A Brief History of Disease, Science, and Medicine: From the Ice Age to the Genome Project (review)

This is history of medicine made easy—which is meant as a compliment, as we are all painfully familiar with how the history of medicine can be made difficult with obscure jargon and tortuous approaches. As stated by the author, "the target reader is a first year medical student, a nurse, a premed student or someone with an interest and a bit of science education. This is not a book for experts" (p. iii). Michael Kennedy, a clinician, understands the importance of the study of the subject by health-care professionals, who "receive little information on medical history in the curriculum" (p. i). He appropriately dismisses the common explanation that present-day medical students are too busy by pointing out that they have always been expected to learn a great deal: "the difference is that much of what they learned in the past has now been shown to be in error" (p. i).

The task of covering several thousand years of Western and non-Western medical history in about 450 pages, however, presents difficulties that result in numerous shortcomings. To begin with, a more appropriate title would have been "A Brief History of Modern Medicine." The book, in fact, covers ancient Chinese, Indian, and Islamic medicine, in addition to Western medicine from Neolithic times to the end of the eighteenth century, in the first 120 pages, whereas the medicine of the nineteenth and twentieth centuries is reviewed in the remaining 300-plus pages.

Older medicine is covered at breakneck speed, with notable imbalances (e.g., Galen gets less than a page, while Billroth gets six pages), inaccuracies (e.g., Morgagni's De sedibus is said to contain "extensive drawings" [p. 107], whereas it contains none; the "school of Vesalius and Fabricius" [p. 221] is said to be Venice, whereas it was Padua), and even blunders (e.g., the Huang-ti nei-ching is said to date "from about 2600 BCE" [pp. 48–49], whereas it was written in the second or first century BC; Celsus is said to belong to the fourth century and to give no details about "removing bladder stones" [p. 42], whereas he lived at the beginning of the first century and described the operation in detail; the Romans, it is stated, "did not employ physicians" [p. 26]).

The pace is slower in the section dealing with modern medicine. The work would be easier to read, however, if the often-crowded facts and information had been more selectively chosen. In addition, the reader is always unsure about the reliability of the data because, although at the end of each chapter there is a list of sources, they are only rarely referred to in the text.

These shortcomings are compensated for by the lively style, the simplicity of the exposition, and by several passages that, written by someone with hands-on experience, illuminate some details with special clarity and impact. For example, in discussing Aselli's discovery, in a recently fed dog, of the chyle (which is visible only after a meal), the author says: "Modern surgeons often observe this phenomenon. Elective abdominal surgery is performed on fasting patients and the mesenteric lymphatics are invisible, the lymph is clear. In trauma, or other emergency cases, the patient may have eaten recently and the lacteals are clearly visible, filled with chyle" (p. 99). In discussing the throat cancer of Frederick III of Germany, he writes: "It is characteristic of second opinion physicians, especially surgeons, that they feel confident the preceding care was less skillful than their own would be" (p. 157).

As mentioned, this book is not for experts—but it is recommended as an overview of how medicine and surgery developed, especially in the nineteenth and twentieth centuries. The reader must beware, however: although the overall picture may be accurate, the details may not be.