The Greatest Benefit to Mankind: A Medical History of Humanity

The Greatest Benefit to Mankind: A Midical History of Humanity.
Roy Porter.
New York and London: WW Norton & Company. 1997.

A history of medicine from the clearly defined conviction of the Hippocratic oath to the muddy ethical dilemmas of modern day medicine. Wrote the book because when people asked if there were a single-volume history of medicine, he did not know what to suggest. Writing the book made him realize how much he did not know.

We are healthier than ever, but more anxious about our health. The story of medicine is not an outline of progress. Many of the worst diseases came from living in proximity to animals. Trade, war and empire sped disease between populations. Typhus joined winter to turn Napoleon's Russian invasion into a rout. To the Mesopotamians, sickness was both judgment and punishment from the gods.

Alexander's early death he blamed on too many physicians. The Romans thought they were better off without doctors. Suffering and disease were viewed as chastisement or trial from God. Early writers on medicine stitched together compendiums of remedies.

Diet before drugs or surgery.

The Koran says nothing about medicine. Islam taught that if God sent a malady, He also sent a cure. Contribution of Arab-Islamic medicine was to pharmacology. Preserved and systematized existing knowledge. The Koran demanded care of the mad. Christian medicine and religion intersected with every organ of the body; the sufferer's complaint appealed to a particular saint for each organ. Each area of the globe has its own medicine. Buddhist monks were dedicated to gaining peace of mind by abandoning desire. Chinese medicine combined drugs in specific proportions. Western and Eastern traditions of medicine are unresolved.

Columbus's voyage proved devastating to the natives because of disease; he brought syphilis back to Europe. Shakespeare: Trust not the physician; his antidotes are poison (Timon of Athens). Paracelsus: leave all to nature. Don't learn medicine from books, but from nature. Harvey: I profess to learn and teach anatomy not from books, but from dissections. Bacon: learning in medicine has been circular; nothing much new added. Some innovations were harmful. From the 1700s, healing emphasized medication. War brought developments in surgery. Hospitals became central, but they also spread disease. Sydney Smith in 1836: there are above 1500 diseases to which man is subject.

In Christian society, dying begins at birth.

Dr. James Barry (1797-1865), medical officer in the British army who was also a crack marksman and a skilled surgeon was found to be, after an autopsy, a woman.

Homeopathy is the law of similars: heat for burns; cowpox vaccination for small pox; smaller the dose the more effective the medicine.

Medicine is a patchwork of theory and practice with divisions among professional factions.

Malcolm Muggeridge in 1962: It is the age of pills.

American Dr. Gorgas in Cuba: Yellow fever eliminated by eliminating mosquitoes and the breeding places of mosquitoes. The causes of sleeping sickness became known but not how to prevent or treat it.

Influenza in 1918 killed three times as many as died in WWI.

Treating the insane with kindness; the insanity plea continues to be contested. Psychoanalysis overshadowed the medical treatment of mental problems.

From the 1960s, diet has been implicated in all manner of diseases.

Cancer was named by Hippocrates. Despite the immense investment of money and research effort, cancer remains a disease imperfectly understood, in which relief is far more common than cure, and relief generally is temporary and subject to serious side-effects.

Basic research, clinical science and technology working with one another have characterized the cutting edge of modern medicine.

The Nuremberg Code for experimenting with humans: consent of the subject; for the good of society; no other method available; based on animal experiments; avoid unnecessary physical and mental suffering and injury; no a priori knowledge that it will result in death or disabling injury; adequate facilities; scientifically qualified persons; subject able to end experiment; terminated if experiment is likely to lead to disability or death.

War is good for medicine. Blood-letting lost favor but what followed, pharmacopoeia, was hardly better. Pressures on doctors to do something. Advice did not make money, pills did. Shift in practice from patient's home to doctor's office. In 1974, Senate investigation reported that 2.4 million unnecessary operations were performed in the U.S. per year, caused 11,900 deaths and cost $3.9 million. More deaths from surgery than the Vietnam War.

Medicine has led to inflated expectations: need to redefine its limits.