Medicine and books: The Greatest Benefit to Mankind: A Medical History of Humanity From Antiquity to the Present
Authors: Benjamin Hope
Journal: BMJ (1998)

Roy Porter 

Harper Collins, £24.99, pp 831 

ISBN 0 00215173 1 

Before I read this, my knowledge of medical history could be summed up in a few sentences. I knew that the medical-industrial complex had become a victim of its own success and that until quite recently doctors could not do much. I had an idea about their professional status, without knowing how that privilege was won and protected. I knew that doctors demand autonomy, but that collectively they make a wonderful political football. Someone had told me that Pasteur discovered vaccination; someone else that it was Turkish folk medicine. 

Roy Porter’s book gave me the chance to flesh out my paltry analysis. Here was a wide ranging, up to date survey of medicine’s place in society. I would find out how medicine got so big, and how doctors can look at things that are so small. I would find out what they did before the antibiotic revolution, and how they got away with bleeding everyone for hundreds of years. I might even get a glimpse of what motivated the heroes and the villains. 

Was I foolish to expect such insight from a telescoping of over 3000 years into less than a thousand pages? No, because Porter pulls it off. Read as a narrative rather than reference, his book provides a powerful overview. He is keen to avoid the pitfalls of his project: the “enormous condescension of posterity,” the temptation to dismiss pre-scientific medical traditions. As he puts it, “I have tried to understand the medical systems I discuss rather than passing judgement on them.” At the same time, he admits his is a “winner’s history,” concentrating on developments that have contributed most to the current biomedical beast that holds sway. (He wryly notes that a history written from the patient’s point of view would look rather different.) 

Surveying developments since the Enlightenment, Porter gains momentum. While he tells us enough about a few of the innovators (especially Virchow) to whet our appetites, biographical material is sparse; his mission is to show the consequences of discovery, to determine when and how it led to real change. Sometimes medical “advances” helped the medical profession, sometimes they helped the state (healthier armies, for example), and sometimes they helped the sick. Arriving at the present day, it is hard to unpick Porter’s strands of medicine, state, and society. True, there is a continuity of benevolence in his story, but there is equally a continuity of amorality and benighted collusion. In sum, his key players spend almost as much energy protecting their own interests as they do putting their weight behind farsighted reform. 

The book does offer an overview—an “Olympian verdict”—but this is not the same as an oversimplified conclusion. Medicine may have failed to deliver the “greatest good to the greatest number,” but there is no conspiracy among medical elites to expand professional dominance. “The medicalization of life could never have become entrenched had not the offerings of practitioners ... become accepted as desirable and beneficial.” But it does not take a Chomsky to know that what is and is not accepted has little to do with whether it is beneficial. Porter does not try to predict the future, but, at the end of his analysis, his horizon is a little bleak. For optimism, plunder the overview: medicine’s triumphs need the substrates of public trust and professional honesty. As long as we have those, there is hope.