Preface

Health is a state of complete physical, mental and social well-being, and not merely
the absence of disease or inrmity. (The World Health Organization)
My primary purpose in writing and revising this book has been to pro- vide an updated
introduction to the history of medicine. Although the text began as a teaching assistant
for my own one-semester survey course, I hope that this new edition will also be of interest
to a general audience, and to teachers who are trying to add historical materials to their
science courses or science to their history courses. As in the pre- vious edition of this book, I
have tried to call attention to major themes in the history of medicine, the evolution of
theories and methodologies, and the diverse attitudes and assumptions with which
physicians and patients have understood health, disease, and healing. Many changes have
taken place in the history of medicine since the 1940s, when Henry E. Sigerist (18911957)
called for a new direction in the eld, a move away from the study of the great physicians
and their texts towards a new concept of medical history as social and cultural history. From
an almost exclusive focus on the evolution of modern medical theories, scholars turned to
new questions about the social, cul- tural, economical, and political context in which healers
and patients are embedded. Profoundly inuenced by concepts and techniques borrowed
from sociology, psychology, anthropology, and demography, the new social and cultural
historians of medicine emphasized factors such as race, class, and gender, as well as
institutional and professional afli- ations. Some arguments about the nature of the eld
remain, but there is general agreement that medical history is not simply an account of the
path from past darkness to modern scientic enlightenment. Given the vitality and diversity
of the eld today, nding a satisfac- tory way to present an introductory survey of the
history of medicine has become increasingly difcult. Thus, a selective approach, based on
aconsiderationoftheneedsandinterestsofreaderswhoarerstapproach- ing the eld, seems
appropriate. I have, therefore, selected particular examples of theories, diseases,
professions, healers, and scientists, and attempted to allow them to illuminate themes that
raise fundamental questions about health, disease, and history. The book is arranged in a
roughly chronological, but largely thematic manner. Medical concepts and practices can
provide a sensitive probe of the intimatenetworkofinteractions inasociety, aswell
astracesoftheintro- duction,diffusion,andtransformationofnovelorforeignideasandtech-
niques. Medical problems concern the most fundamental and revealing aspects of any
societyhealth and disease, wealth and poverty, birth, aging, disability, suffering, and
death. All people, in every period of his- tory, have dealt with childbirth, disease, traumatic
injuries, and pain. Thus, the measures developed to heal mind and body provide a valuable
focus for examining different cultures and contexts. Perhaps immersion in the history of
medicine can provide a feeling of kinship with patients and practitioners past and present, a
sense of humility with respect to disease and nature, and a critical approach to our present
medical problems. The history of medicine can throw light on changing patterns of health
and disease, as well as questions of medical practice, professionalization, institutions,
educations, medical costs, diagnostics, and therapeutics. Since the end of the nineteenth
century, the biomedical sciences have ourished by following what might be called the
gospel of specic etiologythat is, the concept that if we understand the causative agent
of a disease, or the specic molecular events of the pathological process, we can totally
understand and control the disease. This view fails to take into account the complex social,
ethical, economical, and geopolitical aspects of disease in a world drawn closer together by
modern commu- nications and transportation, while simultaneously being torn apart by vast
and growing differences between wealth and poverty. Public debates about medicine today
rarely seem to address funda- mental issues of the art and science of medicine; instead, the
questions most insistently examined concern health care costs, availability, access, equity,
and liability. Comparisons among the medical systems of many different nations suggest that
despite differences in form, philosophy, organization, and goals, all have experienced
tensions caused by rising costs and expectations and pressure on limited or scarce
resources. Gov- ernment ofcials, policy analysts, and health care professionals have
increasingly focused their energy and attention on the management of cost containment
measures. Rarely is an attempt made to question the entire enterprise in terms of the issues
raised by demographers, epidemiologists, and historians as to the relative value of modern
medi- cine and more broadly based environmental and behavioral reforms that might
signicantly affect patterns of morbidity and mortality. Skeptics have said that we seem to
exchange the pestilences of one generation for the plagues of another. At least in the
wealthier, indus- trialized parts of the world, the prevailing disease pattern has shifted from
one in which the major killers were infectious diseases to one inwhich chronic and
degenerative diseases predominate, associated with a demographic shift from an era of high
infant mortality to one with increased life expectancy at birth and an aging population. Since
the end of the nineteenth century, we have seen a remarkable transition from a period
where prevention was expensive (e.g., installation of sewer sys- tems) and therapy was
basically inexpensive (e.g., bleeding and purging) to one where therapy is expensive (e.g.,
coronary by-pass operations) and prevention is inexpensive (e.g., exercise and low-
cholesterol diets). The demand for high cost diagnostic and therapeutic technologies seems
insatiable, but it may well be that improvements in health and the over- all quality of life are
better served by a new commitment to social ser- vices and community health rather than
more sophisticated scanners and specialized surgeons. After years of celebrating the obvious
achieve- ments of biomedical science, as exemplied by such contributions as vaccines,
anesthesia, insulin, organ transplantation, and the hope that infectious epidemic diseases
would follow smallpox into oblivion, deep and disturbing questions are being raised about
the discrepancy between the costs of modern medicine and the role that medicine has
played in terms of historical and global patterns of morbidity and mortality. Careful analysis
of the role of medicine and that of social and environ- mental factors in determining the
health of the people indicates that medical technology is not a panacea for either epidemic
and acute dis- ease, or endemic and chronic disease. A general survey of the history of
medicine reinforces the funda- mental principle that medicine alone has never been the
answer to the ills of the individual or the ills of society, but human beings have never
stopped looking to the healing arts to provide a focus for cures, conso- lation, amelioration,
relief, and rehabilitation. Perhaps a better under- standing of previous concepts of health,
healing, and disease will make it possible to recognize the sources of contemporary
problems and the inherent limitations and liabilities of current paradigms. Once again I
would like to express my deep appreciation to John Parascandola and Ann Carmichael for
their invaluable advice, criticism, and encouragement during the preparation of the rst
edition of this book. Of course, all remaining errors of omission and commission remain my
own. Many thanks also to the students who took my courses, read my books, and let me
know what was clear and what was obscure. I would also like to thank the History of
Medicine Division, National Library of Medicine, for providing the illustrations used in this
book and the World Health Organization for the photograph of the last case of smallpox in
the Indian subcontinent. I would like to thank Marcel Dekker, Inc. for inviting me to prepare
a second edition of A History of Medicine.