This book is exactly what the subtitle promises. It covers all major aspects of Western medicine over most of its formal history in just a few hundred pages. Porter has a smooth and sometimes humorous writing style that flows easily, but never makes light of the topic. "Blood and Guts" is a very readable overview of medical history, recommended for anyone who wants broad familiarity with the subject. Furthermore, references are provided for deeper reading.
I'll give it a "+." Don't be fooled by the seeming simplicity. It takes a deep understanding of a topic to be able to write so clearly and so concisely for a nonexpert audience. Porter knows his stuff precisely because he can explain it to someone like me without diluting its factuality.
Porter organizes "Blood and Guts" by topical area-- disease, doctors, the hospital, therapies, surgery, etc.-- describing each throughout the ages. Despite the considerable overlap between topics, Porter spins an easily readable account that assembles itself into a coherent whole as the book progresses.
Medical history has several curiosities, perhaps the greatest of which is the early disdain for surgery. The Hippocratic Oath forbids the physician from wielding the knife, leaving this gross art to those more skilled in hacking than noodling. Medicine was brains, surgery mere brawn. And yet, for more than ten centuries, medicine consisted mostly of giving wise counsel, dispensing barely effective herbal remedies, and standing by as humans grew sick and died. Hardly something you need deep brainpower for.
Surgery's status made a steep rise after the development of anaesthesia, and with other technical advances such as sterilization and various imaging capabilities. Today, surgeons are the prima donnas of the hospital, having successfully surpassed the general practitioners in social standing.
Equally fascinating are the shifts in how the body and its state of health or disease were viewed. Early "humoral" medicine considered sickness to be essentially an imbalance in bodily fluid dynamics, so that treatments were aimed at restoring the natural state. While this makes intuitive sense at some level, it was a great step forward for medicine to recognize that illness is truly a separate state from health: pathology is genuine and should be the target of treatment.
Paralleling these shifts in the doctors' perspectives were the equally important changes in how doctors were viewed by society. From the "medicine man" to the modern specialist, doctors have had an "aura" of authority and wisdom that can bring comfort to the patient. Surely the confidence inspired by a caring doctor plays a role in helping patients get well.
But it was only the early doctors who were just "caring" (because there was little else they could do). Once effective and scientific treatments were being developed a few hundred years ago, doctors began to inspire as much awe as comfort. With the rise in treatment success came a rise in patient (and physician) expectations. Doctors now feel extremely frustrated when a patient is suffering and no relief is possible, while this used to be the norm in medicine. In turn, patients expect doctors to cure nearly every pain, and are likely to trek off to a new doctor if the first one does not perform adequately in this regard.
The final chapter, entitled "Medicine in Modern Society", touches on some of these issues as well as related modern issues such as national health care and the booming insurance industry. Perhaps because the issues are fresh, I found myself wishing for more than the cursory treatment Porter allotted them, but that would not have been true to the survey purpose of "Blood and Guts." The overall impression is that medicine is in the midst of a major transformation that began during the middle of the 20th century and will not play out until well into the 21st. Time will tell what the outcome is.
A couple of other things about the book are also noteworthy. First, I was impressed with Porter's ability to cover controversial topics in a neutral way. These include abortion and reproductive medicine, the relation between the developed and developing world in terms of drug availability and testing, and the long tradition of gender discrimination in medicine. And second, the illustrations accompanying the text are fascinating. Often lurid or emotionally charged, they depict doctors in action through the ages, and certainly enhance the writing.
"Blood and Guts" is a fine survey of the history of Western medicine. It introduces all the key topics, and then Porter takes the extra step of providing references for deeper reading. Thus, it can serve as a jumping-off point for the reader interested in medical history.
Copyright © Kim Allen 2003
