Ira Rutkow - Seeking the Cure: A History of Medicine in America

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To my fellow physicians and their patients

HEALTH CARE AFFECTS the lives of all Americans, yet few understand how the system came to be. The nation certainly was not founded with todays modern arrangement in placethe dizzying network of physicians, hospitals, clinics, insurance companies, and pharmaceutical firms, to name a few. For much of the countrys history, doctors were solitary practitioners who followed the untested theories of their mentors, tried to gain respect through professionalization, and vigorously defended themselves against external change. These men (and women, eventually), whose bold innovations helped to meld scientific advancement with clinical care, would expand the possibilities of medical treatment for patients throughout the world. Seeking the Cure tells their story. It is a story of medicine, but it is also a story of America.

Fitting this tale into a single, accessible volume has always been difficult. On the one hand, medical history often progresses with discrete breakthroughs, from the introduction of inoculation for smallpox in early-eighteenth-century Boston to the first cardiac surgery using a heart-lung machine two hundred and thirty-two years later in Philadelphia. Each of these discoveries is a story in itself, the tale of a doctor or team of doctors conquering the medical unknown. On the other hand, medical history also moves in gradual, almost imperceptible steps. The growth of medical schools and the ascendance of hospitals, for example, are changes that took centuries to achieve, yet there are few watershed moments that show such evolution. Neither narrativethe discrete or the gradualis complete without the other.

Seeking the Cure weaves together these two braids of medical history to tell a fascinating chronicle. The steady sociological changes in medicine (the process of professionalization with its side issues of credentialing, education, licensing, standardization, and the rise of the medical-industrial complex) form a backdrop against which astonishing scientific discoveries (transformations in treatments and techniques) are grafted. Thus, the reader is able to understand how the shaping of the profession impacted medical achievements, and vice versa. Such parallels in the science and sociology of medicine appear repeatedly, and this two-pronged discussion best conveys the complexity and richness of the history of medicine in America.

But medicine is not a universe unto itself. It is neither a closed kingdom nor the province of physicians alone. The changes and discoveries within the profession also occurred (and continue to occur) as part of the broader fabric of American life. For example, the fact that the earliest efforts to unite the colonies went hand in hand with the first attempts to unify doctors or that American medicine rose to international preeminence around the same time the nation emerged as a superpower in world affairs was not serendipitous. The evolution of American medicine has often closely mirrored the nations history. To explain these parallels, Seeking the Cure intersperses the story of medicine with the economic, political, and social issues of the country as a whole. Putting medical events in a wider historical context allows readers to better situate themselves within the sweep of the narrative. The doctors are center stage, but the theater in which they are initially performing is America, and later the world.

In this respect, it should be stressed that the book is written for as wide an audience as possible. The work is purposefully free of medical jargon, and when technical terminology is used it is explained in plain English. The hope is that Seeking the Cure will be entertaining and educational for the lay reader, the medical professional, and the policy maker, as all three have something to gain by understanding medical history. For the lay reader, the book serves to provide a sophisticated understanding of clinical care that will lessen the anxiety of being a patient. For the physician, it lends perspective to their clinical performance while distinguishing fact from fiction and hero from villain. For the policy maker, it informs the decisions that will shape the future of health care.

At the same time, Seeking the Cure is intended to be a work of revelatory history, specifically one about medical practice, its practitioners, and the professionalization of medicine as a discipline, and not brash policy. No book can be entirely free of bias, but I have attempted to limit this distorting lens and to tell medical history as clearly, concisely, and vividly as possible. There are no critiques of current strategies nor suggestions for future ones. Instead, Seeking the Cure emphasizes the events of medicine within the full tapestry of the American experience.

To the extent that my own perspective shapes the narrative, it is perhaps most evident in the selection of stories that are featured. It would be wonderful to give lengthy coverage to every medical discovery, every research breakthrough, every professional development, but that would require a multivolume tome. And such a work would be less accessible. For example, late-twentieth-century medicine, which , for instance, which considers racism and segregation in medicine, might have substituted the World War II era tale of Charles Drew, a renowned African-American physician whose medical research led to innovations in the use of blood, with the story of the Tuskagee syphilis study, when doctors intentionally permitted impoverished African-American sharecroppers to suffer from the disease even though by the mid-1940s it was known that penicillin was a cheap and effective cure. Some might argue that my approach results in cursory summarizations or exclusions, but Seeking the Cure is not aimed to cover every significant event in Americas medical past, nor praise all famous physicians, nor relate the history of each specialty. The personalities and advances that are highlighted are the ones that struck me as most illustrative, important, or, occasionally, simply fascinating. Collectively, they provide a captivating story, even if certain details are spared.

I will, however, confess to having a bias toward events in surgery. After all, I am a general surgeon. But in my defense, I offer the words of Henry Bigelow. He was a faculty member at Harvards medical school over a century ago and speculated on the differing interest in the progress of surgery versus medicine. Why is the amphitheater crowded to the roof on the occasion of some great operation, while the silent working of some drug excites little comment? Mark the hushed breath, the fearful intensity of silence, when the blade pierces the tissues, and the blood wells up to the surface. Animal sense is always fascinated by the presence of animal suffering.

I have devoted my professional life to medicine, both as a physician and an author. I hope that my dual perspective on the subject (the combining of contemporary historical scholarship with a doctors skills at the bedside and in the operating room) proves useful in the retelling. Traditional historians when tackling the material, often quite ably, are still hampered by their outsider status.

Medicine is a quasi-religious, mystical craft that almost no one can avoid encountering over the course of a life. The nonphysician often wants to peer into this mysterious realm, but must do so through closed fingers. It is to better understand medicines ability to provoke fascination and fear, to serve as a mirror into our lives, that