Putting medicine in its place

The historian Roy Porter was known during his lifetime as a ‘one-man book factory’, a prodigiously productive scholar who wrote or edited over 100 books—proper books, mind you, not light novels dashed off in a weekend, but major chunks of work based on original research. He took early retirement in his mid-50s, something most academics could only dream of, and died of a heart attack five months later. I didn’t now about him at the time, as I wasn’t really paying attention, but I’ve run into him recently as I’ve been reading up on the history of medicine, an area in which he was well-regarded, although he was careful to present himself as a social rather than a medical historian. The Greatest Benefit to Mankind, published near the end of his life, is a hefty but extremely readable tome which offers an in-depth account of medical history, as the subtitle puts it, ‘from Antiquity to the present’. For the most part, what this means is a history of European medicine, but Porter was alert to the shortcomings of such a limitation, and includes in-depth chapters on traditional Chinese medicine, and the Ayurvedic traditions of South Asia. Clearly if you’re working backwards from the present, and asking how our prevailing medical landscape came about, then that is largely the history of Western medicine, which in its modern, materialist phase has finally achieved the healer’s holy grail of turning physiological knowledge into therapeutic efficacy. But Porter is at pains throughout to give historical knowledge and practice its due, as the knowledge proper to its time and place, rather than as incorrect science. This, perhaps, is what he means when he says he is a social historian rather than a medical one, and when he subtitles his book as a ‘medical history of humanity’, rather than a ‘history of medicine’: his book is an account of the historical, social, and cultural processes that have produced medicine.

Modern medicine is as much a product of such processes as any other set of healing practices, and perhaps the most valuable and illuminating aspect of The Greatest Benefit to Mankind is that it sets the current state of affairs in its context, showing that its knowledge, its techniques, its institutions, its practices and assumptions are all as historically determined as everything else, and could quite easily have been something else. The modern profession is able to brandish, for example, its identification of particular micro-organisms as the specific causes of specific diseases, and its preventive and curative capacities based on that knowledge; or its heroic surgical interventions such as organ transplants. Such tokens of its power and its rightness abound, and contribute to a sense that no challenge could be made to its findings or its values. However, many aspects of the ways in which medicine is done are direct consequences of commercial or political pressures—for example, those pressures which have made large, bureaucratic institutions virtually its sole custodians—and there is no necessary reason to suppose that the health of populations could not be equally well-served in other ways. Porter points out that a great deal of therapeutic and diagnostic practice is still broadly empirical, having never been subjected to the rigours of double-blind clinical trials, and much of his account of the twentieth-century documents the changing reputation and public understanding of medicine. For much of history we did not trust doctors, or expect much of them, but for a brief, astonishing period, medical science produced an array of innovations that drove many enduring scourges of human wellbeing back into the shadows, and those lucky enough to have access to the latest therapies became almost blindly trusting of modern medicine. By the time Porter was writing (his book was published in 1997) the rate of innovation had slowed dramatically. After the success of the smallpox and polio eradication campaigns other widespread diseases, such as malaria, proved too resilient for the rich world to wipe them out, whether or not it was technically feasible. New surgical techniques were few and far between. New diseases, most notably AIDS, proved entirely impervious to medical science. Numerous scandals had exposed lax ethics in clinical research, low standards in pharmaceutical safety, and a lack of respect for patients. Porter shows that the consequent loss of confidence in medicine, and the renewed interest in alternative medical traditions, including some out-and-out quackery, is not some new, emergent crisis, but the resumption of normality.

I took a great deal of pleasure in reading this book, and it really is as entertaining as it is informative, crammed with fascinating anecdotes and startling details. Porter’s prose is fluent and lucid, and he has a talent for compression that can squeeze enough of a life into a single sentence for the reader to feel they have encountered something utterly particular, without losing the thread of his broader narrative. However, I had particular reasons for reading it, as I’m researching pre-modern medical practices for the fantasy world that I’m constructing, and for the stories that I’ll be setting in it. In particular, I’m interested in the transition between a medicine based on tradition, or on long-standing written authorities, and one in which knowledge is understood as something that can be made, and the healing arts as something that can progress—because that’s more or less where my invented society is at, culturally. In terms of the history of medicine, then, I’m talking about the Scientific Revolution and the Enlightenment, the seventeenth and eighteenth centuries. This is a period on which Porter is particularly strong. The development of anatomical and physiological knowledge in those centuries was incredibly rapid and incredibly profound, and the book vividly portrays a febrile atmosphere of creativity and productivity spreading across Europe and connecting medicine to the broader disciplines of Natural Philosophy. Most importantly, most strikingly, and most tragically, it shows us just how hard it is to turn such knowledge into effective therapeutic techniques. Centuries elapsed between the putting of physiology on a scientific basis and the first effective interventions based on anything more than happenstance or tradition; even today, the medical profession’s grip on the proper functioning of the human organism is tenuous, many illnesses and injuries remaining completely beyond its grasp. It is impossible to narrow such a complex and all-encompassing historical narrative down to a few headline observations, but of the many impressions The Greatest Benefit to Mankind has left on my mind, among the most prominent is the enormity of the task, the incredible complexity of medicine’s objects, and the jaw-dropping optimism of the many practitioners and thinkers who have tried against all the odds to improve and develop the healing arts throughout the whole sweep of human history. It’s an achievement in its own right to leave the reader with the impression that Porter has done some kind of justice to this olympian topic, and of course I’m not qualified to pass judgement on the scholarship involved, but beyond such considerations, Porter’s book is all the things that I might want from a book. It’s an engaging and exciting story, populated with vivid characters and momentous events, told with style and intelligence.

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