Writing medical history for a wider audience

Author Sandra Hempel offers tips to newcomers and a few to more experienced writers

The history of medicine is fertile ground for writers. It offers us a wonderful mix of discoveries, controversies, mysteries and characters, and all of this against a background of life and death. The writer doesn’t have to look far for tales to tell.

And if this sounds more like a list of ingredients for a popular thriller than for a serious, research-based piece of work, I would argue that the two genres have much more in common than might at first appear. Or at least they should if the writer is doing his or her job.

My first two books are both fast-paced narratives, in one case with a quest at its core, and in the other, a murder. However, both involved a huge amount of research among primary sources, as well as dialogues with academics, in order to ensure that both the science and the narratives were informative and correct.

The starting point for any material is always the question: Who are you writing for? Inexperienced authors sometimes write the piece that they want to write, in the style and to the length that they choose, and then submit to an editor or publisher. That rarely works.

Before you invest time and effort, however, look carefully at the publication that you have in mind or at what the book-buying public is currently reading. Check first that the journal or magazine even accepts readers’ contributions – not all do – and then ask if your idea is of interest. Some publications have guidelines on their websites describing the type of material they are looking for and giving helpful details such as word counts.

Physician and medical reformer Thomas Percival from Warrington, Lancs.

Don’t confine yourself to national publications. Try the county magazine and the local paper as well as the history society and community association newsletters. If you can find a subject with a local angle, then you will vastly improve your chances.

Is there a local historical figure who did some interesting work? Was there an outbreak of disease in the past that the doctors struggled to control? What about a trial where the medical evidence played a key role?

Now, of course, the internet offers new outlets such as blogging and self-publishing where you are free to write whatever you want without having to go through an intermediary. Even so, you still have to engage your readers if you hope to reach an audience.

Sandra Hempel is an author, editor and tutor running courses in writing. She has written for a wide range of national newspapers and specialist medical journals including The Lancet. She has published three books on the history of medicine. For more information, contact Sandra at www.sandrahempel.co.uk




Pioneering cardiac surgery in Sheffield

Will Parker describes the work of a pioneer of cardiac surgery, Judson Chesterman.

The first mitral valve replacement is generally credited to Nina Braunwald (1928-1992) in March 1960, the patient surviving for around 4 months. The first Starr-Edwards caged ball valve followed in the same year and the procedure subsequently became widespread. There is good reason, however, to believe that the first operation of this kind was carried out in 1955 at Sheffield’s City General (now Northern General) Hospital by Judson T. Chesterman (1903-1987, Figure 1).

Chesterman studied at Bristol but settled in Sheffield, where his great-grandfather had set up a prominent engineering firm. He developed a practice in cardiothoracic surgery, performing over 100 heart operations a year by the 1950s. However, many cases of heart valve disease, including those resulting from regurgitation (leaking) rather than stenosis (narrowing), remained inoperable and often fatal.

Charles Hufnagel (1916-1989) of Washington D.C. had reported the implantation of an artificial valve for aortic regurgitation in 1954. Chesterman began designing artificial valves, but focussed on the more difficult problem of replacing the mitral valve, the most commonly affected by then-common rheumatic fever.

Initially working with copper prototypes, these evolved into refined Perspex creations. The hospital pathology technician, Clifford Lambourne, turned the valves, consisting of an oval double-flanged ring in which sat a tethered disc, on a huge lathe (Figure 2). Lambourne told the hospital newspaper years later: ‘Turning left a roughish surface and it had to be smooth…My wife and I were keen cinema-goers. We sat in the cinema, watching films, me with a piece of silk cloth in my hands, polishing the pieces…It took about three feature length films to get the valve smooth enough.’

On 22 July 1955, Chesterman implanted the prosthesis into a 34-year-old man with end-stage mitral valve disease. Lacking cardiopulmonary bypass, he cooled the patient, cross-clamped the vena cavae then quickly performed the operation.

