History and Historiography of Nephrology

The Encyclopedia Britannica defines “the writing of history, especially the writing of history based on the critical examination of sources, the selection of particular details from the authentic materials in those sources, and the synthesis of those details into a narrative that stands the test of critical examination. The term historiography also refers to the theory and history of historical writing”. The entry goes on to explain that “Modern historians aim to reconstruct a record of human activities and to achieve a more profound understanding of them. This conception of their task is quite recent, dating from the development in the late 18^th and early 19^th centuries of “scientific” history and the simultaneous rise of history as an academic profession. It springs from an outlook that is very new in human experience: the assumption that the study of history is a natural, inevitable human activity”.

 

On history and historiography

We may start with a definition of history, given by the Byzantine princess Anna Comnena in the 11^th century: “Time in its irresistible and ceaseless flow carries along on its flood all created things, and drowns them in the depths of obscurity, no matter if they be quite unworthy of mention, or most noteworthy and important, and thus, as the tragedian says, he brings from the darkness all things in the birth, and all things born envelops in the night”. But the tale of history forms a very strong bulwark against the stream of time, and to some extent checks its irresistible flow, and, of all things done in it, as many as history has taken over, it secures and binds together, and does not allow them to slip away into the abyss of oblivion” (1).

In a recent publication, Giuseppe Galasso (1929-2018), Emeritus Professor of Contemporary History at the University Federico II in Naples and a member of the Lynx Academy in Rome, raises fundamental questions about history and historiography (2). The first is about the meaning of crisis in history. “The historical meaning of a crisis is that of a never-ending process. When a history ends, another history begins. In history nothing of the seeds that bloomed is lost”. It is forever. Galasso states that “Historia is not just a colloquium or meeting of historians and or other experts to answer questions in social, moral and cultural life”. He asks “What shall be the attitude towards a peculiar Italian tradition which impresses on the historical work and to the whole social life the mark of the individuality? This approach confers singularity and responsibility to an individual work and stresses the importance of the work of each single person and their output”. “History is memory of men, times, things, quae alteri seculo prosint (for future reference). Thus, history has a value per se. There is no room for discussion of its utility or excessive use”.

In addition, we should not forget that “among components of historical work, the ideas of the historians have a role” (3). Thus “History is not magistra vitae (teacher of life), but memory and interpretation of the individual and as collective biography it is a pre-requisite for those with identity. History is made of events, however events enlighten the past that cannot be deducted (4).

Galasso, as many active historians of nephrology who contributed to this supplement of Giornale Italiano di Nefrologia (GIN), does not believe in the existence of two cultures. “The thinking man is the maker of history. It is not important if he writes about chemistry, physics, biological or medical science, philosophy or social science, mathematics, geometry, law, economy and historiography” (2-4). The French historian and academician Pierre Nora, commenting on historiography, points out that “The way is opened to another history, no longer the determinants, but their effects, no longer memorized or commemorated actions, but the traces of these actions and the play of these commemorations, no longer events as they are, but their construction over time, the disappearance and resurgence of their meanings. No longer the past as it passed but its subsequent reuse; no longer the tradition, but the ways it was built and the mode of its transmission” (5).

In La Mémoire, l’Histoire, l’Oubli (Paris, Seuil 2000) written with the editorial assistance of Emmanuel Macron, the French philosopher Paul Ricoeur (1913-2005) supports the notion that memory is truth, and is capable to rebuild truth. Memory “drives to recognition. Then we perceive and know that something happened, that something took place in which we have participated as actors, patients or testimonies (…). Memory has the ambition, and claims to be faithful to the past. However, memory carries the risk of abuse”.

There is no methodological difference in writing the historiography of human history and that of sciences, including medicine. As a matter of fact, we the historians of nephrology, did not find differences in methodology in the writings about the heavens of the Greek astronomer Aristarchus of Samos (ca. 310 BC-230 BC) and of the Interpretation of Dreams of the Greek diviner Artemidorus of Ephesus (2^nd century AD). However, in writing on science and/or medicine there should be less acquiescence to memory and facts should prevail over memory.

