Book Review

The Cambridge Illustrated History of Medicine

N Engl J Med 1997; 336:884-885March 20, 1997

Article

The Cambridge Illustrated History of Medicine
Edited by Roy Porter. 400 pp., illustrated. New York, Cambridge University Press, 1996. $39.95. ISBN: 0-521-44211-7

The title page of this book includes a magnificent painting of a hospital sick ward in Bruges done in 1778 by Johannes Beerblock. Entering the book through this picture is symbolic of the experience of reading it and browsing through its illustrations, almost experiencing whiffs of the heavy smells of infection. The book immerses the reader in the history of one of the noblest and earliest professions. It will be valuable for those in need of references or photographs for lectures or as a gift for a physician when a grand gesture is wanted.

One of the book's great strengths is in showing us how things we now take for granted have developed. Our familiarity with EM photographs, CAT scans, PET scans, and MRIs has become so great that we scarcely recognize the words from which the acronyms are derived — electron microscopy, computed axial tomography, positron-emission tomography, and magnetic resonance imaging. The growth of our knowledge of these systems and devices has been so rapid that it is difficult to remember their evolution. In looking to the future, the book discusses some promises of medicine, such as the eradication of infectious diseases and the use of gene therapy. This book could serve well as a compelling textbook for medical-school courses that try to relate modern advances to past events.

In a recent book review of a history of women in Western Europe, the historian Lynn Hunt comments that no one would write a book about the history of men, because Western culture posits women as the category in need of explanation. Porter's History of Medicine includes women: six for their contributions to medicine in general and six Nobel laureates in physiology or medicine. Among them are Elizabeth Blackwell, who in 1849 became the first woman doctor in the United States; Helen Taussig, who worked on the “blue-baby syndrome” and was the first woman to be made a full professor at Johns Hopkins University; Margaret Sanger, who established the first American birth-control clinic in 1916; and Marie Stopes, who established the first birth-control clinic in London in 1921. Florence Nightingale, Dorothea Dix, Marie Curie, and Irene Curie are also mentioned.

In its historical analysis, the book puts medicine under the microscope and raises questions about the political and social roles of medicine. In the midst of this history of the splendid band of doctors with compassion, there is also a sordid history of doctors who, without the consent of their victims, have harmed patients. Recalling the amoral acts of medicine will help ensure that such experiments never happen again. The book discusses the human experimentation done by Nazi physicians and includes a photograph of a Jewish prisoner at the Dachau concentration camp being subjected to extreme variations of air pressure, but it does not mention the Tuskegee syphilis experiment, a 40-year study of untreated syphilis in black men in Macon County, Alabama. This study, which resulted in many premature deaths, was not terminated until 1972. Although gaps are inevitable in so broad-ranging a book, this important part of medical history should have been included.

The book is one of unique richness. John Pickstone's chapter “Medicine, Society and the State” and Roy Porter's on mental illness stand out as particularly elegant. Also noteworthy is the chapter on the history of disease by Kenneth K. Kiple, which is a magnificent overview, with photographs of ancient burial sites, a scanning electron micrograph of a louse found attached to the hair of an Egyptian mummy, icons, maps, Aztec drawings of patients with smallpox, a 19th-century engraving of soldiers with typhus, and a photograph of a malnourished child in Sudan. Among the indexes provided is a chronology of events from 9000 B.C. to 1995, starting with the early domestication of plants and animals and ending with the World Health Organization license for the development of the malaria vaccine, and including the founding of the first American birth-control clinic and the first showing, in 1972, of the television hospital drama M*A*S*H. Although its pace is fast as it moves through three millennia, this is a book of rare excellence.

Teaching university courses on the subjects found in this book sensitizes one to many ways of accessing information, such as through the Internet, libraries, and museums. Although a variety of media can be used to examine these subjects, none are as soul-satisfying as sitting with a manageable-sized book and moving back and forth through the well-done chronologic and general indexes, the index of medical personalities, and the list of major human diseases. Paintings by Raphael, Hogarth, Goya, Dürer, van Mierevelt, van Gogh, and Géricault are well reproduced, as are many engravings and photographs of statues, and it was fun to contrast a magnetic resonance image of a human body with an anatomical drawing from Andreas Vesalius's De Humani Corporis. This distinguished book should be shared with students and colleagues and just enjoyed by its owner.

Helen C. Davies, Ph.D.
University of Pennsylvania School of Medicine, Philadelphia, PA 19104