This book is a historical account of how medicine, scientific knowledge (of the human body) and technological advances have changed our thinking and treatment of health and disease from its gory and gruesome beginnings to the polished, white-collared, multi-million dollar industry we have today. The book is divided into eight thematic chapters (disease, doctors, the body, the laboratory, therapies, surgery, the hospital and medicine in modern society), so it does not, thankfully, recount chronologically the history of medicine. Each chapter is about how each of the sub-sections of medicine has progressed over the course of the past few centuries. The major transformations have occurred around major breakthroughs in our understanding of scientific concepts, particularly our knowledge of the human body.
The first chapter is “Disease” and it certainly makes this book start off with a bang. My favorite part was the description of the symptoms that accompanied the cholera infections of the 19th century:
“Acute nausea led to violent vomiting and diarrhea, with stools turning to a grey liquid described as ‘rice water’ until nothing emerged but liquid and fragments of gut. Extreme cramps followed, with an insatiable desire for water, followed by a sinking stage. Dehydrated and nearing death, the patient displayed the classic cholera physiognomy: puckered blue lips in a shriveled hollow face” (p. 15). Love it…
So what caused the advent of so many of the disease pandemics throughout the history of human life? Well, humans, of course. The things we did to become a more “advanced” and “civilized” species, are precisely the things that have brought about more diseases for us to battle. First, it was agriculture (bringing us in close contact with animals (and their parasites), and each other (so we can spread those parasites quickly and efficiently). Then it was the industrial revolution (bringing us even closer together, crowded together in unsanitary living conditions, and the polluted air of the industrialized city. Even those that prospered got hit with diseases that result from affluence such as cancer, diabetes, heart disease, hypertension, and emphysema.
In the second chapter, “Doctors”, the author accounts how doctors evolved from “healers”, to family counselors, who got paid for little more than keeping the affluent sick and dyeing “comfortable”, to men in white coats in hospitals who care and treat the sick, to men (mostly) in white coats in clinics who maintain the healthy, well… healthy. I learned about the original Hippocratic Oath that doctors still take today. Because I have been involved in women’s health rights and issues and am still and advocate for women’s health rights and issues, and have always been fascinated by the intersection of religion/morality and science/medicine, I found several aspects of the original Hippocratic Oath very interesting. For example, the oath states that doctors will not “give a woman means to procure and abortion”, will be “chaste and religious” in their life and practice, will not abuse their position to “indulge in sexual contacts with the bodies of women or of men”. Also, because for a long time, surgery was considered more like butchery than medicine, it also included a statement that doctors would not “cut, even for the stone” but that they would leave cutting to “the practitioners of that craft”. Along those lines, I was to read about the medicalization of pregnancy and childbirth, with the assent of the field of a male-dominated field of obstetrics, and the slow, though steady, rise of female doctors, which began with the first female doctor licensed here in America in 1849. I believe it’s slightly more than half of medical students today are women, though that majority of practicing doctors are still men, and there are huge gaps in the compensation that female and male doctors receive.
As I said before, the seemingly slow progress of the medical field was due to how little we actually knew about the human body for so long. And in Chapter 3: “The Body” I learned why knew so little indeed: we weren’t looking. Yep, we were not looking at the human body at all. It was considered sacred, and therefore, human autopsies were illegal for centuries, and when they first began, they were performed on the cadavers of convicted murderers alone. And even when we did, we were mostly drawing and naming parts without knowing much of what they did. It wasn’t until we began performing controlled experiments in the body systems of animals that we began learning what body functions organs actually performed, and how they actually worked. Most insightful was our discovery of the structure and function of the respiratory and circulatory systems. Which was the followed by increased understanding of how the nervous system works. But the biggest breakthrough that our understanding of the human body brought about was not that knowledge inherently, but our understanding of the nature of disease. Once we understood that there were organs and organ systems with specific functions, we began localizing the source of certain diseases to specific organs, and later to tissues. Which essentially was able to transform medicine into the practice of localizing and diagnosing disease based on specific symptoms to specific body organs or tissues, and then, to some extent, treating those organs or tissues. The key to diagnosing in this way, was the idea that there is such as thing a normal physiology (what the organs and tissues normally look like) and pathology (what diseased organs and tissues look like). I know it sounds like common knowledge to us but, trust me, this was a big deal in the 1700s.
This understanding led to the advent of the laboratory (along with the development of technologies such as the light microscope), which is discussed in Chapter 4 (“The Laboratory”). In addition to advances in the knowledge of organs and tissues at the microscopic level, the laboratory and its tools and techniques, increased our knowledge of the microscopic pathogens present in diseased tissues, giving rise to the fields of microbiology, immunology and endocrinology, and later pharmacology, which contributed to the development of hugely popular antimicrobials, painkillers, and vaccines (discussed in chapter 5 (“Therapies”), all of which ultimately enhanced the ability of Western nations to better withstand their imperialistic and other warfare related activities. The development of antiseptics, painkillers (and later anesthetics), and vaccines, in turn, led to the transformation of surgery from butchery to a medical specialty, by allowing for more surgeries to be performed with less pain, and fewer infections and deathly side effects. Specific improvements in various kinds of surgeries, such as the removal of kidney stones, gall bladder excisions, vascular excisions, lobotomies, and amputations, and, most interesting (to me) obstetric procedures (p.p. 117-119), can be found in Chapter 6 (“Surgery”).
Last but not least, Chapter 7 (“The Hospital”) discusses the evolution of the hospital from the its leper asylum (where those suffering from leprosy, “the unclean”, were forcibly kept) beginnings (13th century), to its madhouse and hospice intermediates (14th to 18th centuries), to its modern role as the sites for medical examinations and treatments by doctors and medical students, which didn’t come about until the 18th century.
The author does a great job of recounting this history of medicine and its unique and separate entities (by the thematic chapters), and yet still connecting each to the next. It is factually accurate, and due to no lack of “blood and guts”, it is also a witty and hugely entertaining two-day read. Thumbs up from me. I can’t wait for more gory and gruesome medical accounts from my next read…
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