Writing Early Modern Medicine for Medical Readers

Poison trials on dogs conducted by Landgrave Wilhelm IV of Hesse-Kassel in 1580. Universitätsbibliothek Heidelberg, Cod. Pal. germ. 177
Poison trials on dogs conducted by Landgrave Wilhelm IV of Hesse-Kassel in 1580. Universitätsbibliothek Heidelberg, Cod. Pal. germ. 177

By Alisha Rankin

Years ago, in a recipe collection belonging to Countess Elisabeth of the Palatinate (1552-90), I found a fascinating entry: a copy of an official document that described trials of a poison antidote on dogs, which I described in a post on this blog. My interest in that document has expanded into an entire book project on poison trials. Because these trials feel vaguely like an antecedent to modern clinical trials (with many twists and turns along the way), I’ve found that this project has provided an exciting opportunity to introduce early modern medicine to a medical audience. Last month Justin Rivest and I had the privilege of publishing a short piece, “Medicine, Monopoly, and the Pre-Modern State: Early Clinical Trials,” in the New England Journal of Medicine. Just a few days later, I published a blog post titled “Poison Trials on Condemned Criminals under Pope Clement VII: A Medical and Moral Testimonial” for the Sperimento blog, run by the Medici Archive Project. The juxtaposition of these two pieces, of similar length and on similar topics but in two very different venues, led me to reflect on writing history for non-experts, and on how different it is to write for doctors than for historians. Because the Recipes Project blog intends to reach a wide audience, I thought it might be interesting to jot down some thoughts on the experience here.

Testimonium de verissima ac admirabili virtute olei compositi contra pestem & omnia venena (Rome, 1524), BNF.
Testimonium de verissima ac admirabili virtute olei compositi contra pestem & omnia venena (Rome, 1524), BNF.

Writing the Sperimento piece felt very familiar. The blog is intended to introduce a specific document in early modern Italian science and/or medicine, so I picked a Latin pamphlet published in 1524 on the authority of Pope Clement VII. The pamphlet described three poison trials conducted on condemned criminals and was intended to show the wondrous workings of an antidote oil created by a surgeon named Gregorio Caravita. I reflected on the religious and moral undertones of the document, and I included several footnotes with the original Latin. It was a pretty typical blog piece – fun to work on and quite helpful to write, as it forced me to sit down and meticulously make my way through the pamphlet. (I had hoped to find a recipe for the oil at the end of the pamphlet, but sadly the recipe remained Caravita’s secret – although Jo Wheeler included a later Medici version in his book.)

The NEJM piece, on the other hand, was far harder. We had to plan the article out very carefully. The word limit was officially 1,200 (although they happily ended up being a little flexible!), and it needed a lot of framing on each end. Justin is an expert in seventeenth- and eighteenth-century France, and I was highlighting work from sixteenth-century Germany. That left each of us just a couple of short paragraphs to present our case from our own research and to tie everything together. This is apparently the first time the NEJM has published a piece on early modern medicine, so we tried our best to make it fit into categories that medical readers would find familiar. That meant keeping modern medicine as the standard against which we compared our historical case. It also – helpfully – forced Justin and me to come up with a coherent narrative over a long period of time.

The hardest part – for me at least – was the footnotes. The journal allowed only five references, which was very hard for two historians with two completely different sets of research that drew on archives as well as printed sources. Justin and I worked and worked to get it down to the requisite number and felt pretty good about the result. Then the peer reviews came back – and the editor clarified that five references meant individual references, not footnotes. Because some of our footnotes contained multiple sources, we had to cut out an additional six references. Uff. We simply had to give up on documenting everything, and I learned how uncomfortable that made me. Would historians think that the article was shoddily researched? Maybe, but I kept reminding myself that historians were not the main audience, an important distinction when I had to choose between my archive and an important English-language journal article. Were I writing for historians, I almost certainly would have picked the archive, to show all the great (hard!) research I’d done. In this case, I went with the article, on the theory that an interested reader could follow up with it more easily.

The fun part of writing for the NEJM was thinking about how to make early modern medicine seem something other than “wrong.” We went for the basic takeaway point that trials (even in a very, very early form) have been used to assess drugs for a really long time. I also did a short podcast with the journal, to expand on certain points. I didn’t have the questions in advance, and I couldn’t help but cringe a bit when the interviewer straightforwardly referred to our historical actors as “scientists” and “researchers,” but in some ways that was validating, as it suggested he was treating our subject with respect.

A truly interesting coda was what happened afterwards. Both the NEJM article and the Sperimento post made the rounds on social media. Interestingly, the latter appears to have been of more interest to early modernists, at least judging by the re-tweets I saw on my Twitter feed (perhaps those footnotes mattered after all!). The NEJM piece, in contrast, really did reach physicians. While we did not receive any major press attention, Tweets came literally from all over the world. Looking at this metrics map of where the article was read was really fascinating:

NEJM page views

I hadn’t quite thought about how far-reaching a top medical journal is – that short essay may well be the most widely read thing I ever write. Most gratifyingly, I received a lovely e-mail from a former student – now a doctor – who was delighted to see his old professor pop up in an unexpected place. But overall, the consensus from Twitter appeared to be “Wow! I had no idea that people were testing drugs that early!” In some ways, that is exactly why we do public history – to make people look at the past a little bit differently and, hopefully, to put modern trends in context. Being forced out of your comfort zone (footnotes!) also makes you think carefully about what message you really want to share. And of course readers of this blog will not be surprised to learn that recipes can lead you to all sorts of unexpected places!

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