July 26th, 2022
IN THE HISTORY OF MEDICINE, SOME THINGS CHANGE, AND OTHERS . . . NOT SO MUCH: A Book Review by Jim Vogele
July 26, 2022
IN THE HISTORY OF MEDICINE, SOME THINGS CHANGE AND OTHERS . . . NOT SO MUCH: a Book Review by Jim Vogele
The History of Medicine: A Beginner’s Guide by Mark Jackson (London: ONEWORLD PUBLICATIONS, 2014)
The History of Medicine: A Beginners Guide is a short, yet dense, survey by Mark Jackson, a Professor of the History of Medicine at the University of Exeter. Professor Jackson is not only a professor and the author of a number of books, including this “Beginner’s Guide,” but, per his biography, he is also a “qualified doctor.”
This book, published in 2014, may not be recent in terms of the Twitter-era timeline, but, on the other hand, since the instructive timeline at the end of the book commences in the 3rd millennium BCE, it is recent enough to provide a fine overview of historical developments in human health and medicine.
Working with Oregon, Washington, Montana and California physician employment agreements, as I do on nearly a daily basis as a physician contract attorney, I am kept abreast of many recent developments in the practice of medicine, which is now a highly-regulated field in the U.S. But when I saw this book in Portland’s excellent bookstore, Powell’s World of Books, I had to pick it up and find out for myself what has changed over the past several millennia. Regardless of your medical specialty — whether you are a Washington medical practitioner or a California healthcare provider, an Oregon veterinarian or a Montana dentist — possessing a historical context for your practice and your healthcare employment agreement will arguably improve not only your perspective on your work but also provide an appreciation for all the hard work, sacrifices, and ingenuity that has, incrementally, given birth to modern medicine.
Science and Medicine Wedded to History and Humanities
As Professor Jackson reveals in his Preface, he was “qualified in, and for a brief period practiced, medicine.” He transitioned, happily it appears, from physician to academic historian of medicine. As Jackson further notes, in his Introduction: “There has been a tendency in recent times to distinguish rather deliberately between science and the humanities, as if they possess entirely different agendas and methods or constitute entirely different intellectual cultures.” In 6 meaty chapters, with 19 illustrations, along with a concluding Timeline, Further Reading section, and Index, Jackson provides a reasonably thorough history of humankind’s ongoing engagement with health and disease, from birth to death.
While this book is part of the Oneworld “Beginner’s Guides” series (which covers topics from aesthetics to the beat generation, French literature, Homer, magic, oil, opera volcanoes and many more), and is on the short side at 200 pages, excluding the Preface, Introduction, and extra material mentioned above, one cannot say the book is a ‘breezy’ read. Indeed, Jackson has a proclivity for rather lengthy, information-packed sentences. This is fine. But varying the length of sentences can also be rhetorically effective. Honestly. Trust me. One the other hand, if you have reviewed your own physician employment contract, you will be no stranger to long sentences. Indeed, a question I commonly receive from physicians is: What does this provision of my employment agreement mean in layperson’s terms?
As for Jackson’s book, in addition to admirably blending science and humanities in his history, the author also deserves credit for including developments in Eastern medicine, including holistic approaches to healthcare, as well as summarizing the important innovations and developments we would all expect: the first surgeries, early use of anesthesia for surgeries, development of antibiotics, the first use of radiation to treat cancer (which occurred in 1896 — I had no idea!). the first organ transplant, and so forth. Many such historical facts are encountered by physicians in the course of medical education, the extent to which the history of medicine is included in medical school curricula varies. Humanists with an interest in medicine can often be heard advocating for the inclusion of more historical perspectives in medical school.
Throughout The History of Medicine, we are reminded of the endless incremental steps involved in the evolution of medicine. From the birth of Hippocrates in circa 460 BCE, to the introduction of smallpox inoculation in England in the 1720s, to Florence Nightingale’s reformation of nursing practice during the Crimean War in the 1850s and the introduction of first birth control clinic in America in 1916, we have come a long way and Mark Jackson takes on a whirlwind tour of it all. His approach, overall, is one of combining science and history: “History not only reveals elements of continuity and change in medical theory and practice but also exposes the close between personal experiences of illness, scientific knowledge of bodies and minds, and the broader social factors that influence our understandings of health and disease.”
