Book Review 373: The Greatest Benefit to Mankind

THE GREATEST BENEFIT TO MANKIND: A Medical History of Humanity, by Roy Porter. 829 pages, illustrated. Norton paperback

Roy Porter’s history of medicine — intended to be comprehensive within the bounds of one volume — is somewhat triumphalist.

And why not? After 5,000 years of being unable to cure or prevent much of anything, about 150 years ago the scientific approach finally reached takeoff, so that today smallpox is eliminated and surgeons are able to repair the hearts of babies in the womb.

Yet Porter — who died young and undoctored in 2002 — is also somewhat pessimistic in “The Greatest Benefit of Mankind.”

And why not? In America at least half the population adheres to cults that still teach that disease is caused  by demons, and there are millions more (often overlapping the first category) who ignore scientific medicine in favor of quackery like chiropractic, homeopathy, naturopathy, qi gong, Rolfing and who knows what other nonsense.

Porter spends about 200 mostly earnest, occasionally lively pages rehearsing the more or less self-conscious medical belief systems of the pre-moderns. He pays no attention to folk or unorganized medicine although these of course are a big part of the whole history of medicine and still much with us; practically everyone in Mexico believes in the imaginary illness called fallen fontanelle, and similar survivals can be found anywhere.

Then he plunges in with his famous (in his home country of England) gusto to the scientific approach, which can be dated almost precisely to 1543, the miracle year when men, at least in western Europe, began to shed the superstitions of 100,000 years. It was a mostly discouraging slog, at least from the perspective of healing, because even though genuine knowledge accumulated, slowly, then, from about 1800, quickly, methods of preventing or curing disease were not found.

Porter writes amusingly and with more than usual candor about the rare advances. We not only learn (what we already knew from other sources) that Samuel Pepys was successfully cut for stone but the icky procedure that the surgeons had to use.

Only once does Porter falter, when he credits the early Christians for inventing the concept of charity as exemplified in the first hospitals. John Boswell, in “The Kindness of Strangers: Child Abandonment in Western Europe from Late Antiquity to the Renaissance,” showed that something like hospitals were created hundreds of years before the alleged appearance of Jesus.

Porter is right to say that hospitals were not originally intended to preserve life but to assist men to a good death — the ars moriendi. Only much later did the concept of leaving a hospital arrive and later still the concentration of medical care in hospitals, soon to be renamed medical centers.

For most of medical history, doctors offered solace not healing. And still today, that is most of what customers are asking for. And, according to Porter, not getting it, which helps explain the embrace of chiropractic and suchlike quackery. He is right at least as far as the quest for solace goes; Numerous studies have found that most (around 60%) of visits to primary care doctors are from people who do not have any organic condition. They just feel bad. Add in the ones who go to chiropractors and the like and the proportion of pointless chasing of medical or pseudomedical attention must soar to some ridiculous figure.

However, the situation is not so simple. Even evangelical Christians who are told by, eg, Rev. Pat Robertson that disease is caused by demons go to scientific doctors, not witch-doctors,  when they are really sick. I recall an amusing though unself-aware instance at a public hearing years ago.

Health insurors generally decline to cover services for certain conditions if the modality chosen is one that does not provide emergency room care. The chiropractor testifying was aggrieved to be kept off that gravy train because, as he explained to the county council, there aren’t any chiropractic emergency rooms.

Of course not. Nobody in his right mind goes to a chiropractor when he is really sick.

Porter’s summary chapters on medicine, state and society and medicine and the people are useful, even if you have no interest in the history of medicine, for their succinct catalogue of most of the issues that the success of scientific medicine has created for itself. It will be particularly revealing for American rightwingers who have swallowed whole the lies told about Britain’s spectacularly successful National Health Service over the years.

What it cannot reveal is why Porter himself refused to go to any doctor.