Review by Benjamin L. Thompson, 2009
The History of Medicine: A Very Short Introduction. By William Bynum. Oxford University Press, 2008. 169 pages. $11.95.
In this Very Short Introduction, William Bynum surveys the historical landscape of medicine in the light of unprecedented concern and controversy over the future of healthcare. As questions about health funding and doubts as to the realistic prospects of medicine have begun to overshadow the solutions that it has provided in the past, the healthcare industry has been increasingly subject to public scrutiny. Taking these contemporary issues into account within their historical contexts, Bynum offers a timely reference of the history of medicine that is both relevant and accessible to anyone interested in the present status and future direction of healthcare.
Bynum’s aim for this volume is, at least in part, to describe both the origins and development of medicine in ancient times, through the scholastic medieval tradition and Enlightenment, to the present day. To accomplish this end, he limits his scope to the history of Western medicine, as this “dominates health consumption and expenditure in the West, and is a major force everywhere” (4). Bynum observes that our interest in healthcare is essentially the same as it has always been, and that this interest is precisely the motive force that has directed the course of medicine over the millennia. He writes, “It seems to me that those in the past who had access have generally sought the medical care that was on offer, and believed that there were good doctors and bad doctors. They wanted a good doctor to take care of them. So do we. What has changed is what constitutes a ‘good’ doctor” (4). Thus, another purpose for this work is to inform the reader in order that they should become able to make such an appraisal.
Seeking to avoid the tendency to view all history as progress and a series of steps leading inevitably to the present, Bynum structures this book thematically, rather than taking a strict chronological approach. He therefore orients its contents around what he considers the five main types of medicine: bedside, library, hospital, social, and laboratory; all of which reflect the different goals of doctors, and “provide both the broad headings for contemporary health budgets, and . . . the identity of interest groups” (3). Each chapter introduces a new turning point in medical history, be it the first surgical procedures, the advent of hospitals, the introduction of anesthesia, X-Rays, vaccinations, or the rise of experimental medicine. The first five chapters are devoted to each of these five kinds of medicine, while the final chapter addresses the place each of these has held over the past century as well as today.
Bynum begins his exposition of the five kinds of medicine with a brief overview of Hippocrates, with whom bedside medicine is associated, and who, as Bynum has observed, “has become the favoured Father for healers of all stripes” (5). Bedside medicine refers to the holistic approach to healing in the classical period, which relied on natural philosophy in general, and the humoral system in particular to explain health and disease. Library medicine refers to the period of the Middle Ages, during which the primary medical achievements took the form of the preserving and transmitting the Hippocratic Corpus, in addition to the scholarly efforts initiated by many of the universities at the time, as they came to recognize the importance of anatomy and, hence, dissection for amassing relevant information. In the 19th century, hospital medicine was essentially large-scale bedside medicine. It was aimed at the successful diagnosis of disease through the assessment of the organs believed to be involved. Medicine in the community aimed at disease prevention as well as health preservation through assessing statistics of populations within the community. It comprised dynamics such as clean water, waste disposal, and vaccination programs. Laboratory medicine, as one might expect, has taken place in the laboratory, and has emphasized increasingly reductionistic methods of understanding and explaining the biophysical etiologies of diseases through the use of animal models.
After placing each type of medicine within its particular historical context, Bynum explains their relevance in the modern era. Bedside medicine, for example, has reemphasized the importance of primary care, as opposed to specialists who focus on particular diseases. Library medicine now manifests itself in light of the information age, ushered in by the Internet. Hospital medicine has received much recent attention, as it is often at the center of concerns and controversies, such as health funding and other various biomedical ethical issues. Medicine in the community, which we commonly refer to as public health, has had to evolve with respect to the community at hand. For instance, drugs, alcohol, and obesity have all become issues of concern in Western culture. Laboratory medicine, Bynum observes, still promises the most hope, but, “As scientific capability rises, so do expectations, and many patients no longer have patience, having been promised so much” (152). Bynum concludes by briefly considering some of the obstacles left in the path of modern medicine, such as AIDS. It should be noted that his tone regarding the prospects of medicine is decidedly positive.
Despite its brevity, The History of Medicine is an enormous resource for those interested in understanding the foundation on which modern Western medicine is built, and, hence, where its weaknesses may be as well. In terms of his organization, Bynum’s thematic approach is particularly helpful, not only for getting a handle on the general chronology of the material, but also for understanding the interdependence that has been necessary for each kind of medicine to operate autonomously. In terms of content, Bynum achieves his end of explaining the relevance of the different kinds of medicine through history by reincorporating each one within its modern context in Chapter Six. From the outset, Bynum explains why his typological framework helps the reader make greater sense of medicine’s complex history. This, of course, says nothing of the incredible job Bynum has done summarizing over 2,500 years of medical history into a pocket-sized volume. Moreover, although this book focuses primarily on Western medicine, it also explores those encounters with alternative traditions, such as Chinese and Indian medicines, and nontraditional treatments such as homeopathy, chiropractic, and other complementary medicines.
In addition to its breadth, the extent of the material’s depth was surprising. Even relatively obscure issues, such as the plasmodiums underlying the spread of malaria through the Anopheles mosquito (137), were given attention. Also, in his attempt to help readers relate, Bynum includes interesting illustrations, which provide a sort of iconic reference for each kind of medicine’s historical context.
One of the books greatest weaknesses is its lack of discussion of some of the most promising recent developments in medicine. In terms of appraising the prospects of medicine, there could have almost certainly been more said concerning the massive promises of genetically based medicine. Bynum merely states that, “The promises of health improvements through sequencing the human genome or stem cell research are so far largely unrealized” (152). Furthermore, Bynum might have considered including more charts, detailing some of the broader strokes of this volume’s material diagrammatically.
As Bynum rightly states in his introduction, “This is a short book on a very big subject” (1). Nevertheless, he covers a vast amount of information, and, thus, sheds new light onto both the historical and contemporary landscapes of Western medicine. While engaging with contemporary issues, discoveries, and controversies, such as the spiraling costs of health care, lack of health insurance for millions, breakthrough treatments, and much more, Bynum effectively engages the reader, leaving him or her with a sense of having gained something, namely, an informed perspective from which to view modern medicine and decide whether or not it is “good.”