A Short History of Medicine (Modern Library Chronicles) - Hardcover

Gonzalez-Crussi, Frank

Hardcover

ISBN 10: 0679643435 ISBN 13: 9780679643432

Publisher: Modern Library, 2007

Synopsis

In this lively, learned, and wholly engrossing volume, F. González-Crussi presents a brief yet authoritative five-hundred-year history of the science, the philosophy, and the controversies of modern medicine. While this illuminating work mainly explores Western medicine over the past five centuries, González-Crussi also describes how modern medicine’s roots extend to both Greco-Roman antiquity and Eastern medical traditions.

Covered here in engaging detail are the birth of anatomy and the practice of dissections; the transformation of surgery from a gruesome art to a sophisticated medical specialty; a short history of infectious diseases; the evolution of the diagnostic process; advances in obstetrics and anesthesia; and modern psychiatric therapies and the challenges facing organized medicine today. González-Crussi’s approach to these and other topics stems from his professed belief that the history of medicine isn’t just a continuum of scientific achievement but is deeply influenced by the personalities of the men and women who made or implemented these breakthroughs. And, as we learn, this field’s greatest practitioners were, like the rest of us, human beings with flaws, weaknesses, and limitations–including some who were scoundrels.

Insightful, informed, and at times controversial in its conclusions, A Short History of Medicine offers an exceptional introduction to the major and many minor facets of its subject. Written by a renowned author and educator, this book gives us the very essence of humankind’s search to mitigate suffering, save lives, and unearth the mysteries of the human animal.

Praise for F. González-Crussi

“What Oliver Sacks does for the mind, González-Crussi [does] for the eye in this captivating set of philosophical meditations on the relationship between the viewer and the viewed.”
–Publishers Weekly, on On Seeing

“[González-Crussi fuses] science, literature, and personal history into highly civilized artifacts.”
–The Washington Post, on There Is a World Elsewhere

About this title

About the Author:

F. González-Crussi is Professor emeritus of pathology at Northwestern University Feinberg School of Medicine. He is the author of Suspended Animation: Six Essays on the Preservation of Bodily Parts, a New York Times Notable Book; The Five Senses, a Los Angeles Times Book Prize finalist; and Notes of an Anatomist, winner of the nonfiction first prize of the Society for Midland Authors. He lives in Chicago.

Excerpt. © Reprinted by permission. All rights reserved.:

If Western medicine is unique, it is because it made the body an object of systematic, scientific study. This is not stating the obvious. The human body has innumerable symbolic meanings, all emotionally charged and often contradictory. Turning it into an object of orderly inquiry and meticulous investigation was no small achievement.

It seems that for some cultures, the body hardly exists at all. Certain aborigines of New Caledonia, in the South Pacific, use the same words to name the parts of the body and the plants or other objects of their natural environment, between which they perceive a resemblance. For instance, the skin of the body and the bark of trees are designated by the same term; the identical word is used for the flesh of human limbs and the pulp of fruits; and the various inner organs share names with the produce that they outwardly resemble. In this society the body is not thought of as an independent entity but is indistinguishable from its surroundings. Similarly, in European societies during the Middle Ages and in certain communities in more recent times, alchemical notions have linked various parts of the body to the constellations of the sky: Aries “rules” the head; Leo, the heart; Scorpio, the genitals; and so on. The body lacks a clear border; in the elemental imagination, it merges with the rest of the cosmos. To cut or incise the body, as in anatomical dissection, would have seemed an aggression against the continuum that linked man and his environment, an attempt against the unity of the world. The impulse to study the body’s anatomy could hardly have arisen in a society in which such concepts prevailed.

Other societies surrounded the body with religious sentiments. In the Judeo-Christian tradition, in which man was created in God’s image, the body is a temple. Thus, it deserves solemn respect. On the other hand, the same tradition gave rise to ascetic movements in which the body was a repository of sin, a despicable, filthy thing that ought not to be made the center of an honest man’s concerns, much less an object of serious study. Either stance was contrary to anatomical investigation. In the Middle Ages, all intellectual activity resided in the Catholic Church, but no clergyman ever distinguished himself as a surgeon or even as a barber (the profession which was then in charge of minor surgical procedures), due to the severe ecclesiastical prohibition against all forms of bloodshed.

For all their admirable medical insights, ancient India and China did not make the interior of the body the basis of their medical systems. And neither the ancient Egyptians nor the ancient Mexicans contributed anything of substance to the knowledge of anatomy. It is astonishing that the opening of innumerable human bodies in ritual practices—the Egyptians embalmed tens of thousands of human and animal cadavers; the Aztecs sacrificed countless victims by opening the chest and extracting the heart—should not have sparked curiosity about the structure of the organs they exposed. Yet their attitude was different: they looked at the world from a mythicoreligious perspective that was incompatible with an impersonal regard of objective reality. Thus, conceiving of the body as an autonomous object and deeming it worthy of study—these are the signal achievements of Western medicine.

