THE GREATEST BENEFIT TO MANKIND - A Medical History of Humanity, Roy Porter, W W Norton & Company, New York, 1997, xvi & 831 pp, (including 66 p index) $35, ISBN: 0-393-04634-6.

Review by Del Meyer, MD

Hippocrates, often called the father of medicine, stated that the art of medicine has three factors: the disease, the patient, and the physician. The present tome is a 10-year exploration of diseases, patients, and physicians, and their interrelations--a medical history of humanity.

The author lists the medical advances of the last half of the twentieth century. Infant mortality has fallen 80 per cent; deaths from infectious disease nearly halved; stroke deaths dropped by 40 per cent; coronary fatalities by 19 per cent--and those are diseases widely perceived to be worsening.

Medicine continues to advance; new treatments appear, surgery works marvels, and 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, specializing in scare tactics (which also play on the public mood), bombard us with medical news and breakthroughs that raise alarm more than spirits. "There is a pervasive sense that our well-being is imperilled by . . . the air we breathe to the food in the shops. Why should we 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 have the leisure to enjoy the luxury of worrying?"

"Likewise, we are healthier than ever before, yet more distrustful of doctors and the powers of what may broadly be call the 'medical system.' Medical science seems to be fulfilling the wildest dreams of science fiction. . . . We turn doctors into heroes, yet feel equivocal about them."

Porter feels such ambiguities are not new. He recalls that in 1858 a statue dedicated to Edward Jenner, the pioneer of the small pox vaccination, was erected in London's Trafalgar Square. Protests followed. It was unseemly for a country doctor to be amidst the generals and admirals. Porter asks if only those responsible for causing deaths rather than saving lives are worthy of public honor?

In Greek times, opinions about medicine were mixed. The word pharmakos meant both remedy and poison - "kill" and "cure" were apparently indistinguishable. Jonathan Swift wryly reflected 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 idea--death and doctors riding together--has loomed large in history. Porter follows this thread as he assesses the impact of medicine and the response to it.

Porter's goal is not to praise medicine--nor to blame it. He feels medicine has played a major and growing role in human societies and needs to be explored so that its place and powers can be understood. He repeatedly emphasizes that the prominence of medicine has lain only in small measure in its ability to make the sick well.

Porter discusses disease from a global viewpoint. A great number of chapters cover medical beliefs from early societies, the Middle East and Egypt; Greece and Rome; Islam; India and Chinese to American medicine and disorders in the Third World. He devotes most attention, however, to what is called "western" medicine. Its ceaseless spread throughout the world owes much to western political and economic domination.

Western medicine has developed distinctive approaches to exploring the workings of the human body in sickness and in health. Peoples and cultures the world over, throughout history, have construed life (birth and death, sickness and health) primarily in the context of an understanding of the relations of humans to the wider cosmos. Modern western thinking, however, has become indifferent to all such elements. The West has evolved a culture preoccupied with the self, reduced to the individual body which must last as long as possible.

Porter's ambitious ten-year effort rewards us by taking us through a series of stages, belief systems, transcendental explanations, natural law, structures of medical organizations, temperaments of individuals, quacks, medical police, the hospital sphere, national insurance, national health schemes, and state bureaucracies throughout medical world history. Through his research, Porter became more aware of his own and the collective ignorance of historians about the medical history of mankind. The most celebrated physician is Hippocrates, yet we know nothing about him. Neither do we know anything concrete about most medical encounters. The historical record is like the night sky: we see a few stars and group them into mythic constellations. But what is chiefly visible is the darkness. As physicians, we need to read this masterpiece so that we see more and brighter stars.