Though acutely successful, as Chesterman later wrote: ‘He read the evening paper and was comfortable at night when I last saw him. He was found dead in the night at about 3.30 am.’ The valve had dislocated. Retrieved at post-mortem examination, it still exists. (Figure 3)

Chesterman realised cardiopulmonary bypass would be key to further procedures of this kind. He subsequently visited Walton Lillehei and Richard De Wall in the US, who had developed the pump oxygenator. Chesterman went on to build and use his own machine in Sheffield on 26 February 1957, one of the first outside America to do so. (Figure 4) 

As well as technological contributions, Chesterman’s legacy includes the subsequent flourishing of a cardiothoracic unit in Sheffield, now housed in the Chesterman Wing at the Northern General Hospital. In addition, he had an interest in archaeology and, after retiring from clinical practice, he  founded the University of Sheffield Osteology Laboratory. 

Further reading:Continue reading

The patient: from neglected factor to media star

Is the patient a case, a body or a partner with power? Christine Gowing looks at the changing perspective in medical history.

Nursing Times, 22 March 1988,

In 1945 the patient voice was merely a distant echo. That year the medical historian Douglas Guthrie published a paper The Patient: a neglected factor in the history of medicine[1], arguing that the patient’s part in the march of medical progress had long been missing while attention had been devoted to the achievements of science and physicians.

The history of medicine was the history of doctors, or, as Roy Porter put it, ‘a history from above and populated with heroes.’[2]  It was only in the 1960s and 1970s that historians began to look at how wider sociological contexts – social, cultural, professional and economic frameworks – influenced medicine’s history.[3]

But how culpable are we still as medical historians when we push the patient out of the narrative?

The presence of patients throughout history has often been denied, simply due to lack of information about them – and at what point did patients anyway emerge with any significance or autonomy in the doctor-patient encounter?

The historian Edward Shorter blamed the science of healing in the 1940s and 50s for overwhelming the art of healing[4], extending Foucault’s claim that clinical medicine was responsible for depersonalisation and the sidelining of the patient.[5]

The patient contributes

It was psychoanalyst Michael Balint’s work in the 1950s that first recognised and encouraged the emergence of the patient in the medical consultation.[6] Balint’s psychodynamic analysis and his understanding of the patient’s contribution enhanced the consultation as a therapeutic tool. Increasingly accepted, this approach encouraged the involvement of patients in the management of their condition, although in the 1980s, medical ethicist Jay Katz would still argue that the doctor-patient power relationship was impacting patients’ decision-making.[7]

And nurses’ relationship with patients? It may be a surprise to hear that it was only in 1962 that nursing training formally recognised the importance of this relationship by including an element on the topic for the first time in the training syllabus.[8]

But now we find the patient as a media star. Remember the momentous day of the first Covid-19 vaccination (outside of a trial) on 8 December 2020? What a victory for science and medical research, for the extraordinary work of the laboratory teams in developing the vaccine and giving hope to a pandemic-torn world. 

However, the image that we probably recall most vividly on that day – and the one that dominated the media throughout the world – was of the first vaccinated patient, 90-year old Maggie Keenan.  On 9 December 2020, the Daily Express exclaimed:


On the same day, the Metro showed an image of nurses providing a guard of honour as she left the vaccination clinic. What we remember in the future when recounting the narrative of Covid-19 – along with the triumph of science and physicians – may be the image of Maggie. 

A named patient placed at centre stage.

Christine Gowing has an MA in the history of medicine with research on 18th and 19th century electrotherapy. She later gained a PhD in the history of the relationship between complementary and alternative medicine (CAM) and biomedicine. The development of the therapeutic alliance in healthcare is a particular interest.


[1] Guthrie, D., A History of Medicine(1945).

[2] Porter, R. (ed), Patients and Practitioners (1985).

[3] Waddington, K., An Introduction to the Social History of Medicine: Europe since 1500 (2011).

[4] Shorter, E., Bedside Manners: the troubled history of doctors and patients (1985).

[5] Foucault, M., The Birth of the Clinic (1989).

[6] Balint, M., The Doctor, his Patient and the Illness (1957).

[7] Katz, J., The Silent World of Doctor and Patient (1984).).

[8] National Archives, Kew, London, General Nursing Council papers, confidential minute, Education and Examination Committee (7 September 1960), DT38/155.

