[National Library of Medicine HF3473] [This transfer made: 8/5/3004, length: 00:47:20]
[Department of Health, Education, and Welfare] [Public Health Service] [National Institutes of Health] [National Library of Medicine]
[A National Medical Audiovisual Center Production] [In cooperation with Alpha Omega Alpha National Honor Medical Society]
[Leaders in American Medicine]
[Owsei Temkin, M.D. William H. Welch, Professor Emeritus History of Medicine, Johns Hopkins University, March 1979]
[Interviewed by: Lloyd G. Stevenson, M.D., Ph.D., William H. Welch Professor, History of Medicine Johns Hopkins University]
[Introduction by: James A. Campbell, M.D. President, Alpha Omega Alpha]
James A. Campbell: The program which you are about to see is one in a series of programs entitled Leaders in American Medicine. It is jointly sponsored by the National Medical Library, the National Medical Audiovisual Center, and Alpha Omega Alpha Honor Medical Society.
It is made possible largely through a most generous donation of Professors David and Beatrice Segal of Columbia University College of Physicians and Surgeons.
Narrator: Dr. Owsei Temkin, William H. Welch Professor Emeritus of the History of Medicine, the Johns Hopkins University, is interviewed by Dr. Lloyd G. Stevenson, William H. Welch Professor, History of Medicine, at the Johns Hopkins University.
Dr. Lloyd G. Stevenson: The year 1979 marks the fiftieth anniversary of the opening of the Institute of the History of Medicine at Johns Hopkins Institute in Baltimore, Maryland.
During much of that time, in fact, during almost all of that time, the institute has been distinguished by the work and graced by the presence of Dr. Owsei Temkin, who, many years ago, came to these shores from Leipzig. Professor Temkin, when did you arrive in Baltimore?
Dr. Temkin: I arrived on September 29, 1932 at about six o’clock pm, from New York. We almost missed Baltimore, because, looking at the station, that old Pennsylvania Station looked so insignificant, that we couldn't quite believe that it represented the city which we had been informed was of considerable size.
Dr. Stevenson: So you have been connected with the Institute for over 47 years. Who were the other members?
Dr. Temkin: Well, the other members were, first of all, of course, Doctor Sigerist, who had arrived about two weeks before me, and then Dr. Garrison, or Colonel Garrison, as he was called, the head of the Welsh Medical Library,
who was also a lecturer in the History of Medicine, and then Dr. Rathbone Oliver, a very well known novelist, a minister of the Ccurch, psychiatrist, who also, as I remember, practiced psychiatry on the floor of the Institute of the History of Medicine.
Dr. Stevenson: Did you experience a break in your work by coming to the Johns Hopkins Institute?
Dr. Temkin: No, not at all, because the chief task before us was to do research. And Dr. Sigerist as well as myself continued just where we let off in Leipzig. My two main subjects were the history of epilepsy, and the study of the late- Alexandrian doctors, and I continued in exactly as I had stopped practically the day before.
Dr. Stevenson: What about teaching?
Dr. Temkin: Well now, of course, all teaching in the history of medicine was optional until 1957.There were no required courses, and the teaching task of the history of medicine was not officially and formally built into the curriculum of the medical school.
Dr. Sigerist gave an outline course which was encoursaged by the Dean, which was attended by most first-year students. And I gave seminar courses, and Dr. Sigerist, too, and we did it more or less in the old German fashion.
Of course, there was one thing to which I had to adapt myself, and that was the change from German to English. And there I was greatly helped by my wife, who was British-born.
Dr. Stevenson: Did not this method of teaching run counter to what was called the Oslerian Method?
Dr. Temkin: Well, I suppose it did. But I can't speak for Dr. Sigerist, but as far as I'm concerned, I was quite blissfully ignorant of what was Oslerian Method was. I had never heard of it before, and I hadn’t heard of the disputes about it.
I don't think that I knew much about Dr. Osler at all. What confronted me in Baltimore, as soon as I arrived, was, of course, the number of Osler pupils who were still flourishing and practicing.