Many Notable Personages in the History of Medicine
The History of Medicine is not a “great man” saga, albeit there are a plenty of male doctors highlighted in Jackson’s book. Because I’m drawn to math, I could not help myself from engaging in subtraction each time Jackson presents a personage of importance, because he includes the years of birth and death for nearly every significant figure he mentions. One obvious observation is that, naturally, doctors live for longer on average today than they once did. But . . . there have always been exceptions.
The reader is struck by, but not surprised by, the molasses-slow pace of the inclusion of women in the practice of medicine. Among the reasons for this, besides blatant discrimination and chauvinism, has been an absurd paternalism, in addition to, frankly, greed: “Obstacles to the entry of women to the profession included concerns that they were not strong enough, the belief that education and work would reduce their ability to have children, and fears that the medical marketplace would become even more crowded.”
Thankfully, as Jackson writes, “In spite of attempts to reinforce the male monopoly on medical care, women began to enter the health-care professions, first as nurses and midwives, but increasingly as doctors.” Yet the road has been far from easy for women as they slowly, despite opposition far and wide, became integral to every aspect of medicine. As we all know, the process of women taking a full and complete role in the field of medicine is an ongoing journey, with true equality elusive (but not impossible) still today.
Medical Notes of Relevance to a Lawyer
Certain aspects of history are of particular interest to a lawyer, and particularly to a physician contract lawyer. Once example in The History of Medicine is Professor Jackson’s description of, “[p]rofessional disagreements . . . particularly around issues such as status, fees and authority.” In a section entitled, “The Medical Marketplace,” Jackson writes:
“Physicians questioned the rights of apothecaries to provide medical advice as well as dispense medication. Apothecaries in turn resisted the encroachment of chemists and druggists on their professional territory. Poaching patients from competitors was regarded in many countries as a form of malpractice and doctors’ reputations were often challenged by patients and their peers, who were happy to expose unscrupulous, dangerous and deceitful practices. A surgeon could be forced to resign because he had failed to obtain a patient’s consent to surgery.”
The jostling for position in the medical marketplace has, therefore, been with us for a very long time. These days, we see the inclusion of broad restrictive covenants, especially noncompete provisions in the employment contracts of Oregon physician contracts, Washington physician contracts, and Montana physician contracts. We do not generally see noncompete provisions California physician contracts, of course, as noncompetes for employees are not allowed under California law. However, with regard to the overall regulation of the medical profession, many regulations are necessary to ensure the safety and well-being of both patients and their physicians. For example, without making light of the situation, we can perhaps all be thankful for the “formal separation of surgeons from barbers in 1745 . . . .”
In another example of socially appropriate and even benevolent regulation, Jackson notes that, “In Britain, the Factor Acts of 1833 and 1844 reduced the hours that children were allowed to work . . . .” That children were not only allowed but oftentimes required to work long hours speaks volumes; and the issue was hardly limited to the 19th century and before, as we know, as child labor remains a major social welfare issue in parts of the world, i.e., a continuing social ill, despite all of our advancements and progress.
Medical Education and the Spread and Practical Application of Knowledge
Jackson addresses various aspects of medical education throughout his history, including that “early medieval learned medicine was developed primarily in libraries and monasteries, [but] during the late medieval period (that is, between 1100 and 1500) medical education and practice also became associated with universities and hospitals . . . .” The institutionalized instruction and training of physicians was greatly enhanced by the creation of universities “at Bologna (founded c. 1088), Salerno (1100), Paris (1110), Oxford (1167), Montpellier (c. 1181) and Cambridge (1209), where students were taught natural science and philosophy as well as medicine.”