The Greeks, as is often the case in the history of Western civilization, take the palm for intellectual curiosity. Still, Hippocrates (c. 460–c. 377 b.c.) knew very little anatomy and did not seem interested in correcting his ignorance: there is no record in the entire Corpus Hippocraticum—his own writings and those of his followers—of any mention of anatomical dissection. Aristotle (384–322 b.c.) constructed a remarkable system of anatomical knowledge, all the more admirable when one reflects that he never dissected a single human body. It was entirely based on dissections of animals: birds, reptiles, mammals, and especially monkeys. But Aristotle was above all a thinker: the body was for him principally an object of metaphysical speculation.

Aristotle was a student of Plato, for whom the world of the Ideal took precedence over the more pedestrian here and now. The Aristotelian philosophical system is formidable, but when it deals with corporeal form it becomes sketchy. Aristotle, the famous Stagirite, seeks to explain the human body’s position in the universe, how it came into being, what its origins are, and the meaning of its life. The details of bodily structure are secondary to the comprehensive nature of his metaphysics.

Two scholars of the Hellenistic civilization did perform anatomical dissections of human bodies: Herophilus (c. 335–c. 280 b.c.) and Erasistratus of Ceos (c. 325–250 b.c.). Both settled in Alexandria, Egypt, a great intellectual center of the ancient world, where Greek communities had long existed and which was the site of the fabled library containing more than half a million volumes, eventually destroyed in a fire. Little is known of these two men. They left no written works and are known only from references by other authors.

Herophilus was born in Chalcedon, an ancient town situated near today’s Istanbul, Turkey. He is credited with having named the duodenum (so called because it is twelve—duodeni—finger breadths long) and the prostate (Greek prostates, “standing before,” since it is placed before the rectum); and for having determined that the arteries are full of blood, not air, as was commonly believed. This misconception may have arisen because arteries, having thick musculoelastic walls, tend to contract postmortem, so that in the cadaver they are usually empty; the blood, having been squeezed out of them, fills the veins, which have thinner, distensible walls. Herophilus also described several brain structures, including a site of cranial venous confluence that still bears his name (torcular Herophili, or “Herophilus’s press”). He traced the course of nerves to their origin in the brain, thereby firmly establishing that impulses for voluntary movements travel from the brain, the site of the will and the reasoning faculty, to the extremities via the nerves, not via the arteries, as was wrongly believed.

His younger colleague and collaborator Erasistratus was born in a hamlet on the island of Ceos (or Keos) and studied in Athens. He described the cardiac valves, named the tricuspid valve, and confirmed and extended many of Herophilus’s observations on the cranial nerves. He stuck to the belief that arteries carry air and explained the bleeding that follows their severance by proposing that the arterial walls, like all tissues, are made of tightly woven tiny veins, which promptly bleed to fill the vacuum that ensues when the artery is cut. The explanation may strike us as far-fetched, but it was perfectly in keeping with the concepts of his time. And it took genius to realize, long before the invention of the microscope, that all tissues possess innumerable small blood vessels (today we call them capillaries), aggregated into a dense network. Erasistratus imagined that the nutriment carried by these vessels poured between the spaces of the net, the parenchyma (Greek for “something poured in beside”).

His realization that the cardiac valves function like guards that impede retrograde flow was no less astounding, given that it came eighteen centuries before the discovery of the circulation by William Harvey (in 1628) and at a time when no valve-based propelling pump had been invented. He may be excused if his explanation of the one- way valves is part of a theoretical system that today sounds like pure nonsense.

There is a somber note that dims the glory of these two outstanding savants. Apparently, the Aristotelian idea that true knowledge of bodily structure is possible only by studying a living being prompted them to vivisect men. The kings of Alexandria, desirous of maintaining their city as a leading center of the arts and sciences, granted permission for condemned criminals to be officially surrendered to the anatomists, who then “legally” laid them open.

Some historians have cast doubt on the reality of that practice. If it did take place, one shudders to think what scenes of indescribable torture may have taken place in the dissection rooms of Herophilus and Erasistratus. The miserable, wretched victims were slowly cut open, their bloody, trembling organs exposed, turned over, palpated, and inspected; all amid shrieks of pain and under the cool glance of the anatomists and their pupils and assistants. Little wonder that such Christian writers as Saint Augustine and Tertullian fulminated against them and their practices, calling them ferocious beasts and bloody butchers. Again, one must place their actions in the proper historical context. The Roman Empire was on the rise. These were times when weekend family entertainment consisted of watching gladiators hack each other to death, wild animals devouring human beings, and other similar “amusements.” Some spectators of these “games” jumped into the arena, rushed over to an agonized gladiator, and drank his fresh blood or tore out a piece of his warm liver to eat in the belief that such ingestion could cure epilepsy.

After the brilliant Alexandrian period, the study of anatomy waned into the intellectual lethargy of the Middle Ages. Interest in human anatomy was briefly rekindled by the famous Galen (a.d. 129–c. 199), who for some time held the post of physician in charge of the gladiators of the arena of his native Pergamum (today Bergama in Anatolia, present-day Turkey). In this capacity, he observed the horrible mutilations and ghastly tears that the fighters sustained, and through the gashes he certainly observed, as best he could, the conformation of the internal structures. But public opinion had changed: there was now great respect for the cadaver, and sentiment was strongly against perturbing the s...

About this edition

• Publisher: Modern Library
• Publication date: 2007
• ISBN 10: 0679643435
• ISBN 13: 9780679643432
• Binding: Hardcover
• Edition number: 1
• Number of pages: 272