Physician: The Life of Paul Beeson (review)

Placing himself consciously in the tradition of Harvey Cushing limning the life of Osler, Richard Rapport, as well a neurosurgeon, has written the first full-scale biography of a giant of twentieth-century medicine. Paul Beeson and Osler intersect, symbolically, through their thematic if not chronological convergence as North Americans called, in their crowning career moves, to Oxford chairs. Like Cushing, and like Osler's more recent biographer Michael Bliss, Rapport had access to his subject's personal papers and to those of his close colleagues, as well as to oral history interviews with many peers and family, both on the east coast (New Haven) and the west (Seattle). These resources he appears to have used judiciously. He also writes with a fine flair.

Rapport announces at the outset that he did not aspire to a comprehensive, Cushingoid account that no one would read. He has instead produced a relatively brief account of a "good, dedicated and fortunate man" (p. xiii), who rode the wave of post–World War II scientification in medical education and expansion of internal medicine. Along the way the reader catches glimpses of sidelights that have escaped others' notice: that many of the mid-century leaders of American medicine (Beeson, Tinsley Harrison, Eugene Stead, and many others) made their early mark in the Deep South; that a certain aristocratic tinge, as though they emanated from the Royal College of Physicians by way of Osler's "Alabama Student," surrounded these leaders of Internal Medicine; that all was not always hunky-dory in Oxford's "firm" system.

From a purely scholarly point of view, it is often difficult to track the author's sources. There is a novelistic quality to the account—for instance when, in the prologue, we hear of the now well-accepted role of the Harvard experience, particularly the impact there of Soma Weiss on early leaders of internal medicine: it would have been helpful to have had a few footnotes to guide today's medical history student to ways-of-knowing about the all-important issue of twentieth-century internal medicine's arc—or, for that matter, Paul Beeson's own career arc. In this same vein, we have no index and rather sketchy footnotes. To make up for this deficiency, in part, we are treated to a marvelous collection of photographs, tipped in to the middle. We are thus left with an interesting hybrid: Rapport has produced neither the typical gush of hagiography—this is far better than the standard "Who's Who," or what he pejoratively calls the Cushingoid "catalog of ships" (p. xiv)—nor a truly well-rounded story of Beeson in context.

The appetite is thus whetted; we want to know more about the stars in Beeson's firmament. The clubbiness of internal medicine, with its many elite cadres, was a prominent feature: we want to know not just how Beeson et al. managed to join these guilds, but what it meant to be so clubby—how insiders and outsiders were arrayed within and around wider contexts. It emerges from Rapport's account, however, that there was a central paradox upon which Beeson himself later could be heard to comment.¹

That paradox goes something like this: After mid-century the expansion of medicine-as-science, and science-as-medicine, depended, as it were, on the emerging leadership's finding ways to put every last departmental telephone bill on some NIH grant. The pyramid scheming that such cost-shifting and research growth in clinical departments reflected, however well intentioned, led ultimately to a revenge effect. While themselves intent on preserving the Soma Weiss style of bedside teaching and "humanism" in medical care, Beeson and his cohort presided over a set of events that pointed oppositely: toward super-subspecialization and its technological imperatives, and also toward the rise of family medicine departments as claimants to the role of the general humanist-scientist—and, with their recent decline, of family nurse-practitioners serving...