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The Art’s History

Will today’s medicine be tomorrow’s barbarism?

The New Physician May-June 2010

Seeking the CureCareful dissection of the past can help us mold our future; this is abundantly true in the ever-changing art of medicine. As students of medicine, we must acknowledge the history of diagnosis and treatment and not perceive our current knowledge as unchanging empirical truth.

This jaundiced face of medicine and our approach to it is illustrated in Dr. Ira Rutkow’s Seeking the Cure: A History of Medicine in America (Simon & Schuster, $28). The author fashions a series of vignettes from early colonial medicine to the modern day—from bloodletting in the mid-18th century to the first organ transplants in the mid-20th century.

In the early 19th century, doctors like Benjamin Rush, deemed the nation’s greatest physician of his era, wholeheartedly ascribed truth to the practice of “heroic” therapies. The mantra “bleed, blister, puke and purge” was repeated by both physicians and their patients. This practice was seen as the epitome of treatment at the time and used for a variety of conditions from rashes to lupus to a meningitis-induced epidermal eruption. But as scientific medicine grew in popularity, the old guard of doctors who believed in heroic therapies was replaced by those who saw the techniques as barbaric.

Throughout Seeking the Cure, Rutkow begs the question: What do we take as medical truths? Shouldn’t we view these with a healthy sense of skepticism?

As scientific medicine began to grow in esteem in the late 1860s, medical diagnosis began to shift from a strictly visual practice to relying on analytical techniques to treat patients. Increasing technology allowed a patient to be studied and diagnosed as opposed to simply evaluated and treated.

These leaps in medical advances changed the face of American academic medicine and the demographics of those who could receive treatment. New treatment tools came at a cost. The latter half of the 20th century marked huge leaps in the understanding of medicine, but with a price tag fewer patients could afford.

Revisiting the extreme example of heroic therapies reminds us of the paramount importance of our own open-mindedness toward new medical therapies. Hand-in-hand with this inquisitive approach is Rutkow’s portrayal of American medicine as a system that is not isolated. Seeking the Cure elucidates the symbiotic relationship between American medicine and the rest of the world. The majority of early American doctors, trained in European medical schools, brought back theories on Listerism and surgical techniques. In turn, the Americans introduced anesthesia and other scientific advances to their European counterparts.

The latter half of the book focuses on the increasing influence government has had on the funding and practice of medicine. This is a particularly pressing issue with the battle over socialized health care that has been waged since President Franklin Roosevelt in the 1940s. Rutkow examines the interconnectedness of scientific advances in medicine and their effect on patient care, federal funding and government policies.

Seeking the Cure is helpful in understanding medicine as a constantly evolving practice that must be viewed as an extension of our past. In Rutkow’s eyes, medicine is an art and a scientific practice. While we can strive to be experts in understanding medicine, it is in treatment of patients as unique individuals where the art is expressed. Having a firm grasp on medical history buttresses our understanding, approach and fervor.

Margo Tanghetti is a postbaccalaureate premed at the University of California, Berkeley.

Our Forefather’s Flaws

By Jatinder Narang, M.D.

Genius on the EdgeWho could have imagined that the brilliant medical pioneer who could undoubtedly be called the “Father of Modern Surgery” was also a drug addict and an isolated individual who found solace by injecting cocaine?

Genius on the Edge: The Bizarre Double Life of Dr. William Stewart Halsted (Kaplan, $25.95) guides the reader through the life and times of this remarkable man who, in the 19th century, helped construct the beginnings of the modern American medical education system. His contributions were so profound that every academically affiliated surgeon can trace the roots of her understanding of surgical medicine to Halsted.

Dr. Gerald Imber’s book chronicles Halsted’s illustrious surgical career. His achievements included creating educational guidelines that provided the impetus to establish the first formal surgical residency program in the United States at Johns Hopkins University.

Halsted’s monumental con-tributions came in surgical medicine’s infancy. Newer surgical procedures were built on trial and error with previous patients. At the time, medical schools were akin to trade schools and did not require an undergraduate degree for admission. Medicine was no more than a business, and instructors profited by encouraging large enrollments. Lectures were both poorly taught and attended, with no emphasis on clinical training.

But with Halsted at the helm, the new school of medicine at Johns Hopkins University required students to have an undergraduate degree, along with a working knowledge of French and German, and instituted a curriculum based more on clinical and laboratory work.

Halsted was a pioneer in performing the first appendectomies. He has been credited for aiding patient safety by introducing the bedside charts, topographically aligning all vital signs so that any changes were immediately apparent.

Yet Imber describes Halsted in his personal life, paradoxically, as “rigid, proper, and secretive; compulsive and negligent; stimulating and reclusive.” His addiction resulted in extended leaves of absence, best described as drug holidays. But because of his incredible contributions, the trustees at Johns Hopkins were willing to accommodate the “vacations” because he was “valuable property.”

Despite Halsted’s history of drug use, prominent physicians of his time ardently supported him, without which he might not have had the opportunities to succeed. Perhaps, without such confidants who provided much-needed encouragement to this complex and brilliant man, surgery would not have evolved so miraculously.

Dr. Jatinder Narang is a graduate of St. George’s University School of Medicine.