The Greatest Benefit to Mankind: A Medical History of Humanity

THE

GREATEST BENEFIT

TO MANKIND

A Medical History of

Humanity from

Antiquity to the Present

ROY PORTER

COPYRIGHT

William Collins

An imprint of HarperCollinsPublishers Ltd. 1 London Bridge Street London SE1 9GF

www.harpercollins.co.uk

First published in Great Britain by HarperCollins Publishers 1997

Copyright © Roy Porter 1997

Roy Porter has asserted the moral right to be identified as the author of this work

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PRAISE

More from the reviews:

‘An endlessly beguiling grand tour d’horizon… Nobody could do this colossal subject better justice than Professor Porter.’

MICHAEL BYWATER, New Statesman

‘History as compulsive as this is a splendid reminder of the essential truth [of mortality]… an admirable and a richly enjoyable book’

New Scientist

‘What? Yet another compulsively readable, astonishingly encyclopaedic book from Roy Porter? The Greatest Benefit to Mankind might be his best to date: an epic, one-volume narrative history of man’s struggle with the infirmities of his body, from Aesculapius to AIDS. The author’s perceptiveness is, as usual, scalpel-sharp; his manner genially bedside; his erudition invigorating. To get the full benefit of Dr Porter’s tonic, take a dose of the book at least once a day and retire early to bed.’

SIMON SCHAMA

‘Riveting … one of the abiding impressions left by this astonishingly erudite historical survey is of the enormous intellectual effort across all cultures to try and understand the origins of illness. Another is what perilous lives we have led, especially since we created cities to live in. There is prodigious labour here, as well as generous helpings of wit… This fine book is much more than a chronicle of the rise of modern medical science. It is also a splendidly salutary reminder of the precariousness and pain of the human lot through most of our history. After reading it, anyone who has ever attended a birth, overcome an infection by taking a pill or had a pain-free operation, should be left profoundly grateful to be living in the second half of the 20th century, rather than any of the centuries before.’

JON TURNEY, Financial Times

‘Excellent … In this fine book, Porter has managed to weave together both approaches to the history of medicine. On the one hand he has drawn thumbnail sketches of the rich variety of personalities whose achievements were seminal to the slow evolution of the field. His choices are nothing if not catholic: Galen, William Harvey, Louis Pasteur and like giants were not unexpected; Jacob Bigelow, Dock and other pioneers of medical education may be less familiar; and the Egyptian healer Iri, keeper of the royal rectum is a genuine collector’s piece. Yet at the same time Porter has managed to set each stage of this complex story in its social and demographic framework. Even more remarkably, he has maintained this dualistic approach in accounts of medical practice in ancient Greece, China and India, through its Arab-Islamic period and in medieval England to the present day. Yet this massive fact-filled volume is written so eloquently, with such style, insight and humour that it is extremely difficult to put down… Porter has performed a great service to today’s (and tomorrow’s) doctors and to the community at large by placing the current medical scene in its broad historical perspective. And in so doing he has managed to write a wonderfully entertaining book. His synthesis of the modern doctor’s dilemma is spot on. All those who have the daunting task of trying to redefine the goals of medical practice for the future should read this book and then read it again. It is a magnificent achievement.’

DAVID WEATHERALL, THES

‘The richness of the historical information is matched by the vividness of his assessment of present dangers from the resurgence of disease.’

JOHN MADDOX, New Statesman, Books of the Year

‘Porter is both immensely learned and highly readable. Readers who, like myself, enjoy discovering unexpected facts will find this book a treasure trove… Roy Porter’s mammoth medical history is an extraordinary achievement; it is lively and full of fascinating information.’

ANTHONY STORR, Observer

‘A marvellous canter through 10,000 years of disease, diagnosis and death’

TIM RADFORD, Guardian

‘Big, broad-minded, compendious yet lively and extremely readable’

Scotsman

‘A bedside book which can be guaranteed to interest, educate and soothe the most disturbed insomniac. The book is amusingly – even racily written. Porter’s role as a commentator has not detracted from historical detail, as the anecdotal style with which he describes the intricacies of medical practice throughout the ages makes it blend seamlessly with his analyses of social conditions. Although doctors and patients who have lived and worked through the medical revolution of the post-antibiotic era, and all the other changes of the past 50 years, may find this book particularly fascinating, it also makes interesting reading to those who have no previous specialised knowledge in either history or medicine. The Greatest Benefit to Mankind is as much a gigantic essay on medicine as it is a textbook and is particularly effective in revealing the changes in medicine over the past 150 years, together with the social and political changes which first prompted them … Porter is particularly stimulating when writing on the history of mental disease… Readers will find enough detail to make them glad that they live in a time where there are anaesthetics, surgical teams and a sophisticated pharmaceutical industry, but the descriptions are not so gory that the insomniac who seeks relief within its covers will later fear to turn out the lights.’

