Friday, March 09, 2007

Irish medicine

If it's Friday, it must be time for history of medicine class! Today's lecture was given to the second-year students by Eran Klein, M.D., OHSU neurology resident. Dr. Klein, being himself of Irish ancestry, was eager to discuss 19th-century Irish medicine and to make his case for why Ireland might have been the site for the transition from 19th-century medicine to modern medicine.

Klein began by describing the national characteristics of medicine in France (development of hospitals, use of autopsies, refinement of the physical examination), Britain (decentralized systems of education and health care, entrepreneurialism), and Germany (development of universities, emphasis on laboratory sciences, bedside teaching from Boerhaave). He then set about to show how Irish physicians combined elements from each of these approaches into the precursor of today's medical system.

Exhibit A is Robert Graves (1796-1853), who is best known for his description, in 1835, of what is now called Graves' Disease. Graves (who also described peripheral neuropathy, scleroderma, and pontine hemorrhage) set up a system of "clinical clerks" in Ireland, taking from the Germans the idea of bedside teaching. In his textbook, Clinical lectures on the practice of medicine, Graves laid out a plan that seems nearly identical to our modern methods of clinical exposure in the third and fourth years of medical education.

Exhibit B is William Stokes (1804-1878) who was an early adopter of the French stethoscope, and used the new device to describe several important cardiovascular conditions. Both Stokes and Graves had been educated first in England, and then in medical centers throughout Europe; their particular genius, according to Klein, was to combine the best of these teachings to create a vibrant medical community back home in Ireland.

By the end of the 19th century, Irish medicine was in decline, probably (opines Klein) because the country itself was relatively poor compared to its neighbors. While it is hard to quantify Irish medicine's influence on later developments, four noteworthy students of Irish medicine went on to establish their own spheres of influence: Alfred Stille and William Gibson in Philadelphia, and James Bovell and Campbell P. Howard in Canada (under whom William Osler later studied).

So, as you celebrate St. Patrick's Day this year, make an extra toast to Stokes and Graves, who may very well have been responsible for the quality of the medical care you receive today!

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