The Greatest Benefit to Mankind. Roy Porter

       CHAPTER I INTRODUCTION

      THESE ARE STRANGE TIMES, when we are healthier than ever but more anxious about our health. According to all the standard benchmarks, we’ve never had it so healthy. Longevity in the West continues to rise – a typical British woman can now expect to live to seventy-nine, eight years more than just half a century ago, and over double the life expectation when Queen Victoria came to the throne in 1837. Break the figures down a bit and you find other encouraging signs even in the recent past; in 1950, the UK experienced 26,000 infant deaths; within half a century that had fallen by 80 per cent. Deaths in the UK from infectious diseases nearly halved between 1970 and 1992; between 1971 and 1991 stroke deaths dropped by 40 per cent and coronary heart disease fatalities by 19 per cent – and those are diseases widely perceived to be worsening.

      The heartening list goes on and on (15,000 hip replacements in 1978, over double that number in 1993). In myriad ways, medicine continues to advance, new treatments appear, surgery works marvels, and (partly as a result) people live longer. Yet few people today feel confident, either about their personal health or about doctors, healthcare delivery and the medical profession in general. The media bombard us with medical news – breakthroughs in biotechnology and reproductive technology, for instance. But the effect is to raise alarm more than our spirits.

      The media specialize in scare-mongering but they also capture a public mood. There is a pervasive sense that our well-being is imperilled by ‘threats’ all around, from the air we breathe to the food in the shops. Why should we now be more agitated about pollution in our lungs than during the awful urban smogs of the 1950s, when tens of thousands died of winter bronchitis? Have we become health freaks or hypochondriacs luxuriating in health anxieties precisely because we are so healthy and long-lived that we now have the leisure to enjoy the luxury of worrying?

      These may be questions for a psychologist but, as this book aims to demonstrate, they are also matters of historical inquiry, examining the dialectics of medicine and mentalities. And to understand the dilemmas of our times, such facts and fears need to be put into context of time and place. We are today in the grip of opposing pressures. For one thing, there is the ‘rising-expectations trap’: we have convinced ourselves that we can and should be fitter, more youthful, sexier. In the long run, these are impossibly frustrating goals, because in the long run we’re all dead (though of course some even have expectations of cheating death). Likewise, we are healthier than ever before, yet more distrustful of doctors and the powers of what may broadly be called the ‘medical system’. Such scepticism follows from the fact that medical science seems to be fulfilling the wildest dreams of science fiction: the first cloning of a sheep was recently announced and it will apparently be feasible to clone a human being within a couple of years. In the same week, an English widow was given permission to try to become pregnant with her dead husband’s sperm (but only so long as she did it in Belgium). These are amazing developments. We turn doctors into heroes, yet feel equivocal about them.

      Such ambiguities are not new. When in 1858 a statue was erected in the recently built Trafalgar Square to Edward Jenner, the pioneer of smallpox vaccination, protests followed and it was rapidly removed: a country doctor amidst the generals and admirals was thought unseemly (it may seem that those responsible for causing deaths rather than saving lives are worthy of public honour). Even in Greek times opinions about medicine were mixed; the word pharmakos meant both remedy and poison – ‘kill’ and ‘cure’ were apparently indistinguishable. And as Jonathan Swift wryly reflected early in the eighteenth century, ‘Apollo was held the god of physic and sender of diseases. Both were originally the same trade, and still continue.’ That double idea – death and the doctors riding together – has loomed large in history. It is one of the threads we will follow in trying to assess the impact of medicine and responses to it – in trying to assess Samuel Johnson’s accolade to the medical profession: ‘the greatest benefit to mankind.’

      ‘The art has three factors, the disease, the patient, the physician,’ wrote Hippocrates, the legendary Greek physician who has often been called the father of medicine; and he thus suggested an agenda for history. This book will explore diseases, patients and physicians, and their interrelations, concentrating on some more than others. It is, as its sub-title suggests, a medical history.

      My focus could have been on disease and its bearing on human history. We have all been reminded of the devastating effects of pestilence by the AIDS epidemic. In terms of death toll, cultural shock and socio-economic destruction, the full impact of AIDS cannot yet be judged. Other ‘hot viruses’ may be coming into the arena of history which may prove even more calamitous. Historians at large, who until recently tended to chronicle world history in blithe ignorance of or indifference to disease, now recognize the difference made by plague, cholera and other pandemics. Over the last generation, distinguished practitioners have pioneered the study of ‘plagues and peoples’; and I have tried to give due consideration to these epidemiological and demographic matters in the following chapters. But they are not my protagonists, rather the backdrop.

      Equally this book might have focused upon everyday health, common health beliefs and routine health care in society at large. The social history of medicine now embraces ‘people’s history’, and one of its most exciting developments has been the attention given to beliefs about the body, its status and stigmas, its race, class and gender representations. The production and reproduction, creation and recreation of images of Self and Other have formed the subject matter of distinguished books. Such historical sociologies or cultural anthropologies – regarding the body as a book to be decoded – reinforce our awareness of the importance, past and present, of familiar beliefs about health and its hazards, about taboo and transgression. When a body becomes a clue to meaning, popular ideas of health and sickness, life and death, must be of central historical importance. I have written, on my own and with others, numerous books exploring lay health cultures in the past, from a ‘bottom-up’, patients’ point of view, and hope soon to publish a further work on the historical significance of the body.

      This history, however, is different. It sets the history of medical thinking and medical practice at stage centre. It concentrates on medical ideas about disease, medical teachings about healthy and unhealthy bodies, and medical models of life and death. Seeking to avoid anachronism and judgmentalism, I devote prime attention to those people and professional groups who have been responsible for such beliefs and practices – that is healers understood in a broad sense. This book is principally about what those healers have done, individually and collectively, and the impact of their ideas and actions. While placing developments in a wider context, it surveys medical theory and practices.

      This approach may sound old-fashioned, a resurrection of the Whiggish ‘great docs’ history which celebrated the triumphal progress of medicine from ignorance through error to science. But I come not to praise medicine – nor indeed to blame it. I do believe that medicine has played a major and growing role in human societies and for that reason its history needs to be explored so that its place and powers can be understood. I say here, and I will say many times again, that the prominence of medicine has lain only in small measure in its ability to make the sick well. This always was true, and remains so today.

      I discuss disease from a global viewpoint; no other perspective makes sense. I also examine medicine the world over. Chapter 2 surveys the emergence of health practices and medical beliefs in some early societies; Chapter 3 discusses the rise of formal, written medicine in the Middle East and Egypt, and in Greece and Rome; Chapter 4 explores Islam; separate chapters discuss Indian and Chinese medicine; Chapter 8 takes in the Americas; Chapter 15 surveys medicine in more recent colonial contexts, and other chapters have discussions of disorders in the Third World, for instance deficiency diseases. The book is thus not narrowly or blindly ethnocentric.