They were almost all collecting old books. I’m not quite so sure that they also read the books, but they had a great bibliographical interest. AS a matter of fact, this bibliographical interest sometimes embarrassed Dr. Sigerist and me because we had not yet been accustomed to compiling medical history and bibliography, so we had much to learn.
Dr. Stevenson: How did this happen, then?
Dr. Temkin: Well, I think, you see, that Dr. Welch formed the transition between the Oslerian method and what we were doing. Osler had been interested in great doctors and in their work.
He wanted to bring the students in contact with the masterminds, and you can do that very well, I think you can do it best, even, if you bring it into your course, in clinical medicine or whatever it is, if you mention the great names, if you mention their works, if you mention what they did at the appropriate time.
Now, as far as Dr. Welch is concerned, in preparing for his duties at the institute, he had spent quite some time at the Leipzig Institute, and had picked up what we were doing and also what was being done in Berlin, and I think that this accounts for his emphasis on the cultural and intellectual background of medicine.
He wanted to humanize medicine, by presenting it within this background, and this was a bridge in preparation for us from the Oslerian Method to our own method.
Now, if you want to teach medicine as it develops against civilization, intellectual life, religious life, social conditions in the world, you can't put that so easily into another course, for this you need, I think, special lectures and seminars.
Dr. Stevenson: You seem to have felt much closer to Dr. Welch than to Dr. Osler.
Dr. Temkin: Yes, I knew Dr. Welch personally, whereas Dr. Osler, for me, was something or somebody with whom I had to become acquainted to what I heard from others, and what I read. It took me a while to realize the great humanist that Dr. Osler was,
and also to understand the great impression he made in all those around him, and his pupils. He was a real teacher, he was not just an instructor.
And by "real teacher," I mean he actually taught his students how to live and how to act, and he did it largely by the authority of his personality. Call it authority, call it charisma, whatever it is.
Dr. Stevenson: But you did not come under this Oslerian influence?
Dr. Temkin: No. I think I was too distant and too old for that. To me, he remained one of the great doctors representing chiefly the Victorian and Edwardian Era in Anglo-American medicine.
Dr. Stevenson: Now, we've spoken of Welch and Osler, let us speak also of Dr. Sigerist and Dr. Schryok(?), who came in the generation before you, but with both of whom you were closely associated.
Dr. Temkin: Yes. Dr. Sigerist, of course as I already mentioned, was my teacher. And I owe to him an initial vista of medicine against a broad background, and personally, above that, I owe him the opening of my career.
As you probably know, it was Dr. Sigerist who had defined the task of medical history as looking forward by taking up medical problems and contributing to their solution, and looking backwards as historians.
And he compared this with the old god Janus, and his two faces, one looking forward and one looking backward.
All my professional life, I have tried very hard to look the god straight in the eye, but it's a little difficult with a person who has two faces, and switching from one face to the other, sometimes almost made me giddy.
Dr. Sigerist's interest in the problems of medicine and their solutions gradually took on more and more of a sociological character.
He became interested in studying systems of medicine as they are practiced in the United States and in Russia, and he became involved in medical care plans. This, I think, describes, briefly, what confronted me, as far as he is concerned.
Dr. Stevenson: And what about Dr. Schryok?
Dr. Temkin: My relationship with Dr. Schryok was that between colleagues. Dr. Schryok was an American historian who approached history from a sociological point of view, and who I think
often expect that generalized sociological answers to the variety of historical phenomena. But he, too, of course, was very much interested in making the history useful for medicine. And he and Dr. Sigerist were both were much interested and involved in medical care plans.
Dr. Stevenson: And why did you not follow their sociological orientation?
Dr. Temkin: Well, I think, first of all, because of a personal inclination. I was much more interested in science, in general, and in medical science, in particular, than Dr. Sigerist or Dr. Schryok were,
and obviously, I wanted to cultivate the history of science and, in a strict sense, the history of medicine.
But then also because I was, to some degree, and have increasingly become, doubtful of the iron laws of economics and the social forces of which Dr. Sigerist was fond, so to speak, and also because I was doubtful of the possibility to generalize historical phenomena.
Dr. Stevenson: Do you then think that medical history is quite useless for planning the future?