“Art and science are linked by their goals and by other many subtle similarities due to their methods. Artists and scientists try to shape the world around them. Both try to define it by means of works which are apparently disconnected and do not share links. However, both are driven by the identical wish to understand, to know,” wrote John C. Polanyi (b. 1929), the 1986 Nobel laureate for Chemistry (6). “Works of art are individual products of creativity which after having been completed cannot be modified. By contrast, scientific discoveries, although generated by individual creativity, immediately after completion are turned into a common patrimony and heritage. The creativity which drives the discoveries is not different from that which generates works of art. Einstein used to explain to his friends and fellows that his contribution to the concepts of space, time, energy and matter did not originate through experimental work or by calculations, rather―as he wrote to Karl Popper―through the play of invention stimulated by his childish capacity to be astonished, when he tried to deepen the ideas on space and time” (6).

 

History is evolution, research, archives and cyclical discontinuity

We now know that history is evolution and research as in Herodotus (484 BC- 430 BC), Thucydides (460 BC-395 BC) and in archives as in Titus Livius (509 BC-17 DC), Diodorus of Sicily (90 BC-30 BC), Polybius (200 BC-118 BC), Gaius Sallustius Crispus (86 BC-34 BC), and Tacitus (56 AD-112 AD). However, history is often cyclical discontinuity (Aristotle, Plato).

 

Facts to be turned into historical facts

In 1961, E. Hallett Carr (1892-1982) in his The Historian and his Facts” (7) introduced the concept that historians select the facts to be turned “into historical facts” due to a bias related to the method of selection. As a compromise, one accepts to turn history into “a continuous process of interaction between the historian and his facts, an unending dialogue between the past and the present”.

In The End of History, the political scientist Francis Fukuyama (b. 1952) pointed out that “we may be witness to the end of history as such, that is the end point of mankind’s ideological evolution and the universalism of Western liberal economy as the final form of government” (8, 9). However later he draws a mellower conclusion: “History is still going our ways” (10).

Let us come back to E. Hallett Carr’s The Historian and his Facts (7). It explores how historians make use of historical facts. Carr notes that in the 19th century, western historians held to an empirical, positivist worldview that revolved around a “cult of facts”, viewing historical facts as information that simply had to be assembled to produce an objective picture of the past that was entirely accurate and independent of any human opinion. He argued that this view is inherently flawed, because historians selectively choose which “facts of the past get into history”. It is precisely for matters of this kind that historians are entitled to rely on what has been called “the auxiliary sciences of history”.

 

History and historiography of nephrology

We started the History of Nephrology in the course of an international Conference in Naples and in Montecassino, Italy, on 28-31 October 1993. The first proceedings appeared in 1994 in the American Journal of Nephrology. The enthusiasm generated in those days encouraged the pioneers to develop a structure for the continuous development of the history of nephrology. This was the birth of The International Association for the History of Nephrology (IAHN) (11). More information can be obtained through IAHN website.

For our first formal congress as the IAHN on 14-16 October 1996, we moved to Kos, Greece, as homage to Hippocrates, the “acknowledged founder of clinical medicine, who lived and taught on that Island” (12). At that time, we envisaged our endeavor as “a report from an archaeological dig rather than a complete canvas of the history of nephrology”. We were well aware that “one could fault the process as being repetitive and antiquarian and out of tune with the recent changes that have already taking general history in the consideration of sociological, professional and technological influences that have shaped medicine in general and nephrology in particular” (13).

We also attempted “to study medicine in history with the goal of tracing a history of nephrology reflecting the advancement of culture by making full use of art and science, economics and philosophy, conquerors and destroyers, kings and statesmen, and of common people. This is a history where one can appreciate the great figures. Those we call giants, those who according to Bernard of Chartres have “given us their shoulders so we can see further and further”. We were aware that we were working to develop a new discipline and that “disciplines (a word derived from the Latin disciplina) are not born in order to reach eternity and can die. To survive they and we are forced to continue to excavate and to identify new niches in order to claim recognition of originality. The history of the kidney, seen thus, is not at variance from other specialties, and represents what mathematicians define as fractal. Boundary regions and exchange zones are vaster and more complex than internal regions. The biographical method allows the possibility of making full use of letters that investigators exchanged with their contemporaries and identifying the academies where they were invited to present, discuss and publish their contributions and to become honorary members” (14).