THOMAS STUTTAFORD, The Times

‘Most impressive… a titanic 800-pager which ranges from pre-history to the present… Porter is the master of the telling quotation… He is also the first historian to tackle the complexities of medicine’s recent past, with the extraordinary therapeutic revolution of the post-war years.’

JAME SLEFANU, Daily Telegraph

‘An impressive sweep from the Greeks to the present day… [The Greatest Benefit to Mankind] bears endless dipping into. It is a unique reference book, mixing an abundance of factual material with lively sociological insights. Certainly no medical student should be without it’

JOHN CORNWELL, Sunday Times Christmas Books 1997.

‘I intend to keep this book within reach for years to come… text book history at its best… Porter matches strong opinions to his mastery of the facts.’

ALFRED W CROSBY, Nature

‘This book is so stimulating and thought-provoking that, frankly, by the time I’d finished it I was in such a brain-overloaded anxiety state that I had to resort to one of modern medicine’s great innovations – a Valium pill.’

VAL HENNESSY, Daily Mail

‘Excellent’

Evening Standard, Christmas Books

‘To combine enormous knowledge and a delightful style and a highly idiosyncratic point of view is Roy Porter’s special gift, and it makes his new book alive and fascinating and provocative on every page.’

OLIVER SACKS

‘Sprawlingly compendious, encyclopaedically detailed and utterly free from any sort of triumphalist condescension about present achievement and past superstition… Every clinician, every aspirant clinician, every patient should read this wise book.’

BRIAN MORTON, Scotland on Sunday

‘Mr Porter, a formidably learned man, seems in this history to have omitted no discovery and no medical scientist of any importance… this account is completely without the cynicism which disfigures so much recently written medical history.’

Economist

‘Only the unique artistry or Roy Porter could have created this panoramic and perfectly magnificent intellectual history of medicine. It makes no difference whether one reads it for its wisdom, insight, inimitable perspective, or simply for its plenitude of information – this is the book that delivers it all, plus the sheer joy of hearing the distinct voice of one of today’s most fascinating commentators on the development of the ancient art of healing.’

SHERWIN B. NULAND

‘Intelligent and highly readable’

AMANDA FOREMAN, Independent

‘Intelligent analysis… Porter stresses at the beginning and reiterates powerfully throughout his captivating text, the authority and legitimacy of scientific medicine in Western society has lain only in small measure in its ability to cure the sick… interesting and provocative.’

LARA MARKS, History Today

‘Everything he writes is highly readable and his erudition is formidable.’

ANTHONY DANIELS, Sunday Telegraph

‘The solid virtues of The Greatest Benefit include clarity, calm and expertise in the art of the compressed anecdote: as in this sentence which concludes the career of the laughing gas pioneer: ‘Wells lost medical support, grew depressed, became addicted to chloroform, and after arrest in New York for hurling sulphuric acid at two prostitutes, committed suicide in jail’. The quotes are often very funny or very sad.’

ERIC CHRISTIANSEN, Spectator

‘Interesting… abounding in titbits of curious information.’

WILLIAM H. McNEILL, TLS

‘This huge book is an amazing achievement’

Irish Independent

‘A hugely enjoyable exploration of medicine and history. From hunter-gatherer to heart transplant, a matrix of ideas and events is woven, seamlessly incorporating medicine, philosophy, science and history. A seductive spell is cast… the prose flows effortlessly, the material well-organised and anecdotally fascinating… A great read.’

ALAN MUNRO, British Journal of General Practice

‘Wonderful… A powerful overview’

British Medical Journal

‘In this excellent book, Porter combines the presentation of full details concerning the science, art and practice of medicine through the ages with a refreshingly critical approach… readable and accessible to a wide audience, outshining other more traditional histories of medicine… truly a major achievement.’

International History of Nursing Journal

DEDICATION

TO

Mikuláš Teich,

true friend and scholar

Sick – Sick – Sick … O Sick – Sick – Spew

DAVID GARRICK, in a letter

I’m sick of gruel, and the dietetics,

I’m sick of pills, and sicker of emetics,

I’m sick of pulses, tardiness or quickness,

I’m sick of blood, its thinness or its thickness, –

In short, within a word, I’m sick of sickness!

THOMAS HOOD, ‘Fragment’, c. 1844

They are shallow animals, having always employed their minds about Body and Gut, they imagine that in the whole system of things there is nothing but Gut and Body.

