Internalism vs Externalism in the History of Medicine

The other day I was reading a book review in the H-Sci-Med-Tech listserv. In it, Dagomar DeGroot, writing about Black Holes: A Very Short Introduction by Katherine Blundell (Oxford, 2016), introduces a nomenclature that is new to me, viz.:

Blundell delves deeper into the history of science… since black holes straddle the boundaries between Newtonian, relativistic, and quantum physics. In a sense, the history of scientific thinking about black holes—or “dark stars,” as a few precocious scholars imagined them in the eighteenth century—mirrors the history of the related disciplines of physics and cosmology. Blundell occasionally suggests links between broader social developments and the history of science, but she concentrates on an internalist summary of the personal breakthroughs of standout scientists. (Bolding mine – TLS)

Until the 1960s, medical history was pretty much the domain of medical doctors. Often classically educated (with Greek and Latin), they could read such ancients as Aristotle, Hippocrates (“the Hippocratic corpus”) and Galen and could bring the wisdom of these masters to the modern era. Physician-written historiography then was largely a “we stand upon the shoulders of giants” enterprise – stories of brilliant or hard-working doctors who advanced the art and science for the benefit of, but without reference to, mankind in the non-medical world. This is “internalist” history.

My research of the Internalist-Externalist debate (thank you Google) brought me to Mary Lindemann’s Introduction in Medicine and Society in Early Modern Europe (Cambridge, 1999). In it, she lays out very nicely the shift in historiography that occurred in the 1960s and 1970s as PhD historians gradually supplanted MDs in the writing of medical history in the west. Among others, she cites what are now referred to as post-modernists (Foucault is mentioned) and their criticism of “whiggish” history and she cites MD / PhD American Association for the History of Medicine President George Rosen’s 1967 call for a redefinition of “the time, matter and manner” of medical history. This redefinition has taken pretty much a “social history of medicine” bent that has emphasized the effect of society on “medicine” – think, for instance of the activist movement that pushed the medical establishment to more quickly find effective AIDS treatments, or the effect of “medicine” on society – think of the change of medical opinion and resulting public policy regarding anti-smoking campaigns.

While I understand the externalist argument as presented, my sympathy still lies with the tight medico-scientific spirit and logic that internalist medical history depends upon and promotes: the search for excellence and progress (with admitted human foibles and flaws included) that motivated and brilliant practitioners create. Internalist history, for this physician, is interesting, compelling and often inspiring. Somehow, the AAHM mantra that “physicians create the history and historians chronicle it” doesn’t quite work: something inevitably gets lost in the translation.

(C)2018 Thomas L Snyder

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