Reviewed By: Barry J Goldlist, MD, FRCPC, FACP
HISTORY OF MEDICINE:
A SCANDALOUSLY SHORT INTRODUCTION
Jacalyn Duffin
University of Toronto Press, 1999
Toronto, Buffalo, London
ISBN 0802079121
Why would anybody other than a medical historian (or an aging doctor such as myself) be interested in a book on the history of medicine? Jacalyn Duffin gives us all the answer in the final chapter of this book (How to Research a Question in Medical History) when she writes: "No medical subject--be it a person, a practice, an institution, a technology, or an idea-- can be fully explored without also studying its political, social, economic, and cultural environment." In this introductory text (compiled from medical student lectures at Queen's University) one gets a clear view of how medicine reflects society, and how health care providers are influenced by non-medical factors in society at large. Although this is not a textbook of Canadian medical history, it is written by a Canadian for a Canadian audience. This is particularly valuable as many of us who are wondering where the Canadian health care system is heading, can get at least an overview from this text of how our current system developed.
The text is organized by topic (e.g. History of Anatomy) rather than as a continuous chronology. This makes the reading much simpler for a relatively uninformed reader, as only one concept at a time is explored. As well, chapters can be read in any order, depending on the reader's particular interests. The exceptional nature of this book is probably based on the relatively rare characteristics of the author: she is a practicing physician (haematologist) as well as a formally trained historian. As a result the book covers both important historical trends as well as the difficulties facing individual practitioners as they try and alleviate human suffering.
My favourite chapter was entitled "Science of Suffering: History of Pathology." The reader is given a clear understanding of how the concept of 'disease' developed, and both the strengths and weaknesses of this diagnostic labelling. The chapter on blood (Why is Blood Special?) literally 'pulses' with excitement and enthusiasm, obviously reflecting the author's particular interests as well as the historical importance of the topic.
Throughout this text, there is a refreshing absence of both medical jargon and dense academic prose, making reading the book an enjoyable process. My one quibble is that Professor Duffin's elegant descriptions of the importance of a population approach to health fails to ask one question that always intrigues me. Does the focus on a population health approach have within it the inevitable potential to put differential values on human life? Was the eugenics movement a result of a 'population health' perspective? In Canada, with universal medicare and no private practice option (as occurs in the United Kingdom), might someone with an 'unimportant' disease eventually be 'uncovered' by medicare? Does focusing on the greater good inevitably result in inhumane or unfair treatment to some? Perhaps a topic for a second edition.
So once again who should read this book? Clearly it is a must read for medical students and doctors interested in medical history. However, it would be a shame to limit this fine text to that small audience. This book can be enjoyed by anybody interested in understanding health care or who is just interested in medical history. It deserves a wide audience.