Eventually, as Professor Jackson, explains:
“Education in science became a key requisite for qualification as an orthodox practitioner; clinical studies at medical school were increasingly preceded by two years of ‘pre-clinical’ education in the basic sciences. Chairs in physiology, anatomy and pathology were created in university medical schools in Europe and North America, and knowledge of the latest scientific innovations was disseminated through journals, learned societies and international congresses. One consequence of this growing reliance on science was a widening of the divide between orthodox and alternative medicine.”
As medical education progressed in various countries and as the medical profession became increasingly regulated, Jackson takes note of the fact that, in Great Britain, “The British Medical Act of 1858 introduced a register of all licensed doctors and established the General Medical Council, responsible for overseeing education and standards of practice.” A century-and-a-half later, if you are a California physician, an Oregon pharmacist, or a Washington veterinarian, you may, on occasion, experience some dismay at the highly-regulated nature of modern medicine; on the one hand, such minute oversight can feel oppressive; on the other hand, as can be seen in The History of Medicine, the regulation of healthcare practitioners is a necessary reality. In one disconcerting anecdote, Jackson relates that, in Britain, the Organ Transplants Act of 1989 was passed only after a story broke earlier that year, “that four Turkish citizens had each sold one of their kidneys for cash.”
While it is a sad irony of history, as Jackson discusses in a section called, “War and medicine,” many important medical advances have arguably emerged from the tragedy of battlefield injuries. Jackson only lightly disputes the suggestion made by, “the American physiologist and historian of medicine, John F. Fulton (1899-1960), [who stated] that ‘the most significant advances in medical science’ were made by military and civilian doctors working under the pressures of war.” As Jackson points out, however, “It is clear . . . that the relationship between war and medicine is more complex than [a] simple medical audit implies.” Nonetheless, as is well known, “In the Crimean War (1854-6), the American Civil War (1861-5), and the Boer War (1899-1902), far more people died of cholera, typhus and dysentery than were killed by enemy weapons.” Moreover, it is perhaps not surprising that developments in both reconstructive surgery and psychiatry were hastened and encouraged as the result of the extreme trauma of warfare.
In Conclusion, a Fine History
Professor Jackson makes many fine points through his book, The History of Medicine: A Beginner’s Guide. Among them is the fact that humankind has throughout recorded history endeavored to treat and prevent illnesses and disease, whether naturally occurring (or, in some cases, e.g. as with smoking, that may be, to a significant extent, self-inflicted). For example, cancer was evident even in the earliest annals of our history. Furthermore, while life expectancy has vastly increased, other health-related woes have arisen. As Jackson explains: Between approximately 1870 and 1950, mortality rates declined and the life expectancy of many populations around the world increased. [However, d]uring the same period, while morbidity and mortality rates from infectious diseases fell, those from chronic diseases rose.”
Professor Jackson also astutely emphasizes the impact of socioeconomic considerations, such as standards of living, wages and nutrition, on our health. While nature spares none of us from the ultimate conclusion to our lives, many ailments do not discriminate among social classes. Today, we hear much about quality of life issues in addition to the ‘quantity’ of life we experience, i.e. the length, of human lives. Medicine plays a vitally important role in both quality and quantity of life.
Many examples of the bridges between modern medicine and ancient experience are emphasized in The History of Medicine. For example, it was not until the 1890s that “one German company, Friedrich Bayer and Company, synthesized and marketed a derivate of salicylic acid, under the trade name, Aspirin.” Aas it was, however, “[d]erived from willow bark, the medicinal properties of [salicylid acid] had been known since antiquity . . . .”
At the end of the day, after reading Mark Jackson’s The History of Medicine, we are left with hope for the future. In surveying how far we have come, Professor Jackson leaves us with an expanded sense of the ingenuity of humankind, as well as with an appreciation for the many accomplishments, some nearly miraculous, of medical practitioners around the world and throughout history. Indeed, when I finished reading The History of Medicine, I found myself wanting even more medical history. In that regard, Mark Jackson has provided, in his “Further reading” recommendations, a detailed bibliography of nearly 100 books that we may consult for further insight into the historical underpinnings and context of modern medicine.