gms | German Medical Science

Maike Rotzoll, Marion Hulverscheidt (Hrsg):

Nie geschehen. Schreiben über die Pest. Texte aus einem medizinhistorischen Lehrexperiment

Centaurus Verlag & Media KG

year of publication: 2011, 227 pages, € 19,80

Creative Writing in medical history, where are the chances? And what is the learning effect? Questions Maike Rotzoll and Marion Hulverscheidt try to answer with their anthology “Nie geschehen. Schreiben über die Pest”, subtitled: „Texte aus einem medizinhistorischen Lehrexperiment“ („Texts from a medical historic teaching experiment.“) Following a classic experiment, the work opens with a methodical “test arrangement” as introduction:

In the context of education in medical history for the course “Geschichte, Theorie und Ethik der Medizin” (“History, Theory and Ethics of Medicine”) medical students in Berlin, Heidelberg and Munich wrote faction about the plague as a performance record. Thus forming historic facts into expressive fiction. Previously the editors conducted student tutorials to gather knowledge from sources about epidemic history in different eras. Texts derived from the seminars are arranged in four chapters, following the historic classification of the selected sources and secondary literature. Direct references are not part of the faction texts, however the cumulative impression and ambitious combination of fact and fiction in the articles reveal the used literature. Nevertheless, to constitute transparency and to allow a differentiated judgement, texts were thoroughly reviewed and annotated by recognized experts.

First chapter, entitled “Antike” (“ancient world”), covers the plague in Athens around 430 B.C. and Constantinople 542 AD. Initial reading already shows the students variety and creativity in terms of choice of perspective and forms of report. From the point of view of a spartan spy, letter-reports and epic poetry in perfect hexametric verses, the reader gains detailed and colourful insight into “plague” breakout, it’s symptoms and impact on society and living.

Articles of the second chapter are devoted to descriptions of plague in late medieval Italy around 1348, using contemporary reports of Boccaccio and Petrarca as sources.

Particularly their narrations of social structures breaking apart, up to the extinction of whole families and medical perplexity in the quest for a remedy, influence the students articles.

Reports on 17^th and 18^th century plague epidemics complete the circle and lead to the modern era. Narrations on research and discovery of the pathogen, told from the perspective of important protagonists such as Yersin and Kitasato as well as changes in hygienic understanding finally lead to sinister end time pictures of new, irrepressible modern plague breakouts.

With their teaching experiment the editors take up a question emerged from reformations of the approbation order in 2003/2004 and the establishment of the new field “History, Theory and Ethics of Medicine”: How can education in medical history be clear, understandable and achieve the requirement to “convey the mental, historical and ethical basics of a physicians behaviour”? [1]

Maike Rotzoll’s and Marion Hulverscheidt’s teaching project provides answers in several respects:

The conversion of historical facts into fictional texts demands prior intensive work on the corresponding sources. Compared to the underlying primary literature the present articles reflect plenty of new arranged and in this way reinterpreted details.

At the same time, involving in medical history can encourage critical reflection on today’s medical practice, notably illustrated by the faction articles in “Modern Age“ entitled chapter four. So, for instance, reading faction with aspects on governmental handling of epidemic hygiene brings the recent swine flu hysteria up to mind.

In the last years techniques of creative writing have progressively found their way even into scientific fields. Methods of “reflective-“ or “point-of-view-writing” have been integrated into curricula for medical students - especially in the angloamerican region - and aim on the competence to change perspectives in the physician-patient encounter and by this means on reflection of the own medical practice as a basic principle for empathy and a better understanding of the patients experiences.

Precisely this opportunity in changing perspectives is offered by the fictional reinvigoration of historic sources in this teaching project.

Manfred Horstmanshoff, Professor of the History of Ancient Medicine at the University of Leiden and himself contributor of a faction-text to this book writes about this technique: „Faction is an exercise in historic understanding, going one step further than mere observance and writing. For me it appears to be an excellent training to those physicians interested in ‘narrative based medicine’. A medicine that chooses the patient’s life story as a basis for his treatment.” (p.52, Translation: CK).

Communication and narrative skills have always been a core competence for physicians in the doctor-patient relationship. A physician aimed to diagnose his patient’s disease should be capable of interpreting his illness- and life-narratives. Therefore integration of creative writing and literature into medical education appears to be meaningful because interpretation of narratives in medicine and literature are in this way comparable processes and a good training.

The question in what extent history may be openly narrated and therefore be literature and consequently art, or just the purpose of an objective scientific analysis, has been argued for a long time. However, as the editors conclude, the premise of this clearly represented teaching experiment was not to educate medical students as professional authors or historians but rather to show them a creative access to innovative and intensive work on medical historic sources.

After reading 26 faction articles one can notice: The experiment was successful.

Skilfully the reader is guided through the different eras of plague related medical-scientific history and gains a structured view, starting from magic-animist and respectively divine thinking to miasma-doctrine up to detection of the pathogen and current implications of epidemics today.

Maike Rotzoll’s and Marion Hulverscheidt’s book (both physicians and medical historians with teaching experience in Heidelberg and Berlin) is didactically as well as scientifically well grounded. Not only informative and entertaining this work can also be understood as a reference book for a new and meaningful way of teaching. It addresses students, readers with medical historic interest and particularly tutors in the history of medicine, science and technology and should be seized as suggestion to implement medical historic education practical and drawn from life.

The author declares that he has no competing interests.