Frank Huisman

The role of the patient in patient safety: What can we learn from healthcare’s history?

Many nations, healthcare organizations and interest groups are addressing the question of how patients can best be involved in designing and executing patient safety policy. Looking back at how patient engagement has developed in healthcare, we can draw lessons on how to engage patients in patient safety.

Blurring boundaries: Towards a Medical History of the Twentieth Century

This special issue intends to show the potential of medical history to contribute to major historical debates, e.g. on the rise of the welfare state. Together the articles in this issue make clear that medical history, for the twentieth century even more so than for earlier periods, is strongly embedded in social, cultural and political history. The second goal of the special issue is methodological. It aims to highlight the conceptual work being done by medical historians in oral history, digital history and the study of material culture. These methodologies allow them to expand the range of actors in the medical field: architects, missionaries, ‘laypersons’, advertisers and drug users all extend the medical field beyond the established categories of ‘doctor’ and ‘patient’. Through their eyes, the particularities of twentieth-century health care become clear: the strong presence of mass media and public opinion, the role of international organisations and the redefining of patients as citizen-consumers entitled to health care. Vervagende grenzen: naar een medische geschiedenis van de twintigste eeuw Dit themanummer wil het potentieel van de medische geschiedenis tonen om bij te dragen tot belangrijke historische vraagstukken, zoals de opkomst van de welvaartstaat. De artikelen in dit nummer maken duidelijk dat de medische geschiedenis – voor de twintigste eeuw meer nog dan voor vroegere tijdvakken – nauw verbonden is met de sociale, culturele en politieke geschiedenis. De tweede doelstelling van dit nummer is van methodologische aard. Het wil de conceptuele vernieuwingen van medisch historici op het terrein van de mondelinge geschiedenis, de digitale geschiedenis en de studie van materiele cultuur onder de aandacht brengen. Dankzij deze methodologieen komen nieuwe actoren in beeld: architecten, missionarissen, ‘leken’, adverteerders en druggebruikers – actoren die het medische veld verruimen, voorbij de traditionele categorieen van ‘arts’ en ‘patient’. Vanuit hun perspectief wordt de eigenheid van de twintigste-eeuwse gezondheidszorg duidelijk: een veld waarin de massamedia en de publieke opinie nadrukkelijk aanwezig zijn, waarin internationale organisaties een rol spelen, en waarin de patient wordt geherdefinieerd als burger-consument met recht op medische zorg.

Peter Jan Knegtmans, Geld, ijdelheid en hormonen. Ernst Laqueur (1880-1947), hoogleraar en ondernemer

Peter Jan Knegtmans, Geld, ijdelheid en hormonen. Ernst Laqueur (1880-1947), hoogleraar en ondernemer (Amsterdam: Boom, 2014, 356 pp., ISBN 978 90 8953 362 3).

Intolerant Bodies: A Short History of Autoimmunity

Almost ten years ago, the British Medical Journal published an editorial with the intriguing title ‘Medicine, Postmodernism, and the End of Certainty’. To quote from it: ‘Utterly unquestioned biological givens are disintegrating all around us...Doctors will become purveyors of choice —or agents of control—within the plastic limits of the flesh’. This almost poetic statement might well have been the motto of this wonderful short history of autoimmunity. It is included in the Johns Hopkins Biographies of Disease series, edited by Charles Rosenberg, who coined the notion of ‘framing disease’. It is difficult to write about the dealings with a phenomenon in an era that had no concept to refer to it. Today, more than eighty autoimmune diseases are recognised, affecting 5 to 10 per cent of the population. Although the cause of autoimmune disease is often unclear, its mechanism is not: the immune system is attacking the body’s ‘own’ tissue. Such is the consensus within the medical community since the 1950s. Before that, the very thought was considered counterintuitive and even outrageous, since the immune system was believed to protect the body from outside dangers. Around the middle of the twentieth century, a profound conceptual change took place. Because biomedical researchers allowed themselves to be inspired by cybernetics and dared to raise philosophical questions about self and non-self, they created the conceptual space for a new kind of basic research. This research became feasible only after scientists had liberated themselves from a thought style that originated in the bacteriological era and that was characterised by a rather static, ontological way of thinking. Clinician-historian Warwick Anderson and historian-clinician Ian Mackay present their ‘complex story’ (156) as the culmination of more than thirty years of intellectual engagement. In their book they chose to focus on four examples of the elusive category of autoimmune disease: multiple sclerosis, systemic lupus erythematosus, rheumatoid arthritis and diabetes mellitus type 1. All of these are now included in the International Classification of Diseases (ICD), published by the World Health Organization. In the ICD they are referred to as 340 (under the heading ‘other disorders of the central nervous system’), 695.4 (‘other inflammatory conditions of skin and subcutaneous tissue’), 714 (‘arthropathies and related disorders’) and 250.01 (‘disease of other endocrine glands’). While the numbers suggest meticulous taxonomic precision, the headings indicate that we are dealing with ‘rest’ categories of disease which are (still) difficult to fathom or delineate. Keen on understanding the complex mechanisms of this disease group and afraid to get entangled in the conceptual web of researchers and clinicians of the past, Anderson and Mackay decided to relate directly to the afflicted bodies of patients. Thus, novels of patient-writers are important sources to them. Because novelists had a way with words, they succeeded in developing a language to express what was happening to their bodies. In a way, the literary expression of laypeople seems to transcend time-specific medical ontologies. Thus, the flesh of Charles Dickens, Edgar Allan Poe, Joseph Heller and Flannery O’Connor is speaking to us directly. Anderson andMackay present their story of autoimmunity as an alternative history of biomedicine, with its own periodisation. Traditionally, history is divided in a rather linear way, moving from humoralism to bacteriology and immunology. According to this view, the western medical tradition went through a paradigm shift from constitutionalism to specificity around 1900. Anderson and Mackay argue convincingly that autoimmune diseases were inconceivable in the ontological terms of bacteriology. Therefore, rather than organising their story in terms of Kuhnian paradigms which are mutually exclusive, they resorted to the Fleckian notion of

Itinerant Dentists and Patent Remedies in the Dutch Republic

This chapter describes the rise of dentistry in terms of the interaction between a changing medical rhetoric and a marketplace under pressure. During the second half of the eighteenth century, physicians began to take an active interest in surgery. In the corporate health care system of the Dutch Republic, this had far-reaching consequences for itinerant medical practitioners. Because they were pushed out of the market for general surgery, some of them opted for a career in dentistry, an alternative in which the regular profession was hardly interested.