‘Blitz Spirit’ in the Time of Pandemic

Frances Williams looks at the historic concept of ‘Blitz Spirit’ and its evocation during this period of pandemic

Themes of resilience and strength have been drawn from the Second World War and put to use in the current pandemic – including the psychological defence, ‘Blitz spirit’. Yet a risk is run when nostalgia distracts us from important differences between the past and present. They can further skew historical accuracy, too.

Health Secretary Matt Hancock stated in early 2020: ‘Our generation has never been tested like this … Our grandparents were, during the Second World War, when our cities were bombed during the Blitz. Despite the pounding every night, the rationing, the loss of life, they pulled together in one gigantic national effort.’

Working directly with the older generation, palliative care doctor, Rachel Clarke (@doctor_oxford) said they certainly seemed to have taken the ‘Blitz spirit’ to heart, thinking themselves stoic and resilient. Dangerously – and sometimes tragically so – some of over 70s weren’t washing their hands or taking lockdown measures seriously enough, even though the pandemic deaths were mostly among their own age group.

(Photo: Aldwich Tube station 1940, Imperial War Museum)

Historical dispute

The ‘Blitz spirit’ has always been a disputed phenomenon, reflecting contested post-war histories of ‘morale’. Certainly, in the lead-up to war, the government was worried about the likelihood of ‘bomb neurosis’, a form of shell shock that civilian populations might suffer if subjected to prolonged bombing.

A new era of ‘total war’ fed a perception of the vulnerability of citizens to ‘knock out’ blows from the air, that might lead to febrile mental states. A network of specialist hospitals – called ‘neurosis clinics’ – was set up outside UK cities, but ultimately little used.

In his 2012 work, War on Fear: Solly Zuckerman and civilian nerve in the Second World War, Ian Burley cites a visiting commentator from the US who observed the British public’s capacity for ‘pluck’ and such outsider reflections were fed back to the public in the form of propaganda. A prominent psychologist of the day advocated biscuits and nips of whiskey to allay ‘nerves’ during bombing raids, reported by Edward Glover in 1940 in The Psychology of Fear and Courage.

Covid-19 spirit?

In her new book, Blitz Spirit: Voices of Britain Living Through Crisis, Rebecca Brown re-visits the ‘alleged phenomenon’ of the Blitz spirit, delving into diaries from The Mass Observation Archive, daily diaries kept by hundreds of people during the war. These cast fresh insight into our current pandemic, she proposes, because they show the nuance and diversity of everyday feeling.

Many popular descriptions of our of states of mind in lockdown now are anecdotal: a ‘corona coaster’ of high and low moods, sleeplessness and vivid ‘pandemic dreams’.  Speculations centre on how we might arrive at the right level of panic – especially given we get much of our information from internet sources of variable reliability.

Professor Nikolas Rose in Mental Health and Social Change in the Time of Covid-19 points out that the pandemic and the measures taken in response, such as severe restrictions to physical interactions and our daily routines, are discrete and separate. Added to this are widespread uncertainty and distress about the virus, loved ones, education, work and money. Increased anxiety and fear are normal in the circumstances. ‘We need be wary of rushing to frame them in terms of mental health,’ he warns.

As the NHS staff operate on ‘the front line’ of our current battle, it may be that they bear the longer term psychological cost – including diagnoses of PTSD – than the wider ‘civilian’ population on the ‘Home Front’. For now, these are speculations.

In the interim, it is important to consider the ways in which the pandemic is not like a war, and the risk that ‘nostalgic framings’ might distract us from our own mistakes, as says Martha Lincoln in her blog On Memorys Battlefield: The Pandemic as Our Next Forgotten War (2021).

Frances Williams completed her PhD in arts, health and devolution in 2019 and is currently Visiting Researcher at Glyndwr University.

Further reading

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Andreas Vesalius (1514-1564) – the greatest anatomist that ever was?

For me, any mention of anatomy conjures up memories of the hours spent during medical school in the Dissection Room, overpowered by the smell of formaldehyde, trying in vain to orientate myself with more than a little help from Gray’s Anatomy for Students. I remember being constantly told that whole-body dissection was a privilege, and not something that was offered by all medical schools. But sometimes I wondered, when did anatomy become such a fundamental component of a medical education, and why?

