Book Review

Genetics and Medicine in the United States 1800 to 1922

N Engl J Med 1995; 332:275-276January 26, 1995

Article

Genetics and Medicine in the United States 1800 to 1922
By Alan R. Rushton. 209 pp. Baltimore, Johns Hopkins University Press, 1994. $45. ISBN: 0-8018-4781-8

The title of this book is initially confusing, in that it is not a history of genetics and medicine but, rather, a history of clinical genetics and the attitudes of the medical establishment toward what was then a new and mysterious field. Dr. Rushton describes the era from 1800 to 1922 with special reference to the early part of this century, but there is a sense of déjà vu in reading about the attitudes of organized medicine regarding a new specialty. Driven by the current emphasis on increasing primary care at the expense of specialized training, those in charge of health care planning have put on the same blinders that were evident 80 years ago with respect to the improved health care made available by scientific advances and a depth of training and understanding of new techniques and knowledge. Similarly, earlier physicians generally rejected the emphasis on prevention, as found in genetics, in favor of pure therapeutics — a debate that has not yet ended.

Another aspect of history's repeating itself is Rushton's discussion of a group of geneticists, better called eugenicists, led by Charles B. Davenport. They made mention of the dilution of good American (read “WASP”) stock by Eastern Europeans (read Jewish and Catholic immigrants). The same argument was made in 1925 by Karl Pearson and his colleagues in England, and these arguments both here and in Britain led to attempts (often successful) to limit immigration. A major component of these arguments was the lesser “intelligence” of immigrant groups. We have seen the same false arguments applied in recent years, initially by Arthur R. Jensen and quite recently in a popular book by Charles Murray and Richard J. Herrnstein (The Bell Curve: Intelligence and Class Structure in American Life. New York: Free Press, 1994), but now applied to the black population of our country.

This book is divided into chronologic sections, with additional chapters on the impact of genetics on the specialties and the general practice of medicine. These five chapters are of interest primarily because of the broad collection of references that are not generally cited in today's literature. It is always useful to understand — and preferably, to read — the thinking that preceded our current philosophy and practice. One often finds that although technology may change, thought processes tend to repeat themselves. My only complaint about these references is that the author frequently mixes citations of original papers and current reviews and commentaries, rather than consistently referring to primary sources. (For example, on page 37, in discussing epilepsy and severe mental illness, the author refers to “Mann, 1883; Hamilton, 1886; Temkin, 1971.”)

The book's final chapter, entitled “On the Making of Paradigms,” is somewhat out of place. It departs from historical study and turns to the author's own thoughts on the future of genetics in medicine; therefore, it shows evidence of personal bias, as opposed to analytic reporting. This section is not well researched and contains some mistakes and misapprehensions. For example, in a discussion of retinoblastoma, it is stated that “in familial retinoblastoma, both copies of RB gene have mutations.” In fact, only one mutation is inherited, whereas a second mutation occurs randomly in cells destined to become malignant; the latter process is identical to that in nonfamilial retinoblastoma. In this last chapter, the author ends with a plea to alter the environment so as to improve the lot of those who have potentially detrimental genetic abnormalities. He ends by saying, “This is true eugenics.” In fact, this practice is not eugenics at all; rather, it has long been termed “euthenics” and has been the backbone of therapy for genetic diseases for many decades.

My guess is that this book will be deemed useful by students of the history of science and medicine but that it will not find its way into most libraries of medical scientists and clinicians.

Kurt Hirschhorn, M.D.
Mount Sinai School of Medicine, New York, NY 10029-6574