Dr. Temkin: Oh, not at all, not at all. I think that medical history, like all history is very important for all of us. It is a very important and useful tool.
It helps us to orient ourselves and to calculate where we stand, that is to say where we think that we stand, and also helps us in shaping the choice of where we want to go.
Now I already mentioned here is the term choice, because, I think, whatever determining influences there may be on medicine or another cultural phenomena, there is always, in human affairs, this element of choice, and it can never be replaced by an astrological prediction.
I am echoing, here, the late philosopher, Scott Buchanan, who compared the use which astrologers of old made of astronomy with all kinds of predictive uses of natural and social science in our days.
Dr. Stevenson: But, in turning away from determinism, doesn't this bring us dangerously close to the doctrine of complete liberty of will?
Dr. Temkin: No, I don't think so. You see, I do not have in mind any metaphysical problems of freedom of liberty of will, or of determinism.
What I have in mind is the choice of human beings with which we all count in our daily life. We debate, we say "This is good, this is bad. This is right, this is wrong. This is beautiful, this is hideous."
And accordingly shape our opinions. And it doesn't make a great difference whether you believe in the freedom of will or whether you believe in determinism.
As far as my observation goes, even the most hardened determinist still continues to debate and to make choices and to think about good and bad and right and wrong.
Dr. Stevenson: And does this ability to make choices, to act according to goals, is that what you refer to as "man's moral nature?"
Dr. Temkin: Yes, I think so. I think it is the view of man, as a responsible being, who at least tries to take rational motives into consideration for what he does.
Dr. Stevenson: In your recent book, "The Double Face of Janus," you turn to medical history as a proper field for studying the moral nature of man, and that brings us to some questions which, I think would benefit from some elaboration.
First of all, you define medical history as "All that is historical in medicine, and all that is medical in history.” This is so general as to be rather vague.
Dr. Temkin: That is true, but this is intentional, because I just wanted to indicate the broad complex for historical questions and medical questions that opens before us.
Now, as far as historical questions are concerned, almost everything in medicine can be questioned, approached, and, if we are lucky, solved, from a historical point of view, that is, made understandable from a historical point of view.
Diseases have their history, drugs have their history, medical concepts have their history, and so on. I don't think I have to elaborate it because we are all familiar with that.
On the other hand, there are many historical events which will benefit from medical questions asked and possible medical answers given.
They are not only the diseases of famous people in which we are interested, we are also interested in the medical nature of epidemics.
Think, for instance, of the Black Death, which had a great impact on the cultural and economic life of mankind.
Some historians believe that it was really the Black Death which put an end to the flourishing medieval culture of the thirteenth, early fourteenth century.
So this definition which I have given is intentionally given as broadly and almost vaguely, because I wanted to avoid any specification. It is open to new questions and to new answers.
Dr. Stevenson: But why is medical history particularly suitable for studying man's moral nature? Were you thinking of the biographies of the great doctors you've listed?
Dr. Temkin: Well, of course the great doctors are included, obviously, but they are by no means the only subject. The attitude of man towards disease, and towards death, just to take one particular field, reveals his courage or his fear, his hopes or his despair.
And it teaches us very much about the potentialities of human beings. I mean the moral, if you like, moral potentialities of human beings. Let me just give you two examples.
The first is something which is probably known to you and it is the description of the death of Socrates, as Plato relates it.
Now, of course, Socrates' philosophy of the immortality of the soul and so on, that is not a medical subject.
But his attitude towards death, his courage with which he faced death, even the slow effects which the hemlock had on him, that is a medical problem.
In other words, I shouldn't say a problem, but this is a lesson, a moral lesson, in the attitude of one particular individual towards death, which, of course, as you know, then, once he had shown the way, stimulated many others to have the same encounter with death.
But it had medical consequences because, by pointing out that the death of the body really was not the death of the real person that counted, Socrates or Plato, whoever it was, facilitated the approach to the dissection of human beings.
If it's not the body that counts, then you may just as well dissect it. And the other example which I wanted to mention is one that I find very puzzling, and, I think very interesting.
The doctor is supposed to be the apostle of health. He is supposed to prevent health, to bring health back to people, and to promote health.
