_ The Growth of Medicine
Man and Medicine. An Introduction to Medical Knowledge. By Dr. Henry E. Sigerist. With an introduction by Dr. William H. Welch. (Allen and Unwin. 12s. 6d.)
MEDICAL students make a motley crowd, and when for the first tome they stand within the gates of the hospitals from which they are later to emerge as healers of the sick, their thoughts must turn in a chaotic medley of different ways. It is for young students in this condition of mind that Dr. Sigerist's book is primarily intended, and what he is anxious to show them is the structure of medicine in the frame of general culture, and the historical picture that effects a syn- thesis of the multitudinous studies they have to face. Unfor- tunately, it is more than doubtful whether the average medical student met with in this country will turn aside to listen to this new and fascinating lesson. It may be different else- where, for example in Germany, where Dr. Sigerist's book was written, or in the United States, where it was translated into English which in places hardly does justice to the material it conveys. But if the medical student in this country fails to read this book, it will be his loss, for the book has a broad and modern point of view, and eminently succeeds in its object of providing a rational survey of the growth and present position of medical science.
The book opens with a chapter on normal man, and with a discussion of the evolution of knowledge of his anatomy, physiology and psychology. Information is presented in such a way as to establish the view " that every change in medical thinking is the outcome of the world point of view of the time," while scientific method, too, is extolled for the part it has played in effecting the changes. This chapter ends with a calm exposition of psycho-analytical views—which in a volume called an introduction to medical knowledge, is a fair sign that this branch of medical practice has at last truly lifted itself from the shabby position into which the more conservative devotees of surgery and medicine had forced it. For it is not five years since a British Medical Association Commission sat to discuss whether psycho-analysis was re- spectable enough to be regarded as a branch of medicine.
From normal man to sick man—and Dr. Sigerist traces the steps whereby the invalid, after travelling through different cultures as a leper dangerous to his fellow:creatures, or as one atoning for sins, or as one who is inferior, at'last arrives in a calm where disease means purification, Where disease is grace, and where succour and healing is a Christian duty which aids the soul in its unfolding. It is only its history which allows of a true understanding of the significance of the modem'social attitude towards disease, with all its paraphernalia of sick insurance, State aid and voluntary hospitals.
The idea of isolated diseases is an abstriction from the fact of sick people, and these abstractions achieve their meaning and validity in the ever-recurring sequence of symptoms which characterize certain types of sick people. The isolation of the concept of specific diseases was not, hOwever, common to all medical systems. Thus Hippocratic medicine did not define diseases ; it classified men, and so developed the con- stitutional theory of disease, whereby it was believed that the form of a sickness is determined, not by the kind of disease, but by the type of ailing man.
In easy exposition Dr. Sigerist goes on to modem concep- tions of the nature of sickness, to modern Methods of medical study, to the question of treatment, and still further on to the wider problem of public health and hygiene. The last is a fascinating story, with its significant beginnings in such religious exercises as the dietary laws of the Jews, and "with its modern advance dating from the development in England of the technique of smallpox vaccination. Although it was in England at the beginning of the nineteenth century that factory acts aimed at protecting the worker from ill-health were first enforced, vaccination laws in Germany were the earliest attempts of a State to interfere directly with the
physical life of the individual. And so the tale proceeds ; but to concentrate in a review on any part of Dr. Sigerist's book is to do the rest an injustice. Everywhere it teems with interest ; everywhere it is full of stimulus and broad vision. It is indeed a generous book.
S. ZucEmastisi.
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