The answer I feel, lies with a certain character from the sixteenth century: Andreas Vesalius (1514-1564).


Born in Brussels in the early sixteenth century, Vesalius was the son of the apothecary to the Holy Roman Emperor. He became influenced by medicine at an early age and chose to pursue a career as a physician. Vesalius is renowned both for his skill as an anatomist and for his crucial role in elevating the status of the discipline of anatomy: he, more than any other individual, established it as an elementary component of a medical education.

Investigation into the field of anatomy before Vesalius was limited. There had been plenty of animal dissection: Aristotle’s extensive work on the classification of living things from the fourth century B.C. is probably the best example here. However, evidence of human dissection before the sixteenth century is sparse. There was a brief period in the third century B.C. when Herophilus of Chalcedon and Erasistratsus of Cos had carried out human dissections but enthusiasm for this practice was short-lived and it was soon prohibited due to the pressure of public opinion – Egyptians believed in the need of an intact body for the afterlife.

It was not until the twelfth century that there was a revival in interest in the field of human anatomy. At this time, ancient Greek physician and philosopher Claudius Galen was still regarded as the reference point in terms of human anatomy. However, Galen did many of his studies on animals and consequently some of his observations relating to the ‘human’ body were in fact false. Despite this, Galen’s writings had been accepted as scripture and had not been questioned… until Vesalius came along.

Vesalius’ greatest achievement in my mind was his book, De humani corporis Fabrica (‘On the Fabric of the Human Body’): the first complete account of human anatomy. This work was impressive in its content – it corrected many of Galen’s previous mistakes and errors – but more importantly, in what it represented in the wider field of medicine and medical education.

The Fabrica took Vesalius four years to complete but he was an absolute perfectionist. Extensive correspondence between Vesalius and his publisher demonstrates how he stipulated exactly how the Fabrica was to be set out, which drawings were to be included and how the various parts of the anatomy should be labelled. The Fabrica is beautifully illustrated and enormously detailed: a salute to Vesalius’ meticulous care and attention.

The Fabrica generated an anatomical revolution. Anatomy used to be stigmatised as the poor relation of surgery, but the Fabrica helped assert it as an integral component of medicine. Finally, anatomy was being recognised as a great skill, and the humble anatomist was being duly applauded.

Something that Vesalius emphasised in the Fabrica is the importance of observation and ‘seeing for oneself’. He was adamant that medical students learnt best by picking up a scalpel themselves rather than just reading a book or learning by rote. Vesalius himself refused to have a ‘cutter’ – an assistant who would perform the dissection for him. Instead, Vesalius did the dissection himself, surrounded by mesmerised students, and lectured as he went. This is wonderfully illustrated on the frontispiece of the Fabrica: on the left hand side of the exposed cadaver is Vesalius, pointing out the various abdominal contents, getting his hands dirty! Students surround Vesalius, clamouring to get to the front, eager to see the great anatomist at work.

Image 1: Frontispiece, Vesalius, De Humani corporis fabrica libri septem. Credit: Wellcome Collection. CC BY


Ultimately, by the end of the sixteenth century, Vesalius had surpassed Galen as the primary anatomical authority. He is thought of as one of the great innovators of anatomy, not because he discovered anything radically new, but because he altered the way in which the medical community thought about and practised anatomy. Vesalius’ work inspired and influenced budding anatomists and there were rapid advances in practical anatomy after his death. Realdo Columbo’s work on the heartbeat and pulmonary transit is one such example, and this proved vital in William Harvey’s later work on the circulation of blood.

So, to all those medical students out there, when you are next in the DR at the end of a long morning, more concerned about your mounting hunger than the insertion point of iliopsoas, take a moment to remember Vesalius: the greatest anatomist that ever was.


Lucy Havard



Further Reading

  • ‘Andreas Vesalius’, Science Museum (online). Available at: http://broughttolife.sciencemuseum.org.uk/broughttolife/people/andreasvesalius
  • ‘Vesalius’ Renaissance anatomy lessons’, British Library (online). Available at: https://www.bl.uk/learning/cult/bodies/vesalius/renaissance.html
  • Vivian Nutton, Ancient Medicine. Routledge: London, 2012.