From Publishers Weekly
Some histories are simply too long for a short treatment, as this engaging but cursory volume demonstrates. Each chapter takes on various subtopics in the history of Western medicine: disease, doctors, the body, the laboratory, therapies, surgery, the hospital, and medicine and modern society. Porter, who died in 2002, cleverly uses this scheme to discuss major developments in rough chronological order: for example, in "The Body," he explains that important advances in anatomy preceded the evolution of the modern laboratory. The book derives from lectures in the social history of medicine that he gave at Wellcome Institute at University College, London. Even on the printed page he maintains a conversational tone that makes the topic wholly accessible. And his sometimes incisive observations go beyond the purely medical: "politicians... have been able to look to improved health care as a carrot to dangle before the electorate. Votes were to be had not just in bread and circuses but in beds and surgery." But too often such social analysis is sidelined by a rapid-fire recitation of dates, practitioners' names and fleeting references to their contributions. Porter clearly knew and loved his subject, but he could not bring himself to part with some of the trees to paint a clearer picture of the forest.
Copyright 2003 Reed Business Information, Inc.
From The New England Journal of Medicine
The death of Roy Porter at the age of 55 years in early 2002 was a grievous loss for both the scholarly community and the general public. One of the most prolific historians of his generation, Porter wrote and edited about 80 books. In a world of specialization, he was an exception. His first book dealt with the history of geology; subsequently, his attention shifted to 18th-century medicine and the history of psychiatry. But he never was confined by period or subject. In 1994 he published London: A Social History (London: Hamish Hamilton), which was followed three years later by The Greatest Benefit to Mankind: A Medical History of Humanity (Hammersmith, London: HarperCollins), an 800-page tome that spanned the centuries from the ancient Greeks to the present. Porter was also a catalyst; he encouraged scholars to ask novel questions and to examine untraditional sources. His works on 18th-century medicine and his emphasis on the need to understand patients as well as physicians opened new horizons. Beyond his scholarly activities, he reached a broad audience through public lectures and radio and television appearances. His dynamic personality, his humor, and his sense of irony appealed to both scholars and the general public. Blood and Guts -- a brief book, running to fewer than 60,000 words -- originated in lecture courses given at the Wellcome Trust Centre for the History of Medicine at University College London. In breathtaking and fearless fashion, Porter surveys Western medicine from antiquity to the present. The history of medicine, he suggests, is not synonymous with the history of physicians. On the contrary, the subject involves complex interactions of human beings, disease patterns, and healers set within societies and cultures that each have their own unique beliefs. The chapters cover such topics as disease patterns, healers, the investigation of the body, the emergence of the biomedical model of disease, therapeutics, surgery, and the hospital. Nowhere was change linear; heated debates invariably accompanied theory, practice, and discussions dealing with appropriate institutional and structural forms of medicine. In the final chapter Porter assesses the broad sociopolitical and economic implications of the health care industry, which in the United States now accounts for about 15 percent of the gross domestic product yet leaves about 40 million persons without insurance coverage. Although the evolution of medical thinking and practice occurred in an international setting, Porter emphasizes national differences as well as similarities. In Britain, for example, the National Insurance Act of 1911 and the founding of the National Health Service in 1948 ensured that primary care would remain in the hands of generalist family physicians, whose role was to be gatekeepers for hospitals and specialists. In the United States, by contrast, general practice lost out to specialism. In both nations, medical care, increasingly driven by bureaucracy and technology, helped to undermine the element of trust between patient and doctor, thus contributing to the revitalization of alternative medicine. By the end of the 20th century, for example, there were more registered alternative healers in Britain than general practitioners; in the United States there were 425 million visits to providers of unconventional therapy, as compared with 388 million visits to primary care physicians. In such an inclusive and brief book, inevitably some statements are open to challenge. Porter repeats the familiar claim that diseases of affluence, such as cancer and coronary heart disease, result from Western lifestyles that include fatty diets, junk foods, cigarettes, alcohol, and drugs. The data supporting such a claim, however, are less than persuasive. With the exception of the connection between lung cancer and smoking, the cause of most cancers remains unknown. Similarly, the relation between coronary heart disease and risk factors is at best murky. Deaths from coronary heart disease rose sharply during the first half of the 20th century, when most of the risk factors mentioned were absent, and fell dramatically in the second half, when they peaked. Porter also repeats the famous statement attributed to Surgeon General William Stewart in 1969 that the war against infectious disease had been won. Stewart never made such a statement, even though many persist in attributing it to him. Those who are knowledgeable about the history of medicine will find relatively little that is new in this brief book, but Blood and Guts is a delightful and informative introduction to an important subject by one of the outstanding scholars of his generation. The book may even lead some readers to follow up by reading Porter's magisterial work, The Greatest Benefit to Mankind. Gerald N. Grob, Ph.D.
Copyright © 2003 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.