It even goes so far that today we have very serious discussions about the prolongation of life where hope already has gone.
This is the philosophy of medicine towards health, but the attitude of the physician, when it comes to his own health, contradicts it, because the physician who sacrifices his own health in the interest of his patients is a hero.
And the physician who experiments on himself and consequently dies, is a great hero. Think of Dr. Lazar in the expedition of Walter Reed.
Now this really documents that somewhere beyond our faith in health, we still believe that there are valuesin us which go beyond health and for which health is worth sacrificing.
Dr. Stevenson: Finally, you say also, of medicine, that it is a mood of looking at man with compassionate objectivity. Is this not a contradiction of terms? The word "objectivity" would seem to rule out such an emotion as compassion.
Dr. Temkin: I don't think it does. I don't think that objectivity and emotion necessarily contradict each other and make each other impossible.
Well, to give a very simple example, which I think is also a good example, nobody wants to win his battle more passionately than the general, and just because he wants to win it, nobody has to study the enemy and his dispositions as objectively as the general has.
Now let's switch from the general to the doctor. The doctor wants to cure his patient, but in order to do it, he has to study him scientifically, and that means objectively. But at the same time, if he does not have any compassion, he will not have an incentive to do all he can for his patient.
Of course, we must not think of compassion in sentimental terms, that is not meant. What I mean by compassion is the insight which we all have that suffering and death confront all of us.
That none of us, including myself, is exempt from it, and therefore, if we have compassion with ourselves, we'd better have it with others, too.
Dr. Stevenson: I assume that your preference for humanistic historiography stems directly from your classical education. Am I right about that?
Dr. Temkin: You are partly right. But partly, you are wrong, and I think I am responsible for it because, here in the United States, the distinction between a Realgymnasium and a humanistic gymnasium is not always there,
and therefore, I often have talked just about my time with the gymnasium, but, as a matter of fact, I attended a Realgymnasium, where we had a lot of Latin, but nex to no Greek.
Instead, we had English, on top of French, and we had much more math and science than the so-called humanists.
But then, when I was a medical student, I began to study Greek on my own, very intensively, and this was connected with a very sad event in my own family.
I was, at that time, already in my clinical years, and my mother, who was suffering from a terminal illness, spent several months in the hospital.
And since I was an advanced medical student, I had the privilege of serving as a "night nurse,” so to speak.
Now, as you know, the routine of a hospital begins very early, and at five o’clock, I had to get up, but my lectures didn't begin before seven or eight o’clock.
So I had two or three hours on my hands which I used for about three months, to study, very intensively, Greek. Then later on, when I was an intern, I took lessons with a teacher, who was a classicist.
Incidentally, he was a great admirer of Plato, and he expected me to write a commentary on Plato's Timaeus, then combining my interest in Greek and my scientific interest. I have never written that commentary, and I am afraid that I sorely disappointed him.
Finally, I took the final examination in Latin and in Greek of a humanistic gymnasium so that I had the best of both worlds of the Realgymnasium and the humanistic gymnasium.
But I think that, as this example of my studying Greek goes, the urge, the interest, in the classics and the desire to learn more about them came only partly from my school, and partly, I think I was following an inner urge and drive.
Dr. Stevenson: That is how the urge began? It was self-initiated?
Dr. Temkin: Well, I can tie it down to one particular event. When I was about fourteen or fifteen years old, I had a classmate who was a rather mediocre student, and by no means a linguistic genius, but, for one reason or another, he was interested in Greek books.
And he bought Greek works, that is to say, works that were printed in Greek and not translated. Neither he nor I could even read the alphabet at that time.
And I was very much surprised if he got very any further than simply, from time to time, looking at his books. But I resolved, when I saw these books, and when his enthusiasm infected me, that someday I would learn that language and read those books and know what was in them.
Dr. Stevenson: And you seem to have regarded your works in Greco-Roman Medicine as your specialty.
Dr. Temkin: No. My specialty is the history of medicine. That is my medical specialty, and that is enough of a specialty. Now it is, however, important, and of course have done it, and the same is true of Sukoff and of Sigerest, that you have a special province, a special period of special interest.
