Cambridge Illustrated History of Medicine (review)

With a wealth of illustrations, many of them reproductions of paintings in full color, this book resembles a history of art. Raphael’s painting The Transfiguration [of Christ] (p. 91) is particularly beautiful, as are also Goya’s The Procession of Flagellants (p. 86) and Gerard Douw’s Der Arzt (p. 170). There are many photographs and a number of maps. In its illustrations, design, and typography the book is beautifully produced and technically excellent. The text is another matter.

In ten chapters, seven authors discuss various aspects of medicine and the history of medicine, beginning with a history of disease by Kenneth Kiple. The authors of the various chapters on the history of medicine tend to follow the same path from Antiquity through the Middle Ages and Renaissance to the nineteenth century, whether they are discussing the rise of medicine (chap. 2), concepts of disease (chap. 3), medical science (chap. 5), hospitals and surgery (chap. 6), drug treatment and pharmacology (chap. 7), or mental illness (chap. 8). Thus the book provides a group of parallel histories rather than an integrated history of medicine. As a result the text is occasionally repetitive. In the later chapters the treatment of important topics is often fragmented.

Roy Porter’s chapter on medical science contains serious errors. He reproduces Charles Singer’s 1946 diagram of Galen’s physiology, which has long been known to be wrong; the Royal College of Physicians’ film on William Harvey contains a more accurate account of Galen’s ideas. Porter also states that Louis Pasteur “showed that all grubs arose from minute insect-laid eggs and organisms pervading the atmosphere” (p. 184). Pasteur was not concerned with the origin of grubs, but with that of the microorganisms that cause fermentation and putrefaction. Almost two centuries earlier the Italian Francesco Redi had shown that maggots or grubs in meat developed from eggs laid by flies. Pasteur showed that microorganisms arose from germs carried in the air, not from the substance of the air. Porter also credits Pasteur with the identification of streptococci and staphylococci, forgetting that these organisms were first described by Alexander Ogston at Aberdeen.

Porter’s account of endocrinology is sketchy and frequently wrong. Among malfunctions of the thyroid gland he mentions goiter and cretinism, but not myxedema. He says nothing about the parathyroids nor the isolation of thyroxine. He does not mention iodine deficiency as a cause of cretinism, goiter, and myxedema, nor the prevention of such conditions with iodized salt. He notes that the pituitary gland was found to secrete a growth hormone, but he says nothing about the pituitary hormones that control sexual or adrenal function. He omits any discussion of the endocrinology of the menstrual cycle. He does mention the contraceptive pill, but says nothing about the history of the science on which it was based.

In his account of antiseptic surgery, Porter writes that “putrefaction in wounds had long been accepted as the . . . consequence of exposure to the air. Lister came to the conclusion that carbolic acid would be effective as an antiseptic” (p. 231). Lister used carbolic acid to combat not the air, but germs in the air, influenced by Pasteur’s demonstration of their presence. Porter’s account of twentieth-century surgery is rife with error. He places the Mayo Clinic in Rochester, New York, whereas it is actually in Rochester, Minnesota, about a thousand miles farther west. If Porter’s geography is vague, his intellectual landscape is also misty. He gives a singularly garbled account of the development of heart surgery, mentioning that open-heart surgery began in 1952 “with the implantation of artificial heart valves” (p. 237). The first open-heart operation performed under hypothermia in September 1952 was to repair an atrial septal defect; artificial heart valves were not implanted until 1958, after the development of heart-lung bypass techniques. Both operations were performed at the University of Minnesota.

John Pickstone informs us that medicine is about power, not human suffering or its relief. He seems...