Book Review

Porter, R (1998); The Cambridge Illustrated History of Medicine. Cambridge University Press
ISBN: 0-521-44211-7  [USD 42.17]

My relationship with this book started in the south Indian city of Hyderabad in Dec 2002, at the time of my enrollment in the ‘Health Systems Research’ program. Before long, my initial perplexity with the notion of reading history in a technical school soon gave way to a mesmeric realism of the massive import and relevance of the subject to my field of work. The Cambridge Illustrated History of Medicine is one of the many seminal works of the celebrated British historian, (Late) Roy Sydney Porter (1946–2002). Until a year prior to his death in 2002, Porter was serving as the Director of the Wellcome Institute for the History of Medicine at University College, London.

Porter deftly chronicles the evolution of medical profession from the pre historic era, through the 19th century ‘age of science’ and right up to the contemporary post-modern medical enterprise. The book scores high both in terms of insightful narratives and aesthetic use of visual imagery. The 4th century carvings of Athenian ‘God of healing Asclepius’; the illustrations of the 113 A.D. Roman ‘Battlefield – School of Surgery’, and, the painter’s rendition of the first ever surgery performed under general anesthesia in 1846  at Harvard Medical School, are just a few examples of the visual ambience that add to the authenticity of the book.

The writer’s mastery of the subject is unmistakable, both in terms of comprehensiveness and lucidity of prose. He has tried to offer a balanced perspective on the inherent complexities of the health care ecosystem alongside its evolution over time. The chapters are logically organized, each capturing a key element of the medical discipline in its entirety (e.g., History of Disease; Primary Care; Hospitals and Surgery; Pharmacology).

In ‘Medicine, Society and the State’, the author questions the ‘altruistic’ imperative that has long come to be attributed to the medical profession. He argues that medicine has historically been an instrument of sociopolitical power and that medicine of its times has always aligned itself with the powers-that-be, for its own survival rather than anything else. Porter manages to hold his ground well throughout and profusely cites examples like the complicity of German doctors in the experiments and exterminations during the holocaust. However, coming from a sociological ‘conflict’ perspective, there is a discernible bias in Porter’s assertion on this account.

The author does well to reflect on the new ethical challenges brought about by the rampant use of technology and dehumanization of the doctor-patient relationship. The take home message from the book is as profound as it is pragmatic– ‘History can provide us valuable lessons for the future’. The book concludes on a positive note:

“…as long as science holds its current position, medicine will surely stay with it. Not bounded by it; that is one of its current weaknesses. But, rooted practically and intellectually within it.”

The book is a must-read for public health practitioners.

Review by: Sanjeev Verma