The Patient’s Story

Thomas McKeown

  • Health, Medicine and Mortality in the 16th Century edited by Charles Webster
    Cambridge, 417 pp, £18.50, December 1979, ISBN 0 521 22643 0

As life must be possible before it can be pleasant, human health and its relation to survival and population growth are among the great themes of history. Why did early man, although apparently well-adapted to his environment, have high mortality rates and a short expectation of life? Why did the change from a nomadic to an agricultural existence ten thousand years ago lead to the predominance of infectious diseases as causes of sickness or death? What was the relation between population growth and agricultural and industrial developments? And where, among the nutritional, environmental, behavioural and medical advances of the past three centuries, are we to find the explanation for the decline of the infections and the modern transformation of health?

The variations in health and population size are interesting in their own right, but they are no less important in relation to their consequences. In Plagues and Peoples (1977) W.H. McNeill attributed the rise and fall of civilisations to the impact of infectious diseases, and writing of the growth of population in the Mediterranean in the 16th century, Braudel concluded: ‘This biological revolution was the major factor in all the other revolutions with which we are concerned, more important than the Turkish conquest, the discovery and colonisation of America or the imperial vocation of Spain. Had it not been for the increase in the number of men, would any of these glorious chapters ever have been written?... The increase lay behind all the triumphs and catastrophes of a century.’

Remarkably, medical historians have had little to say about the history of man’s health. The reason, I would suggest, is not that they were uninterested: it is that they believed the explanations for the changes were self-evident. Since the 17th century, medical thought has been dominated by the concept of the body as a machine whose protection from disease and its effects depends primarily on internal intervention. The modern improvement in health was assumed to be due to advances in medical knowledge applied through specific preventive and therapeutic measures, and the possibility that health was being transformed by changes in the conditions of life was not seriously considered. Hence histories of medicine, like histories of art, have two main themes, the great men and the great movements: Leonardo and the High Renaissance; Pasteur and the rise of bacteriology. Historians have written about the lives and works of Hippocrates, Galen, Paracelsus and Osler: but they have not inquired whether the great physicians were able to treat disease effectively. They have been concerned with the description of significant events in medical history, rather than with the central problems related to human health.

The deficiency in historical studies has begun to be recognised, and the Cambridge Monographs on the History of Medicine provide welcome evidence of the new approach. They are intended to cover ‘all aspects of health, disease, and medical treatment, being especially concerned with biological aspects of normal life, with patients, and with systems of health care’. The first volume, edited by Charles Webster, is of particular interest as an indication of the aims and methods of the series.

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