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by Roy Porter
W. W. Norton, 2004
Review by Mark Welch, Ph.D. on May 6th 2005

Blood and Guts

When Roy Porter got into his stride there was probably no better communicator of the richness, diversity, inter-connectedness and exhilaration of the social and cultural history of medicine. In a considerably shorter format than he produced elsewhere, Porter sketches in a vigorous and expansive manner a thematic taste of the history of medicine from very early times to modern day dilemmas. The book, so he confesses, is largely based on lectures given over a long period of time, to many different audiences, but that serves to enhance the mental picture of a somewhat manic gallop, interspersed with delightful titbits of information and gossip that bring out the character of so many of the people whose work he engages -- you can almost sense the gesticulations, the running thoughts and the enjoyment of the jokes, asides and scurrilous details he drops throughout.

This history is thematically arranged around the ideas of disease, doctors, the body, the laboratory, therapies, surgery, the hospital and medicine's relation to modern society. In each of these relatively short chapters, the text itself is less than 170 pages, he links together the intellectual development and the happenstance of fortune to portray both an idea of progress and the peculiarities of the particular form of medicine and medical establishment we have today. At each point, however, he casts a humanistic eye onto the patients, onto the sufferers; the ones who bore both some of the barbarities of treatment, and the stigma of disease. He writes in the Preface that the "agonies of the sick and dying haunt the story of disease and medicine" he relates. As always, Porter's identification with the human in the story is one of his strong points.

He uses a vast array of sources and his breadth of scholarship is first rate, and his profound understanding of the wider cultural milieu hugely significant. The manner in which he melds academic treatises with personal diaries and illustrates them with literary examples conveys at every level, the cultural context. He sees the value of Roderick Random alongside the papers of John Hunter, or how a Punch cartoon adds understanding to a report from The Lancet.

Porter is justifiably renowned for his work on the Enlightenment in particular, but less so for his scholarship of the modern period. However, he does venture there in an interesting way. Having shown the development of a scientific approach to medicine and disease, he confronts the ethical difficulties of what may be possible to do and what may be right. This, is many ways, leads forwards into relatively unexplored areas, and Porter seems to be searching for the moral vision apparent in earlier times. He clearly applauds some of the great public health initiatives of the Twentieth Century, such as the National Health Service in the UK, and similar enterprises elsewhere, but he seems very dubious about the overall effects of gigantic service industry medicine has become. Health, which once seemed an inalienable right, may be becoming a negotiable commodity. For Porter that would represent a significant shift in its historical trajectory. We may, he thinks, after an apparent golden age, be entering an age of anxiety.

This may be a weakness of this particular book. Porter may be a better historian than pundit, and more comfortable in that role too. His survey of modern developments seems more ill at ease, or insecure, as if he cannot quite see the path ahead. He also seems considerably more pessimistic and perplexed by the paradoxes and political interests that are moving us away from a concern for humankind, medicine being arguably one of its greatest achievements, to a selfishness and lack of concern for anyone but ourselves. After what is often a joyful and marvelling exposition of the history of medicine, it is a sombre note on which to end. Nevertheless, Porter's extraordinary scholarship makes an invaluable contribution. Even though it is brief, this book will stimulate and provoke, it will engage and inform. It makes his readers miss him all the more.



2005 Mark Welch


Mark Welch, Ph.D. Assistant Professor in the Faculty of Nursing at the University of Alberta, Edmonton, Alberta and Co-Director of the PAHO/WHO Collaborating Centre for Nursing & Mental Health.