Medicine is art, but now it’s science, too.
Feb 14, 2011, Vol. 16, No. 21 • By AARON ROTHSTEIN
‘The Agnew Clinic’ (1889) by Thomas Eakins
Geoffrey Clements / Corbis
Michael Bliss, university professor emeritus at the University of Toronto, medical historian, and honorary fellow of the Royal College of Physicians and Surgeons of Canada, begins this small book with a vignette about a disastrous smallpox outbreak in Montreal in 1885. This, he argues, was one of the last events of the premodern medical era, which was defined by superstitious and religious ideas as well as doubts about the powers of secular science.
By 1885, medicine had already taken some important steps forward, though: Methods of containing viruses like smallpox did exist. During the Montreal outbreak, Bliss recounts, the Board of Health made vaccination available to the general public, but much of the populace refused to get vaccinated because of anachronistic fears. Many people panicked about the mild side-effects of the shot, which included low fever and skin inflammation; ethnic tensions also contributed to a reluctance to get vaccinated. French Canadians believed that the vaccine was an “English notion” and was “being promoted and encouraged by the English as a race weapon against the French.” Some health officials propagated what Bliss calls the “most insidious” of the anti-vaccination arguments: They believed that, instead of vaccinating the population, the city should simply maintain cleanliness in public areas. But this strategy is not an alternative to vaccination, as smallpox spreads through aerolized droplets from coughing and contact with scabs, clothing, and linens. Others relied on prayer to “stay the hand of the sender of the plague.” Many of Montreal’s Roman Catholics believed that the only way to fight smallpox was to renew one’s devotion to God.
Partly because of these hesitations, smallpox killed 3,164 Montrealers, 2 percent of the population, and 2,600 in the suburbs of Quebec, almost none of whom had been vaccinated.
This ignominious event in Montreal contained the last throes of an outdated ideology. Four years after smallpox dissipated in Montreal, our modern medical era began when the secular Johns Hopkins Hospital in Baltimore admitted its first patient. Bliss rightly focuses on William Osler, a young physician on the Hopkins staff in many ways representative of medicine’s coming-of-age. Although born into a religious family and what we might call a semi-religious man himself—Osler advised Yale students in 1913 to “learn to know your Bible, though not perhaps as your fathers did”—he retained none of the superstitions associated with religion. And his accomplishments were vast: Osler wrote his own medical textbook; he developed the clerkship system in America so that senior medical students could have more patient contact on hospital wards; and he expanded the intern system to create resident physicians and surgeons who could become specialists.
Harvey Cushing, a colleague of Osler’s, similarly symbolized the new age of medicine: “Cushing,” Bliss writes, “became the first surgeon who could access the human brain at will and with the near certainty of doing more good than harm.” This was, Bliss asserts, surgery’s first golden age, where patients could be cured of certain bodily disorders such as tumors and diseased nerves. Bliss also recounts the development of insulin during the early 20th century by Frederick Banting and his colleagues, J. B. Collip, J. J. R. Macleod, and C. H. Best. For the first time in the history of medicine, doctors could prescribe an effective treatment for diabetes.
Much of this is drawn from Bliss’s previous books—Plague: A Story of Smallpox in Montreal, William Osler: A Life in Medicine, Harvey Cushing: A Life in Surgery, The Discovery of Insulin, and Banting: A Biography—and as he writes, this volume is meant to be a synthesis of what he has written “as a historian of medicine.” The novelty of his work is in its argument about the “key turning point in our attitudes about modern health care.” Indeed, Bliss’s synthesis obviates the importance of the late 19th and early 20th centuries in the history of medicine, but he never really explains why the developments of this time, both in attitude and discovery, are so much more important than other medical developments at other times.
After all, there are many findings which have been significant contributors to our modern medical age: What about William Harvey’s discovery of the circulatory system in the early 17th century? Before this, scientists believed that blood was consumed by the body. Nearly all of our treatments today are based on the idea of circulation, that chemicals will be distributed throughout the body by our blood. The medical historian Paul Strathern has explained that the discovery of circulation of the blood “marked the beginning of modern medicine.” And you could make the argument that the Catholic Church, in not objecting to cadaver dissection during dissection’s inception in the Middle Ages, took a huge step in the right direction. Might superstition have begun to disappear during the first dissections allowed by the Church? And are we not still facing superstitious and pernicious ideas about medicine? The model/actress Jenny McCarthy has mounted a campaign against childhood vaccination because she believes it causes autism—despite the absence of any evidence for this, except outright fraud.
Bliss does not explain why, if this 20th-century shift was so singular, it occurred in the first place. But The Making of Modern Medicine does give us a valuable perspective on medical progress. Physicians have incredible healing powers—surgery to repair limbs and hearts, medications which can raise or lower blood pressure, life-saving blood transfusions—and there are still more incredible developments to come. And yet, a cursory glance demonstrates that our advancement is not quite as substantial as we think. Take vaccination. Variolation, a less refined form, was used in China during the Song Dynasty (960-1279): A person’s scabs would be blown into another’s nose through a tube, thereby bestowing immunization against smallpox. Regardless of technological advancements, our strategy has not changed much since then. In order to immunize ourselves against viruses like smallpox, we inject patients with a small dosage of the virus. And amazingly enough, there is still no “effective treatment,” Bliss claims, “for the destruction caused when the smallpox virus invades a human subject.” So we still can’t treat it, as was the case in Montreal in 1885, and we have not had enduring success against a plethora of other diseases and viruses, such as HIV, various cancers, Alzheimer’s, and Parkinson’s, among many others.
We have come very far in medicine, but have still barely plunged into the depths of knowledge of medical science. Bliss quotes Osler, who said that modern medicine should be understood as “man’s redemption of man.” But to put too much faith in science is to turn science itself into a church and, as Bliss observes, this church has “no ultimate salvation to offer.”
Aaron Rothstein is a writer in New York.