Not only is it natural, for Sukoff it was [?] the Middle Ages, for Sigerest it was it was Early Medieval Medicine, and I found mine in Late Antiquity. I also had another period that interested me, the early 19th century.
This studying one period in depth is important in order to avoid dilettantism. But, by and large, this comprehensive approach recommends itself in serving usefulness for medicine.
Dr. Stevenson: You speak of dilettantism. Could you put, in a nutshell, how to avoid it?
Dr. Temkin: Yes, if I have to put it into a nutshell, and if you'll excuse my being somewhat frivolous, I would say, don’t trust what anybody tells you, and above all, don't trust what you think yourself.
Dr. Stevenson: Do you think that all medical historians should be generalists of the kind you describe?
Dr. Temkin: Oh, no. I think the term "historical generalist” really, if I may express myself somewhat strongly, is an abomination before the lord.
Neither Sukoff nor Sigerest were "specialists,” nor have I ever considered myself a "specialist."
I think it was my friend Adelstein who once connected this term of "historical generalist.” I’m not talking about the medical practitioner, we sometimes call the generalists, the historical generalists.
With our age of specialization, everybody has to specialize, and therefore there has to be somebody who specializes in not specializing, and that's the generalist.
Dr. Stevenson: Well, we seem to be close to the question of the usefulness of medical history, on which you wrote a paper way back in 1946. How does what you just said fit with what you said then, thirty-odd years ago?
Dr. Temkin: Well, of course, that was a long time ago and I don't vouch for believing in every little detail of what I said, but by and large,
I think I would still stick to what I said in 1946, but I would now, perhaps, try to see the usefulness of medical history for medicine under three broad categories.
One, which is familiar to all of us, that is to say, since medicine is not a strict system, the historical approach can keep together the various fragments of which the science and the art of medicine consist.
That is of educational use, in the classroom, above all.
And so is the second, that is to say, to strengthen the humanistic picture of man above supplementing the scientific picture of man which a student obtains during his medical course.
The third one is of more general significance, and I don't think I mentioned it, clearly at least, in 1946.
I would hope that the history of medicine can be the critic of medicine in the sense in which the history of literature provides criticism for literature, in the sense in which the history of art is useful for art, in the sense in which political history is useful for statecraft.
It does not mean helping or fortifying, it means criticism in a very objective sense, and I think that, if medical history is approached in a broad way, in which I sketched it, without undue specialization, it will serve this purpose best.
Dr. Stevenson: I think it would be a good thing if you could give us an example of the critical role.
Dr. Temkin: Well, I think a very easy example is given by the history of pharmacology, or, even more specifically, the history of drugs. Drugs have their history, obviously. They are invented or discovered under particular circumstances, their actions are known, or at least, very often, just empirically known.
This knowledge very often proves wrong, it has to be corrected. We know more, and sometimes even less about a drug than we knew before.
We have to study how often a drug was prescribed, how much it was prescribed, what indications there were for the use of the drug. And we have to read it up to our modern, present times and evaluate where we stand now with a drug, even a simple drug like aspirin is a good example.
Now, I think, here, very much can be done, and is still to be done. I tried to give an example once, in a short essay on the anti-syphillitic treatment before 1900, and Dr. [?] has enlarged on it, taking digitalis and some other drugs.
Not only is there much here to be done here in detail, but someday we may even understand why medicine in our own days is so drug-oriented, in contrast to Osler’s skepticism of drugs and even curative medicine altogether.
And Osler expressed himself in this way even as late as about 1900, when the period of therapeutic nihilism, and even therapeutic skepticism, had long passed and was no longer fashionable. What has happened in the meantime?
Dr. Stevenson: Well, all of this was over thirty years ago, and the situation has changed considerably since then. At that time, most medical historians were still physicians, and that is certainly no longer true, at least in the United States.
And you are suggesting a role for physicians who thought of medical history as their medical specialty, but you can't expect all of the medical historians in 1979 or 1980 to have the method of historians, but the aim of physicians, as you said in 1946.
