The Great Canadian Peritonitis Debate 1844-47

In 1844, a highly publicized death in Montreal was investigated by the courts. The two physicians involved gave conflicting opinions. The attending doctor, Wolfred Nelson, an anglophone "patriote" politician and later the first elected mayor of Montreal, thought his patient had died of peritonitis secondary to bayonet wounds. Andrew Holmes, Dean of the McGill Faculty of Medicine, who had witnessed the autopsy, said there was no pathological evidence for such a diagnosis. Widely reported in the lay press, their public disagreement spilled over into the medical literature where it exploded into a protracted three-year polemic occupying many pages of early Canadian medical journalism in both French and English. Another death from appendicitis in 1847 added fuel to the raging debate. Peritonitis was a relatively new diagnosis tied to the new concept of tissue-specific lesions. Its relationship to appendicitis had not yet been clearly described. Both physicians cited medical authorities, but each accused the other of misquoting and the dialogue often descended to the level of personal insult. The debate was ostensibly about the physical and pathological signs of peritonitis, but it was sparked by more than academic disagreement. Nelson and Holmes were at opposite poles of the political spectrum: they came from different medical backgrounds, practised different styles of medicine and were both involved in education for very different reasons. This controversy illustrates the extent to which these two prominent practitioners were aware of the history of a new disease as portrayed in contemporary literature and it illuminates the evolving role of the medical practitioner in mid-nineteenth century Canada. En 1844, les tribunaux se sont penchés sur un cas de décès largement diffusé à Montréal. Les deux médecins impliqués donnèrent des opinions contradictoires. Wolfred Nelson, le docteur responsable, politicien « patriote » anglophone qui allait devenir le premier maire élu de Montréal, pensait que son client était mort de téritonite, suite à une blessure de baïonnette. Andrew Holmes, doyen de la faculté de médecine de l’Université McGill, présent à l’autopsie, déclara qu’il n’y avait pas de preuve pathologique d’un tel diagnostic. Le désaccord public des deux médecins, largement rapporté dans la presse juridique, se répandit dans la littérature médicale; il y éclata une polémique qui traîna pendant trois ans et occupa de nombreuses pages du journalisme médical canadien à ses débuts, en français comme en anglais. Un autre décès, consécutif à une appendicite en 1847, alimenta le débat qui faisait rage. Le diagnostic de la péritonite, relativement récent, était relié au nouveau concept de lésions des tissus spécifiques. Ses liens avec l’appendicite n’avaient pas encore été clairement décrits. Les deux médecins citaient des autorités médicales, mais s’accusaient mutuellement de citations erronés et souvent le dialogue dégénérait en insultes personnelles. Le débat portait manifestement sur les signes physiques et pathologiques de la péritonique, mais il fut allumé par plus qu’un simple différend académique. Nelson et Holmes étaient diamétralement opposés politiquement : et ils différaient tant du point de vue de leurs origines et de leurs pratiques médicales, que des raisons de leur implication dans l’enseignement. Cette controverse montre le degré de conscience de l’état des connaissances d’une nouvelle maladie, telle que décrite dans la littérature contemporaine, et il éclaire l’évolution du rôle du médecin au milieu du XIXe siècle au Canada

Making the Case for History in Medical Education

Historians of medicine have struggled for centuries to make the case for history in medical education. They have developed many arguments about the value of historical perspective, but their efforts have faced persistent obstacles, from limited resources to curricular time constraints and skepticism about whether history actually is essential for physicians. Recent proposals have suggested that history should ally itself with the other medical humanities and make the case that together they can foster medical professionalism. We articulate a different approach and make the case for history as an essential component of medical knowledge, reasoning, and practice. History offers essential insights about the causes of disease (e.g., the non-reductionistic mechanisms needed to account for changes in the burden of disease over time), the nature of efficacy (e.g., why doctors think that their treatments work, and how have their assessments changed over time), and the contingency of medical knowledge and practice amid the social, economic, and political contexts of medicine. These are all things that physicians must know in order to be effective diagnosticians and caregivers, just as they must learn anatomy or pathophysiology. The specific arguments we make can be fit, as needed, into the prevailing language of competencies in medical education.History of Scienc

Medical miracles: Doctors, saints, and healing in the modern world

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