The Western Medical Tradition 1800 – 2000

The common perception of the history of medicine is of the progressive advance of reason and science over superstition and ignorance – whose ultimate triumph could scarcely be more conspicuous than in the impressive 'palace of disease' of the modern hospital. Most medical historians, however, are antipathetic to this triumphalist view - what the later E P Thompson described as 'the enormous condescension of posterity'. Thus the authors of the two volumes 'The Western Medical Tradition' (all associated with the Academic Unit of the Wellcome Institute based at University College London) note in their introduction that 'the struggle against disease has called for resourcefulness, intelligence and learning at all periods of history'. The principle of avoiding condescension is commendable enough, but the practicalities of weaving a coherent story from the many strands of the history of medicine stretching over so long a time span are prodigious. Hence any non-judgmental version of history inevitably runs the risk of getting bogged down in the details and failing to give due emphasis to those crucial moments that signal the transition from one way of knowing to another. Indeed there are times when it seems the authors themselves don't properly grasp the significance of the events they are describing. This is particularly apparent in the first volume that covers the two thousand years from 800BC to 1800AD (first published back in 1996 and now in its ninth edition) and a standard textbook for university courses in the history and philosophy of science. The two great works of genius by Andreas Vesalius and William Harvey, the founding fathers of medicine's bulwark traditions of anatomy and physiology, are a case in point. Vesalius's De Fabrica with its seven hundred and fifty folio pages illustrated by three hundred and twenty wood engravings is both a great work of art, repeatedly copied and plagiarised down the centuries, and a philosophical treatise of the splendours of the human body. William Harvey's experimental demonstration of the circulation of the blood in his slim seventy page De Motu Cordis, by contrast, is a literary masterpiece in which he remorselessly exposes his simple conjectures to the rigours of experimental verification. These massively influential texts merit just three pages each: the pedestrian account of the De Fabrica and its brilliant illustrations fails to convey Vesalius's singular achievement of teaching doctors and scientists to see and there is a scarcely a hint of Harvey's timeless legacy in teaching all those who came after him to think. The second volume from 1800 – 2000 (first published in 2003) is much better, although, like the proverbial curate's egg, not consistently so. The highlights include a terrific chapter by W F (Bill) Bynum 'The Rise of Science in Medicine' from 1850 to the outbreak of the First World War. This was truly a golden age where as the histologists Jan Purkinje famously remarked 'every day brings new discoveries' – as indeed it quite literally did. Professor Bynum's gives a lucid account of the lives of the brilliant physiologists of these times – Claude Bernard in France, and the German quartet Emil Du Bois-Reymond, Carl Ludwig, Ernst Bruche and Hermann von Helmholtz. But he also places their achievements within the wider context of the major expansion of research institutions and laboratories in this period that signalled the crucial transition to the professionalisation of science. This period also witnessed the formulation of the germ theory of disease, whose powerful implications for the public health and preventative medicine he illustrates with the two very different biographies of Tuberculosis ('the captain of the army of death') and Syphilis ('two minutes with Venus, two years with Mercury'). His contribution closes with a moving description of the significance of illness in people's lives during this period - epitomised by the cruel inadequacy of the treatment of breast cancer as experienced by Emily Gosse, wife of the great naturalist (and creationist) Philip Gosse and mother of the literary critic Sir Edmund Gosse. 'Her last illness contains both individual and universal elements,' writes Professor Bynum, 'it reminds us that grave diagnoses created shockwaves even in the deeply religious and that pain and suffering was not routinely embraced, even amongst those who might nevertheless seek to find meaning in them.' The final chapter by Anne Hardy and E M (Tilli) Tansey covers the post-war therapeutic revolution contrasting the extraordinary surgical, technical and pharmacological innovation of the first few decades with its aftermath and the emergence of the paradoxical phenomenon of 'doing better but feeling worse' – despite the enormous and continuing financial investment in medical research in welfare services. In a parallel theme the authors thoughtfully review the baneful influence of western medicine on the health of the developing world. Three-quarters of the annual health budget of a country such as Bangladesh is spent on metropolitan hospital based services, thus effectively marginalising the health needs of the ninety-two percent of the population that live in rural areas. There is much of interest in the second volume but its main value (and indeed the purpose for which it was written) is as a standard reference or textbook to be consulted or dipped into – rather than to be read from beginning to end. Those seeking a readable history of medicine from antiquity to the present would be vastly better advised to buy the late Roy Porter's masterpiece The Greatest Benefit to Mankind that eclipses these two volumes on every count, not only in being so much better written, but in the intelligence of its judgements.