking, such as microhistory and the loose intellectual movement of «new historicism» and its interest in literary tropes, add to the impression that biography and some its salient features, for example the focus on narrativity, are important contributions to medical historiography.

Yet biography is not just history by other means. Even when one speaks of biography as an ancilla historiae, one should remember that servants are never entirely in the hands of their masters. Maybe the notion of biography as a adjunct to history should be dropped altogether? As an alternative I suggest to let the ontological assumption which Plutarch made in the introduction to his life of Alexander two millennia ago – viz., that biography (bios) and history (histoira) are two distinct ways of writing about the past – gloss the present debate about the relation between history and biography.

Remember that historia literally means «an inquiry». But in the course of time such inquiries of the past have by tradition come to mean studies of phenomena like nations, classes, economic institutions, political movements, social interactions, cultural constructs, etc. Bios means «an individual life course», and even if some historians today pretend they are writing biographies of cities or countries or even diseases, most historians nevertheless prefer to think about biography as the art of writing the lives of individual human beings. So whereas historia by tradition deals with the collective phenomena of the past, bioi (vitae, biographies) deal with its individuals. One past, two genres.

In other words, even though most historians today think of biography as a genre that takes a secondary role in assisting its more influential master, history, this is not the only role there is for it. Biography has other, more independent, roles as well; for example, at least in the last two centuries is has also been written and read as an aesthetic genre in its own right; literary scholars would probably say that biography has in fact always been emancipated from being a servant to history, that it has always blossomed in its own right.

Medical biography as literature is an interesting topic, which I will not pursue further here. Instead I will use my remaining few minutes to sketch out yet another possible role for medical biography (and in doing so, I will switch from a descriptive-analytical to a somewhat more normative stance). I am thinking of biographical writing as an example of the ancient practice of «spiritual exercises», a tradition which has been high-lighted in Pierre Hadot’s (1987, 1995) recent reinterpretation of Hellenistic philosophy (1984) which has also had a seminal influence on Michel Foucalt’s idea of «souci de soi» (care of self) in the third and last volume of Histoire de la sexualité (1984).

Hadot’s point is that already in classical times there was a pronounced difference between «philosophy» in the sense of systems, concepts and theoretical discourses, and «philosophy» as a mode of life. He traces the distinction through the history of philosophy, from Plato, via Petrarch, Montaigne and Descartes, to Kant, Nietzsche and Wittgenstein. One thing is to philosophise about what the world is like, or to find out what justice and goodness may be, or what characterises true knowledge, etc. Another thing is to live and practice justice, goodness, truth, etc.

Hadot uses the term «spiritual exercises» for the kind of practical thinking that informs philosophy in this second sense, as a mode of life (the term itself is not crucial; for some readers it may smack of cheap therapeutical practices, which is not the intention). The point is that there is a tradition in philosophy for «spiritual exercises» as a practice of intensive focus on the intellectual matter at hand, not primarily in order to contribute to the theoretical discourse of philosophy or to understand the world (even if this is a nice side-effect). but to change one’s own self in relation to the world.

Hadot restricts his analysis to philosophy. But one can easily extend his distinction to other scholarly activities, in science and medicine as well as in the humanities. Following Hadot, one could then say that it is, of course, a good and admirable thing to do science or medicine to understand the physical world and the human body, or to pursue humanistic scholarship in order to understand language or culture. But it is another, and equally good and venerable thing, to be a scientist or a scholar as a mode of life. Similarly with biography. The purpose of the genre is thus not only to help understand a larger historical context, or to be an aesthetic genre. but also to function as a «spiritual exercise», i.e., to inform the practice of «souci de soi» (care of self), to use Foucault’s wording. In other words, biographical writing enhances both the understanding of individual action in the past and the writer’s and the readers’ understanding of themselves in the world today, thus making them better fit to cope with the present world (cf. Söderqvist, 2002b; Söderqvist, 2003).

Summing up: I believe medical biography has at least two major roles to play in scholarship today. One is to penetrate the intricacies of the medical system of the past by using individuals as lenses, or microcosms, to show how the political, social, economic, military, cultural, and cognitive aspects of medicine and public health have interacted in complex ways. The other is to write and read medical biography as a «spiritual exercise», i.e., as a contemplation of one’s place in the contemporary medical and health system and in the world at large. In other words, biographies of scientists, doctors and nurses can help medical and health professionals understand the place of their work in the course of life as a whole; similarly biographical stories of patients may help us all, as potential sufferers, to cope with the situation of being ill. (Maybe even biographies of historians of medicine and public health could be of some use?)

I started by asking: Why are there so few medical biographies? I hope my answer has not scared you from inviting me to the next congress to give the concluding address, but now to answer another question: How can we stem the tide of all these many new and good medical and public health biographies?