"On Second Thought" and Other Essays in the History of Medicine and Science (review)

Owsei Temkin."On Second Thought" and Other Essays in the History of Medicine and Science. Baltimore: Johns Hopkins University Press, 2002. x + 272 pp. $42.00 (0-8018-6774-6).

Why should we study the history of medicine? This is a question that occupied Owsei Temkin throughout his long life, and to which he returned constantly in his writings. Even as he approached his hundredth birthday, he still offered us some second thoughts, to accompany the republication of a second harvest of his essays. As might be expected, they range widely across the centuries, from Hippocrates and Galen to Gall and Wunderlich, and from dietetics and drugs to morality and medical prophecy. To these have been added Dr. Temkin's latest thoughts on medical history and on the Hippocratic oath. Given the circumstances of their composition as noted in the preface, one can only marvel at the author's determination to overcome the frailties of old age. The flesh may have been unwilling, but the clarity and wisdom of the author's mind still remain to warn, challenge, and even entertain his readers, for an acute sense of irony pervades many of his new observations.

What is striking throughout, and was evident also in The Double Face of Janus (1977), is the conviction that the history of medicine should have a place in a modern medical school, not as an antiquarian pursuit but as a central element in the formation of the physician. Reflecting on the past—whether on medical classics or on less-familiar compositions, such as Pennier de Longchamps's 1766 dissertation on truffles—can serve, according to Dr. Temkin, to enhance our understanding of the medical predicament in the face of illness and death. A document like the Hippocratic oath, he argues, has gained its authority in part because it responds to many medical dilemmas. Its demand for holiness and piety must be set in a context that places enormous responsibility in the hands of the practitioner to act for the good of the patient. While the oath itself takes the form of a document that can be signed, it also implies the internalization of its ethical values. Even if not a Pythagorean document as Edelstein suggested, its religious tone serves only to emphasize the moral choices open to the physician.

But an ethical dimension is not all that can be gained from a study of the past. One may learn humility in the face of the ever-increasing accumulation of new data that supersede long-established views. As with prophecy, the only certainty is that some parts of our understanding are likely over the course of time to be proved wrong. Galenic humoralism, Brunonianism, even Virchow's cellular pathology, have all been replaced or modified. The modern understanding of epilepsy has changed considerably since The Falling Sickness (1945/1971), that exemplary study of the history of one condition and its treatments, was first written. But rather than descend into a historical pessimism or an anarchistic deconstruction of medical science as something imposed by inexorable social forces, we are invited instead to consider the paradox that we are unlikely to be able to determine for certain which theories and ideas will be replaced, and which will continue to form part of the accepted "facts" of medical science. Reflecting on the variety of ways in which illness has been understood and treated in the past was not, for Dr. Temkin, a melancholy review of past follies, but an essential element in the physician's awareness of all that is included within the Hippocratic triangle of patient, doctor, and illness.

The belief in the virtues of historical understanding as part of the make-up of the physician can be traced throughout Dr. Temkin's writings, from his earliest papers in Leipzig, including an appeal for the "Geisteswissenschaften" (humane sciences) in medicine, to...