The Greatest Benefit to Mankind: A Medical History of Humanity (review)

Roy Porter. The Greatest Benefit to Mankind: A Medical History of Humanity. New York: W. W. Norton, 1997. xvi + 831 pp. Ill. $U.S. 35.00; $Can. 47.99.

Imagine a collaborative overview of world medical history by Richard Shryock and Henry Sigerist, with a touch of Fielding Garrison. Imagine further that the reach extends well into the twentieth century, the writing is elegantly economical, the integration of science and culture done wonderfully well--and you have a general idea of Greatest Benefit to Mankind: A Medical History of Humanity.

The analogy to previous authors is simplistic, of course. Roy Porter specifically lists the reasons his book is different. Among these, it is not another social account focused on people's history, which has been done well already. The demographic and epidemiologic importance of disease are covered, but largely as a canvas for a more general history. Now that rapid and pervasive transportation is well on the way to making the world a single epidemiologic community, disease is perforce covered globally. Porter seeks the origins of the "doing better, feeling worse" syndrome that is widespread in patients and society alike, and restates his solid conviction that medicine's status today, as always, has derived little from its ability to cure specific illness: "The particular powers of medicine, and the paradoxes its rationales generate, are what this book is about" (p. 8).

Porter admits that his coverage of non-Western medicine is limited, though there are fine chapters on Chinese and East Indian medicine. His emphasis is on Western Europe--more specifically, England, France, and Germany--and the United States. Further, he concentrates on what we would consider the science of a given epoch; as an example, he makes no apology for spending more time on Hippocrates than on folk medicine in ancient Greece.

The book's format adds to its uniqueness, bringing together virtually all approaches to the history of medicine in one remarkable volume. In a chronological framework, a typical chapter begins with the medical science of the period and ends with cultural considerations--though the integration of the social milieu becomes more prominent with passing time, beginning roughly with the Enlightenment, when such information becomes increasingly available.

One comes away from a reading of this book with a highly satisfying sense of balance. In the interplay of human beings and culture, credit and doubts are appropriately assigned. The penultimate two chapters, entitled "Medicine, State and Society" and "Medicine and the People," solidify this balance, but even-handedness is present throughout. The last chapter is titled "The Past, the Present and the Future," and the restraint shown here is especially appealing. Porter leaves no doubt that medicine's principal accomplishments have been in the prevention and treatment of microbial disease, while little has been done to alter mortality in current killers such as cancer, cardiovascular disease, and dementias. He indicts medicine for inflated expectations (which is showing encouraging signs of change), but he does not say enough about the malign role of sloppy journalists seeking a daily breakthrough, and the inundation of false hopes propounded by television and radio, at least in the United States.

Throughout the chapter summaries Porter emphasizes the unknowable without weasel words such as "probably" and "likely." He ends each story with its history. His account of psychiatry, for instance, without pretending to predict which, if either, will dominate eventually, ends with traditionalists on one side, and the other side looking on psychoanalysis as a carnival show and pinning its hopes for the future on the brain scientists and pharmaco-psychiatry. He believes that the future of medicine is unknowable, though he indulges himself far enough to assert that medicine, as developed in this book, will not be as important in world health as will changes in politics, economics, and the nature of disease itself.

The scientific presentation, though factually familiar to general...