SAMUEL TAYLOR COLERIDGE, on doctors (1796)

CONTENTS

COVER

TITLE PAGE

COPYRIGHT

PRAISE

DEDICATION

I Introduction

II The Roots of Medicine

III Antiquity

IV Medicine and Faith

V The Medieval West

VI Indian Medicine

VII Chinese Medicine

VIII Renaissance

IX The New Science

X Enlightenment

XI Scientific Medicine in the Nineteenth Century

XII Nineteenth-Century Medical Care

XIII Public Medicine

XIV From Pasteur to Penicillin

XV Tropical Medicine, World Diseases

XVI Psychiatry

XVII Medical Research

XVIII Clinical Science

XIX Surgery

XX Medicine, State and Society

XXI Medicine and the People

XXII The Past, The Present and the Future

FURTHER READING

INDEX

ACKNOWLEDGEMENTS

ABOUT THE AUTHOR

ABOUT THE PUBLISHER

CHAPTER I INTRODUCTION

THESE ARE STRANGE TIMES, when we are healthier than ever but more anxious about our health. According to all the standard benchmarks, we’ve never had it so healthy. Longevity in the West continues to rise – a typical British woman can now expect to live to seventy-nine, eight years more than just half a century ago, and over double the life expectation when Queen Victoria came to the throne in 1837. Break the figures down a bit and you find other encouraging signs even in the recent past; in 1950, the UK experienced 26,000 infant deaths; within half a century that had fallen by 80 per cent. Deaths in the UK from infectious diseases nearly halved between 1970 and 1992; between 1971 and 1991 stroke deaths dropped by 40 per cent and coronary heart disease fatalities by 19 per cent – and those are diseases widely perceived to be worsening.

The heartening list goes on and on (15,000 hip replacements in 1978, over double that number in 1993). In myriad ways, medicine continues to advance, new treatments appear, surgery works marvels, and (partly as a result) 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 bombard us with medical news – breakthroughs in biotechnology and reproductive technology, for instance. But the effect is to raise alarm more than our spirits.

The media specialize in scare-mongering but they also capture a public mood. There is a pervasive sense that our well-being is imperilled by ‘threats’ all around, from the air we breathe to the food in the shops. Why should we now 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 now have the leisure to enjoy the luxury of worrying?

These may be questions for a psychologist but, as this book aims to demonstrate, they are also matters of historical inquiry, examining the dialectics of medicine and mentalities. And to understand the dilemmas of our times, such facts and fears need to be put into context of time and place. We are today in the grip of opposing pressures. For one thing, there is the ‘rising-expectations trap’: we have convinced ourselves that we can and should be fitter, more youthful, sexier. In the long run, these are impossibly frustrating goals, because in the long run we’re all dead (though of course some even have expectations of cheating death). Likewise, we are healthier than ever before, yet more distrustful of doctors and the powers of what may broadly be called the ‘medical system’. Such scepticism follows from the fact that medical science seems to be fulfilling the wildest dreams of science fiction: the first cloning of a sheep was recently announced and it will apparently be feasible to clone a human being within a couple of years. In the same week, an English widow was given permission to try to become pregnant with her dead husband’s sperm (but only so long as she did it in Belgium). These are amazing developments. We turn doctors into heroes, yet feel equivocal about them.

Such ambiguities are not new. When in 1858 a statue was erected in the recently built Trafalgar Square to Edward Jenner, the pioneer of smallpox vaccination, protests followed and it was rapidly removed: a country doctor amidst the generals and admirals was thought unseemly (it may seem that those responsible for causing deaths rather than saving lives are worthy of public honour). Even in Greek times opinions about medicine were mixed; the word pharmakos meant both remedy and poison – ‘kill’ and ‘cure’ were apparently indistinguishable. And as Jonathan Swift wryly reflected early 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 double idea – death and the doctors riding together – has loomed large in history. It is one of the threads we will follow in trying to assess the impact of medicine and responses to it – in trying to assess Samuel Johnson’s accolade to the medical profession: ‘the greatest benefit to mankind.’

‘The art has three factors, the disease, the patient, the physician,’ wrote Hippocrates, the legendary Greek physician who has often been called the father of medicine; and he thus suggested an agenda for history. This book will explore diseases, patients and physicians, and their interrelations, concentrating on some more than others. It is, as its sub-title suggests, a medical history.

