Reviews and Notes: Medicine and Western Civilization

DJ Rothman, S Marcus, and SA Kiceluk; eds. 443 pages. New Brunswick, NJ: Rutgers Univ Pr; 1995. $22.95, paperback; $50.00, hardcover. ISBN 0-8135-2189-4. Order phone 800-446-9323.

Few medical schools in the United States teach the history of medicine—no wonder! Why should medical history have a place within their walls? It would take time away from the marvels of molecular biology and the complex modern technology used in diagnosis and treatment. Even the proponents of medical history would probably concede its irrelevance to today's curriculum if it were to focus, as it often has, primarily on persons, dates, and places. How would knowing who first described cretinism help treat thyroid disease today? How would grasping the concepts of yin and yang illuminate a diagnostic analysis of an arrhythmia?

The editors of this new anthology have found a curricular place for medical history. They do not see this history as a chronicle of persons, dates, and places marching in a parade through three or more millennia up to today's marvels. They do see it as a series of pictures of how medicine has been molded in part by the society of its times and how medicine, in turn, has molded society. What is even more important is the editors' demonstration that the strains and stresses in human life today were strains and stresses through all of the known past. A fair conclusion is that seeing this larger picture of human life equips one to better see human life clearly today.

The editors make their case by presenting documents from the medical literature and the world's wider literature that together illustrate the sometimes differing, sometimes concurring perspectives of medicine and general society. The section titled “The Experimenter” includes Robert Koch's “The Aetiology of Tuberculosis,” a picture of medicine seeing the causation of human disease. It is followed by an extended excerpt from the 1973 Senate hearings, “Quality of Health Care—Human Experimentation,” a picture of society looking at medical research. “The Institutionalization of Doctors and Patients” includes, among other papers, Pinel's “The Clinical Training of Doctors,” a view within the profession of how physicians should be trained to care for the ill, and Orwell's “How the Poor Die,” a view of how one keen observer outside of the field of medicine saw the ill being cared for. Each document is prefaced with a short essay that describes the origin of the document and the importance it had in its time and place.

Perhaps the document that most vividly and concisely shows the persistence of human failings and, indirectly, the hope for solutions is William Blake's poem, “The Divine Image,” which serves as a preface to the entire collection. Its last stanza says:

And all must love the human form,

In heathen, turk, or jew;

Where Mercy, Love, & Pity dwell,

There God is dwelling too.

Two hundred years later, this plea, this hope, still speaks sharply to human needs. Look at the Balkans, look at the Middle East.

I cannot praise this collection too highly. The documents included are among the most absorbing reading I have done in many months. Fanny Burney's account of pain suffered in a lumpectomy done before anesthesia is hair-raising. Styron's reliving in print the despair of depression leads one to pray for never having to endure it. I believe that this is a book for all physicians, not just those in training. But will a place be made in more medical schools for history of this kind?

• Copyright ©2004 by the American College of Physicians