Public Health: The Development of a Discipline. Volume 1: From the Age of Hippocrates to the Progressive Era (review)

Logan Clendening’s Source Book of Medical History (1942) and Ralph Major’s Classic Descriptions of Disease (1945) have long served as invaluable references for medical students and physicians who were interested in the history of their profession. Until now, however, there has not been a comparable resource for students and practitioners of public health. Dona Schneider and David Lilienfeld have begun to fill that gap with the first volume of a planned two-volume anthology of original readings in the history of public health. As the subtitle indicates, this volume contains readings from Hippocrates to the early 20th century. The book comprises 28 chapters, each consisting of a short biographical sketch of the author followed by an excerpt of his or her work.

And what a treasure this book is! It has given me a chance to become reacquainted with old heroes, such as Alice Hamilton, and to find new ones, such as George Baker. In 1767, Baker discovered that “Devonshire Colic,” an endemic disease in that part of England, was actually lead poisoning, caused by lead in the machinery used for making apple cider. Baker carried out experiments in his home laboratory that demonstrated the presence of lead in local cider. (His experiments involved the precipitation of lead sulfide, the same test for lead that I recall using in a college Qualitative Analysis course.) Then, “being unwilling to make any positive assertion, solely on the authority of my own trials, more especially as I had been under the influence of a preconceived opinion” (p. 91), Baker brought samples of Devonshire cider to London, where he consulted and carried out experiments with a chemistry teacher, “Dr. Saunders,” who confirmed and extended his observations. To my knowledge, Baker’s recognition of the possibility of bias due to preconceived opinion is the first statement of the insight that led, ultimately, to double-blind clinical trials. How can you not love someone like this?

When I saw that one chapter was devoted to Abraham Flexner’s “Medical Education in the United States and Canada,” I was puzzled. I have always associated Flexner’s stress on the importance of basic medical sciences in medical education with the separation of medicine from public health. I was, therefore, surprised and delighted to read:

But the physician’s function is fast becoming social and preventive, rather than individual and curative. Upon him society relies to ascertain, and through measures essentially educational to enforce, the conditions that prevent disease and make positively for physical and moral well-being.

(p. 606)

Next year (2010) will mark the centennial of the Flexner Report. I hope that, in the celebration surrounding this centennial, Flexner’s concern for public health will be given equal billing with his belief in the importance of chemistry as a prerequisite for admission to medical school.

An anthology such as this necessarily reflects the editors’ orientation and interests, and so invites readers to ask “What would I have done if I had edited this volume?” The editors have deliberately stressed the contributions of Anglophone authors. Only four of the 28 chapters (Hippocrates, Peter Panum, Ignác Semmelweiss, and Robert Koch) present works translated from other languages. This bias gives the impression that public health is an invention of the English and the Americans, and leaves out many important contributions from France and Germany. I couldn’t find a single reference to the French Revolution or to the Parisian Conseil de Salubrité (health council), which played foundational roles in the development of public health. Although the volume contains two papers by Robert Koch, there is nothing by Rudolf Virchow or Louis Pasteur, both of whom were more concerned with public health than was Koch. Workers’ health is represented by only a two-page extract of Percival Pott’s report on scrotal cancer rather than...