With The Greatest Benefit to Mankind: A Medical History of Humanity, Roy Porter has produced a monumental history of medicine, both as an institution and as an aspiration. It can be read as an encyclopedia of medical development through the ages. It is also an extended meditation on the purposes and limits of medicine. On both levels, it is a highly impressive work. Porter’s history will likely live as a standard work for years to come.
Porter writes with authority. He holds a chair in the social history of science at the Wellcome Institute for the History of Science in Great Britain, and he is the editor of the Norton History of Science Series. He has published extensively on the history of medicine. Even so, the ambition of his undertaking is breathtaking. He had to master a voluminous and complicated literature, ranging over thousands of years of medical activity. Although his work is chiefly concerned with the evolution of medicine in the Western world, Porter does not ignore medical traditions in other parts of the world, and he pays attention to the medical practices of Africa, India, and China. Such a prodigious exercise in erudition could easily become an unreadable litany of doctors, diseases, and drugs, but Porter manages to keep his book fluid and engaging, leavening his facts with witty observations and fascinating anecdotes. Readers of this work will lay in a rich store of medical information, ranging from the ancient Egyptian recipe for curing baldness to the surgical techniques of heart-transplant pioneer Christiaan Barnard.
The organization of Porter’s book is straightforward. He begins his narrative with the Near-Eastern precursors to Western civilization in Mesopotamia and along the Nile. He then moves to ancient Greece and Rome before settling comfortably in the familiar Western European heartland. Aside from forays to India and China, Porter moves forward chronologically through the great Western epochs, Middle Ages, Renaissance, and Enlightenment, before reaching the more modern times of the nineteenth century. There, because of the accelerating expansion of medical knowledge, Porter’s treatment becomes more topical. His chapters reflect the growth of medical specialization, and he addresses such subjects as the new discipline of psychiatry and the institutionalization of medical research.
One reason that Porter’s story is so absorbing is because medicine, and the questions that it raises, touches us all. Human beings have always wrestled with their nagging physical frailty. All human societies have possessed ideas about life and death, disease and health. Most have linked the individual’s well- being to forces immanent in the wider world, attributing bodily distempers to such powers as divine will or malevolent spirits. In such societies, the way of health lay in one sustaining the proper relationship with the cosmos.
The Western medical perspective took a distinctive turn in antiquity, when Greek healers began to treat illness as simply a derangement of the body itself. The Greeks shifted medical explanation from the realm of the transcendental and began looking for purely natural causes of diseases and their cures. The Greeks thus laid the foundations of medicine as a science. In addition, Greek writers would shape the parameters of Western medical discourse for millennia. The library of medical works associated with the legendary Greek physician Hippocrates stressed the importance of maintaining the bodily equilibrium of the four humours, or “fluids” (blood, phlegm, choler, and black bile), the balance of which regulated a person’s health. Disturbances in the humoral order led to illness; restoration of the natural state of the humours in a person was the task of medicine. The humoral vision of the human constitution would persist for almost two thousand years, into the eighteenth century. It encouraged physicians to emphasize the importance of what would today be called “lifestyle,” urging their patients to monitor their diet, exercise, and cleanliness, striving always for the classical idea of moderation. Ancient medical men devoted themselves to preventing health problems in part because there was little that they could do to assist ailing patients. Such trusted remedies as bleeding probably did more harm than good. Physicians lacked accurate anatomical and physiological knowledge. The Greeks refused to dissect human beings, relying on animal studies and the practical insight gleaned from battlefield medicine. Only later, in Hellenistic Alexandria, and beyond that, during the period of the Roman Empire, did medical men begin to speculate openly about the working of the human body. The most notable example was the Roman physician Galen, who took great pride in his anatomical expertise. Yet even Galen confined himself to dissecting apes and other animals. The stigma attached to the cutting...
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