Disease and Medicine in World History (review)

This brief, sometimes quirky, yet well-informed introduction to the history of disease and medicine has the virtue of being just what its title claims: a genuine world history. Sheldon Watts treats the written medical traditions of Greek, Muslim, and Christian physicians and those of their Indian and Chinese analogues as only part of the practice of medicine, being intent to emphasize the existence (and occasional value) of folk healers whose empiric discoveries of herbs and sanitary practices were usually disdained but sometimes accepted by literate, upper-class physicians.

The book is schematic, deliberately emphasizing "differences, disconnectedness and discontinuities" (p. 12). After an introductory manifesto, "Sickness and Health: A Global Concern," chapter 2 accordingly groups Pharonic Egypt and the pre-Columbian New World under the rubric "Before the Advent of Acute Epidemic Diseases." Subsequent chapters include "Pluralism in Ancient Greece" (chap. 3); "The Evolution of Medical Systems in the Middle East, c. 632 to Modern Times" (chap. 4); "Health and Disease in the Indian Sub-continent before 1869" (chap. 5); "Medicine and Disease in China, c. 1900 B.C.E. to 1849" (chap. 6); "Globalization of Disease after 1450" (chap. 7); "Medicine and Disease in the West, 1050-1840" (chap. 8); "The Birth of Modern Scientific Medicine" (chap. 9); and finally, "Health and Medicine in the World, 1940 to the Present" (chap. 10).

Throughout, Watts tends to disdain medical book learning. He calls Galen "a synthesizer and simplifier" who "all but closed the door of intellectual inquiry" (p. 41), and says of Ibn Sina's Canon: "It has all the advantages of a book for teenage students which can be easily memorized even though students do not know what key words mean. It was this scholastic triumph of rote learning over medicine that was the principal contribution which, in due course, the Islamic world passed on to the West" (p. 45). The baleful influence of Ibn Sina's Canon also tainted Indian medicine, according to Watts, but Chinese doctors remained immune. Instead, "there was often fruitful bottom-up as well as top-down exchange between itinerant health care providers and the philosopher-physicians who wrote learned treatises on medical-related issues. . . . By way of contrast, in the medieval and early modern West no respectable physician would ever admit that he had anything to learn from itinerant practitioners, all of whom he regarded as fakes and charlatans" (pp. 72-73).

On the other hand, Watts warmly endorses the "science of clinical bacteriology" (p. 114) inaugurated by Robert Koch in 1876; but he scorns British "sanitary science," embodied in Edwin Chadwick's sewers: "an engineering solution to the nation's disease problems" (p. 116). Indeed, Watts says the theory that the cause of epidemic disease was airborne miasma, arising from dirt and excreta, which had inspired Chadwick's successful reforms in Britain, persuaded British medical officers in India to "smother the germ theory" and permit cholera and other epidemics to ravage that subcontinent until 1947 (pp. 116-24). His judgment of the triumphs and failures of organized medicine since 1940 is similarly ambiguous: "Massive decline in the percentage of a given population that died of infectious diseases in early childhood or before the age of 50" was balanced by "the great increase of the number of people, who in middle and old age, suffered from chronic disease conditions" (p. 128). Moreover, long-standing inequities between health services for rich and poor widened, and many infections have started to come back in forms resistant to once all-powerful antibiotics.

Watts concludes his book on an apocalyptic note by quoting Robert Koch: "We cannot be fully self-realized [or happy] so long as everything around us suffers and creates suffering. . . . We cannot be moral so long as the course of human affairs is determined by force, deception and injustice," and then affirms in his own voice that "as historians of medicine and of disease we are aware...