My focus could have been on disease and its bearing on human history. We have all been reminded of the devastating effects of pestilence by the AIDS epidemic. In terms of death toll, cultural shock and socio-economic destruction, the full impact of AIDS cannot yet be judged. Other ‘hot viruses’ may be coming into the arena of history which may prove even more calamitous. Historians at large, who until recently tended to chronicle world history in blithe ignorance of or indifference to disease, now recognize the difference made by plague, cholera and other pandemics. Over the last generation, distinguished practitioners have pioneered the study of ‘plagues and peoples’; and I have tried to give due consideration to these epidemiological and demographic matters in the following chapters. But they are not my protagonists, rather the backdrop.

Equally this book might have focused upon everyday health, common health beliefs and routine health care in society at large. The social history of medicine now embraces ‘people’s history’, and one of its most exciting developments has been the attention given to beliefs about the body, its status and stigmas, its race, class and gender representations. The production and reproduction, creation and recreation of images of Self and Other have formed the subject matter of distinguished books. Such historical sociologies or cultural anthropologies – regarding the body as a book to be decoded – reinforce our awareness of the importance, past and present, of familiar beliefs about health and its hazards, about taboo and transgression. When a body becomes a clue to meaning, popular ideas of health and sickness, life and death, must be of central historical importance. I have written, on my own and with others, numerous books exploring lay health cultures in the past, from a ‘bottom-up’, patients’ point of view, and hope soon to publish a further work on the historical significance of the body.

This history, however, is different. It sets the history of medical thinking and medical practice at stage centre. It concentrates on medical ideas about disease, medical teachings about healthy and unhealthy bodies, and medical models of life and death. Seeking to avoid anachronism and judgmentalism, I devote prime attention to those people and professional groups who have been responsible for such beliefs and practices – that is healers understood in a broad sense. This book is principally about what those healers have done, individually and collectively, and the impact of their ideas and actions. While placing developments in a wider context, it surveys medical theory and practices.

This approach may sound old-fashioned, a resurrection of the Whiggish ‘great docs’ history which celebrated the triumphal progress of medicine from ignorance through error to science. But I come not to praise medicine – nor indeed to blame it. I do believe that medicine has played a major and growing role in human societies and for that reason its history needs to be explored so that its place and powers can be understood. I say here, and I will say many times again, that the prominence of medicine has lain only in small measure in its ability to make the sick well. This always was true, and remains so today.

I discuss disease from a global viewpoint; no other perspective makes sense. I also examine medicine the world over. Chapter 2 surveys the emergence of health practices and medical beliefs in some early societies; Chapter 3 discusses the rise of formal, written medicine in the Middle East and Egypt, and in Greece and Rome; Chapter 4 explores Islam; separate chapters discuss Indian and Chinese medicine; Chapter 8 takes in the Americas; Chapter 15 surveys medicine in more recent colonial contexts, and other chapters have discussions of disorders in the Third World, for instance deficiency diseases. The book is thus not narrowly or blindly ethnocentric.

Nevertheless, I devote most attention to what is called ‘western’ medicine, because western medicine has developed in ways which have made it uniquely powerful and led it to become uniquely global. Its ceaseless spread throughout the world owes much, doubtless, to western political and economic domination. But its dominance has increased because it is perceived, by societies and the sick, to ‘work’ uniquely well, at least for many major classes of disorders. (Parenthetically, it can be argued that western political and economic domination owes something to the path-breaking powers of quinine, antibiotics and the like.) To the world historian, western medicine is special. It is conceivable that in a hundred years time traditional Chinese medicine, shamanistic medicine or Ayurvedic medicine will have swept the globe; if that happens, my analysis will look peculiarly dated and daft. But there is no real indication of that happening, while there is every reason to expect the medicine of the future to be an outgrowth of present western medicine – or at least a reaction against it. What began as the medicine of Europe is becoming the medicine of humanity. For that reason its history deserves particular attention.

Western medicine, I argue, has developed radically distinctive approaches to exploring the workings of the human body in sickness and in health. These have changed the ways our culture conceives of the body and of human life. To reduce complex matters to crass terms, most 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 human beings to the wider cosmos: planets, stars, mountains, rivers, spirits and ancestors, gods and demons, the heavens and the underworld, and so forth. Some traditions, notably those reflected in Chinese and Indian learned medicine, while being concerned with the architecture of the cosmos, do not pay great attention to the supernatural. Modern western thinking, however, has become indifferent to all such elements. The West has evolved a culture preoccupied with the self, with the individual and his or her identity, and this quest has come to be equated with (or reduced to) the individual body and the embodied personality, expressed through body language. Hamlet wanted this too solid flesh to melt away. That – except in the context of slimming obsessions – is the last thing modern westerners want to happen to their flesh; they want it to last as long as possible.