Dr. Temkin: No, you're quite right. You are quite right. I have changed my attitude in this respect. I now believe, in this country, I don't want to speak for other countries, but in this country at least, the distinction between medical historians who come from medicine and medical historians who come not from medicine has become unfruitful, it has outlived itself.
I think we should not look at the degree which a man has, what we really should look at is where his special interest lies in the history of medicine, that is to say, towards what it is directed.
Now, with many, and probably largely those who come from medicine, it will be directed towards medicine, that is to say, it will be interested in medical problems.
With others, it might be quite different, it might be an interest in the cultural role of medicine, and so on. I do not think this exactly matters so much, what matters is that we have good people, and not that we survey the degrees they have.
Dr. Stevenson: I assume that you extend this liberality to those who do not share your approach to medical history, but have some quite different orientation.
Dr. Temkin: Well, may I ask this question? By simply reminding you of the famous anecdote about Frederick II, who said that in his realm, everybody could go to heaven in his own way.
Dr. Stevenson: You seem to be reluctant to formulate a program for the history of medicine and to specify tasks for the future. Am I right in that?
Dr. Temkin: Well, I have given you the historical analysis of drugs as an example of what might be done and what, in my opinion, would be a fruitful task;
however, it’s one thing to give an example and quite another thing to formulate programs for the future for everybody to follow.
Quite apart from my personal disinclination to play the prophet, I do not believe that this leads very far. I think that eventually all good people will find their own way, regardless of what they hear the prophet say.
Dr. Stevenson: What you're saying recalls the story that Johns Hopkins students used to tell about Professor Franklin Mall, and it is said that his young wife asked for his advice about how-to bathe the baby, and, according to the story, he replied that you simply put the baby in the bath and let it work out its own technique.
Dr. Temkin: [Laughter] That of course is a wonderful story and it shows Dr. Mall’s approach to teaching, and some people think that it had bad results, and others think it had wonderful results, but I am not Dr. Mall and I don't think that. But I, of course, the medical historical [?] has to be helped, and has to be aided.
And I think what you can't do or what I can’t do, or could do, I have now to speak in the past, was to do two things. One is really something very passive, something Dr. Sigerest always emphasized.
He said his main role was to document to the students what he did and then let them learn from it. I think, whether he wants it or not, the teacher has to exhibit himself for better or for worse.
And I am not yet sure that the features which the student does not like in his teacher may not sometimes be more fruitful than the ones which he imitates. Now the other task, the other thing, which a teacher in my opinion has to do, is something much more active.
He has to see to it that his pupil is put in command of the tools of medical history, that he's taught the craftsmanship of medical history, and I think therefore, although I knew that many of my pupils would later on study fields which I had not cultivated; as a matter of fact,
I knew more or less from the very beginning that many of them would go into American medicine, which I never got around to work on, apart from one or two papers.
But, nevertheless, or just because of that, I may say, I insisted that they know something about other periods, and I tried to teach them the art of finding data and the art of interpretation, which is best learned from classical texts.
I am quite sure, I have no doubt and I had no doubt, that they sometimes, well, I hope they didn't exactly curse me, but they felt exasperated when, again and again, I came with these things which seemed to be so far away from their interests.
But I think I did the right thing, because if you master your craft, then I think you will be best equipped to do what is the right way for you.
Dr. Stevenson: Looking back over your 47 years of association with the Institute, would you like to sum up your experience?
Dr. Temkin: Well, I would only like to say that the time, the years I spent at the Institute were very happy ones for my work and for me, that I owe much and am deeply grateful to the Johns Hopkins University which provided me with all these wonderful opportunities I had in doing research and in teaching.
And I would like to express the hope that the next fifty years in the life of the institute also will be prosperous and productive ones.
Dr. Stevenson: Thank you very much, Dr. Temkin.
[Music]
[Owsei Temkin, M.D., William H. Welch Professor Emeritus History of Medicine, Johns Hopkins University, March 1979]
[Interviewed by: Lloyd G. Stevenson, M.D., PhD, William H. Welch Professor History of Medicine, Johns Hopkins University]
[A National Medical Audiovisual Center Production]
[In cooperation with Alpha Omega Alpha National Honor Medical Society]
[Leaders in American Medicine]