Our task as stated by one of the founding members of the IAHN “… medical school represents only a short period of 4 years in the life span of a physician. […] Medical societies should step in to fill this gap (teaching the history of the profession), as should subspecialty societies. They should assume the lead in the continued medical education of their membership. That can only be to their own advantage, as reflected in the words of August Comte (1798-1857), the founder of modern sociology, “To understand a science it is necessary to know its history”. That has been the raison d’être of the International Association for the History of Nephrology (IAHN) founded in 1994 to encourage the exploration and dissemination of the history of nephrology” (15).

Have we been objective in our work? Herodotus warned “bits of the story are yet untold, and that what has been told comes tainted by the conditions of what we are to day “. Plutarch elaborated further “So is it very difficult to trace and find out the truth of anything by history, when, on the one hand, those who write it afterwards find long periods intercepting their view, and, on the other, the contemporary records of any actions and lives, partly through envy and ill-will, partly through favour and flattery, pervert and distort truth” (16). This urge for accuracy may be characterized as pedantic, as indicated by Thucydides “Most people, in fact, will not take the trouble in finding out the truth, but are much more inclined to accept the first story they hear” (17). Moreover, historical truth is never definite and unchangeable. “History is the study of the human past as it is described in the written documents left by human beings. The past, with all its decisions completed, its participants dead and its history told, is what the general public perceives as the immutable bedrock on which we historians and archaeologists stand. But as purveyors of the past, we recognize that the bedrock is really quicksand, that bits of the story are yet untold, and that what has been told comes tainted by the conditions of what we are today” (18).

Most of us write the history of nephrology by taking into account our own concepts of the current state of nephrology worldwide and as perceived from our own local and regional history of nephrology. Our reports are thus the product of our view of the past, seen through our own lens, reflecting our personal characters as the model used to recall the creators of the past.

 

Conclusion

In 1991, Charles R. King published a masterpiece, The Historiography of Medical History: From Great Men to Archaeologists (19) showing that the writing of medical history in the 20^th century has paralleled the historiography of general history. To quote, “Historiography, that is the history of medical history, began as the history of “great men”, then became historicism, and recently has emphasized social and intellectual interpretations of history. It is timely to consider medical historiography, because recent writings on medical history have failed to discuss the aspect of historical interpretation. This paper considers four understandings of the historiography of medical history and emphasizes the work of a major historian of each school: the history of “great men,” the narrative creation of the past based on a description of the deeds and lives of great men, as illustrated in the work of Fielding H. Garrison; historicism, the view that the study of history can lead to the discovery of general laws of social development that may be used to predict future events, as demonstrated in the work of Owsei Temkin; social history, historical writing that concentrates on social groups, their interrelationships, and their roles in economic and cultural structures and processes, as found in the writings of Henry Sigerist. Intellectual history, the comprehensive historical study of ideas, including not only the history of articulate thought but consciousness in general, for example, inarticulate assumptions, unstated beliefs and presuppositions, implicit opinions, feelings, states of mind, and collective mental processes, as demonstrated in the writing of Michel Foucault”(19).

His conclusion was that “The history of medicine is always written from the basis of the historian. Contemporary historiography provides an understanding of the major methods of historical analysis and their influences on the writing of medical history. Medical history in the 20^th century has emphasized the historiographic methods of the history of great men, historicism, social history, and intellectual history. Each methodology has inherent biases that influence the historian’s analysis of the past. Understanding the historian’s biases provides the reader important tools for the interpretation of medical history” (19).

