- Just What Do Physicians Do?Unexpected Continuities from Sixteenth-Century Padua
The historical roots of bedside medical practice are often traced to the halls of the peri-revolutionary Parisian hospitals. But Michael Stolberg would have us look instead almost three hundred years earlier and one thousand kilometers to the southeast, to the medical schools of sixteenth-century Padua. There, in the most renowned medical institution of the time, students routinely followed teachers to the bedsides of their sick patients. In this paper, Stolberg adeptly uses student notes to examine clinical teaching in the Hospital of San Francesco, helping us understand how these physicians related scholarly analysis offered in the sterile confines of the classroom to the practices performed in the messy world of bedside medicine.
Just what is it that physicians do at the bedside? How do they make sense of a sick person? How does what they have learned (or taught) in the theoretical world of the lecture hall relate to what they do as practitioners? And how do skilled physicians impart to their students the sorts of practical knowledge necessary for patient care? Stolberg offers fascinating insights into what learned physicians taught students. They were advised first to talk to the patient, and only then to move in to palpate the pulse. They did so in order to put the patient at ease and prevent fear from complicating the diagnostic process. This admonition raises all sorts of fascinating questions about the relationship between patients and physicians (and makes the reader wonder just what patients had to fear). The affective component of the doctor–patient relationship and the importance of nonverbal communication were explicitly addressed. Students were advised to take note not only of the factual information offered by patients, but also how patients answered the questions put to them. [End Page 662]
Contrary to the standard history of medicine, which puts the advent of routine physical examination much later, physicians in the Padua schools felt their patients’ abdomens with some regularity, seeking evidence of disease through palpation of the liver and spleen. The Parisian hospitals are said to have made the teaching of physical diagnosis more efficient by gathering many patients together in one location. In Padua, despite the presence of a hospital, teaching was carried on in much the same way in patients’ homes as it was in hospitals. Moreover, teaching in the home offered certain advantages. For one, students would become acquainted with caring for the more affluent members of society. For another, as students walked from house to house with a senior mentor, it would offer an opportunity for more extended educational discussion—a sort of proto “teaching rounds.” Going to the bedside offered another set of “real world” lessons. Then, as now, unlike the theoretical world of the lecture, in the real world, people do not always do as the physician directs them.
Another essential element of early modern practice was examination of the urine (as well as other bodily excreta). Its rationale and theoretical basis used a model of disease very different from the one familiar to modern physicians, and yet the notion of tracking the body’s condition through routine examination of its fluids (sometimes even in the absence of the patient) is one that seems familiar, even obvious, today. In my own work, I characterized as novel an early, twentieth-century transition to following disease in hospitalized patients through regular examination of the urine.1 Stolberg shows that the same fundamental concept was in play some five hundred years earlier, albeit with a very different set of underlying assumptions and without the same laboratory tools. Sixteenth-century physicians justified this ritual in different terms than their colleagues in the early twentieth century, but the long historical continuity of the practice conveys an important lesson—that the significance of a medical practice extends well beyond its expressed rationale.
While the image of physicians talking to patients, feeling the pulse, and examining urine may seem familiar to twenty-first-century observers, Stolberg does not let us forget that these Paduan practices were justified with ideas such as morbid humors. His careful [End Page 663] description of the rationale reminds us that...