Looking at the work accomplished by IAHN’s members in the historiography of nephrology in the years 1993-2016 we see the adequacy of methodology employed, the giants of the discipline, the progress of the academies and the cultural social and economic life. This richness will be of great advantage in the years to come. There were talents, curiosity, a capacity for asking questions, appropriate selection of wiring models and careful scrutiny of the topics. Since the history of nephrology is not yet a discipline, nor is it taught in postgraduate courses of nephrology, it reflects the general aspiration of scientists to be recognised as cultured.

References

1. Anna Comnena. In: The Alexiad. Translated by Elizabeth AS. Dawes Publications Byzantine Series Cambridge, Ontario, 2000.
2. Galasso G. Storia della storiografia italiana. Editore Laterza, Bari, 2017; p.234-236.
3. Cantimori D. Storici e Storie. Torino, Einaudi, 1971; p.408-409.
4. Galasso G. Niente Altro che Storia. Bologna, Il Mulino, 2000; p.201-203.
5. Nora P. Comment on écrit l’histoire de France,Les lieux de mémoire, t.III, Les France, Vol 1, 1993; p.27.
6. Montalcini RL. L’asso nella manca a brandelli. Milano, Baldini & Castoldi, 1998.
7. Carr E.H. The Historian and his Facts. Cambridge, University of Cambridge Press, 1961.
8. Fukuyama F. The End of history. National Interest 1989; 16: 3-18.
9. Fukuyama F. The End of History and the Last Man. Free Press, 1992.
10. Fukuyama F. History is still going our ways. Wall Street J 2001; October 5.
11. Eknoyan G, De Santo NG, Massry S. On the Future of the History of Nephrology. Am J Nephrol 1994; 14: 255-256
12. Eknoyan G, Marketos SG, De Santo NG, Massry SG. On the Order of Things on the History of Nephrology. Am J Nephrol 1997; 17: 201-202.
13. Eknoyan G, Antonello A, De Santo NG. Calò L, Massry SG. On progress on the history of Nephrology. Am J Nephrol 1999; 19: 99-100.
14. De Santo NG, Bellinghieri G, Touwaide A, Massry SG, Savica V, Eknoyan G. History of Nephrology: a process confronted with changing times and of those who practiced it. J Nephrol 2009, 22 (S4); S1-S2.
15. Eknoyan G., Why the history of nephrology? G Ital Nefrol. 2016; Jan-Feb;33(1).
16. Plutarch, Pericles, 75 AD, translated by Dryden J., http://classics.mit.edu/Plutarch/pericles
17. Thucydides, History of the Peloponnesian War, book-1, chapter-20.
18. Hirst K., What Is History? A Collection of Definitions, Updated November 22, 2017,– Thought Co, https://www.thoughtco.com
19. King CR. The historiography of medical history: from great men to archeologists. Bull NY Academy of Medicine 1991; 67(5): 407-428.

 

 

Acknowledgements

We thank Professor Giuseppe Galasso, Emeritus Professor of Contemporary History at the University Federico II, Naples and member of the Lynx Academy in Rome, for gracious teachings on methods of historiography in science and medicine. He died on  February 12, 2018, the day we received the galley proofs of the present paper.

Thanks are due to the founders of IAHN who in 1993 launched a broad project and nurtured it over the years. Few were experts or had masters in history. Most of them loved history and were driven by the Greek mythology goddess of inevitability and fate, Ananke. They did well. Nephrology has now a small niche in the history of ideas.

We thank Professor Garabed Eknoyan, Division of Nephrology of the Selzman Institute of Kidney Health, Department of Medicine Baylor College of Medicine, Houston, Texas, a Founder and Honorary Member of IAHN, for his many contributions to this supplement throughout the various stages of its development and for his meticulous review and editing of various manuscripts.

Biagio Di Iorio, the learned Editor in Chief of Giornale Italiano di Nefrologia and active member of IAHN, supported the publication of the present supplement and made it possible.
Simona Saviano, critical and creative as always, was instrumental in driving the project to a successful end. The final thank is for OSC Rome, the new Publisher of Giornale Italiano di Nefrologia for significant inputs to the on-line and paper edition of this Supplement.

 

The 10^th Congress of the International Association for the History of Nephrology in Wieniec-Zdroj, Wloclawek (Poland)

 

The Congress

The 10^th IAHN Congress, endorsed by the ERA-EDTA, the Polish Society of Nephrology, the Centre of Postgraduate Medical Education and the Voivodeship Marshal’s Office took place in the Jutrzenka Spa, in Wieniec-Zdroj – a hundred-year-old Spa amidst the Kuyavan forests near Wloclawek on May 25-27, 2017. Wloclawek, one of the oldest cities of Poland, located at the banks of the Wisla river, is the site of the famous gothic Cathedral.

The congress was superbly organized by an outstanding team headed by Professor Janusz Ostrowski and his wife Maria Ostrowska. It included also Professor Marek Muszytowski the councilor of the IAHN, Przemyslaw Rutkowski, Professor of Nephrology in Gdansk, Justyna Szczepanska, Wioletta Wieczorek and Radoslaw Zebrowski.

The congress comprised 10 plenary sessions and 2 poster sessions for a total of 54 presentations. During the congress an exhibition of the famous painter Grzegorz Bienias, Professor at the Krakow Academy of Fine Arts, took place. Also, a magnificent concert was organized in the Basilica Cathedral of St. Mary of the Assumption (dated XIV century).

The congress was opened by Professor Janusz Ostrowski President of the Congress, Professor Boleslaw Rutkowski President of the Scientific Committee, Piotr Calbecki Marshal of the Kuyavian-Pomeranian Voivodeship, Andrzej Wiecek President of the ERA-EDTA, Michal Nowicki President of the Polish Society of Nephrology, Ryszard Gellert Rector of the Centre of Postgraduate Medical Education and by Vincenzo Savica President of the IAHN.

In the first plenary session Professor Andrzej Wiecek, President of the ERA-EDTA, illustrated the History of the European Renal Association-European Dialysis and Transplant Association. Boleslaw Rutkowski, Janusz Ostrowski and Andrzej Wiecek illustrated the History of the Polish Society of Nephrology. Professor Garabed Eknoyan, Professor of Medicine and Chief of the Renal Section of Selzman Institute of the Baylor College of Medicine in Houston, TX, USA gave an original talk on “Why the history of nephrology” and explained the point in question. The Congress paid tribute to Nils Alwall. The group of speakers for this session included Jan Kurkus, Horst Klinkmann, Stewart Cameron and Janusz Ostrowski. 

 

Honorary Members

Professor Andrzej Wiecek, President of the ERA-EDTA, was awarded a diploma of honorary membership. He joins Ori Better (Haifa), Bernardo D’Onorio (Gaeta), Silvana Favaro (Padua), Stewart Cameron (London), Charles Kleeman (Los Angeles), Donald V. Seldin (Houston), Garabed Eknoyan (Houston), and Shaul Massry (Los Angeles).

 

Council

Professor Janusz Ostrowski (janusz.ostrowski@diaverum.com) was elected President for the years 2018-2019, Professor Vincenzo Savica became past President with the additional special duty of Treasurer (from December 2017 on). This was due to the difficulty in opening a Bank account for the IAHN in Poland. Przemyslaw Rutkowski, Biagio Ricciardi, Ioannis Stefanidis, Ahmet Acidumann were elected members of the Council for the years 2017-2021. They join Katarina Derzsiova (council member 2015-2019), Marek Muszytowski (Council Member 2017-2019 and Secretary of the IAHN) and Natale G De Santo (ex officio member). Biagio Ricciardi, in addition to his role of a councilor, in spirit of service, has accepted to continue to care for the website of the IAHN.

 

 The 11^th IAHN Meeting

The 11^th IAHN Meeting will take place in Larissa (Greece) on September 12-15 2019. This is the town where Asclepios was born and Hippocrates died. President of the Congress is Ioannis Stefanidis, M.D., Ph.D., Professor of Internal Medicine/Nephrology and Dean of the Faculty of Medicine of the School of Health Sciences at the University of Thessaly, Larissa, Greece.  Iwannis stefanidis  <stefanid@uth.gr>.