DOCTORS: The Biography of Medicine

This is vintage scholarship nurtured by the rich resources of Yale's Medical Libraries and cultivated by Yale surgeon and medical historian Nuland. While the writing of history as biography is not without criticism, it has been a favorite approach in science and medicine. Thus, Nuland's cast of characters is familiar, even predictable--from the Hippocratic school through Galen, Vesalius, Harvey and others, down to Semmelweis, Virchow, Lister, and some contemporaries. What Nuland does with the material makes a difference, however. First, there is a philosophical thread that runs through it, stated as a dichotomy between the physicians of Cos (the Hippocratic school with its emphasis on regard for the patient) and the physicians of Cnidis (who concentrated on the diseased organ). This is holism versus reductionism, way back when. Both schools were doomed, Nuland notes, the Cnidians because they lacked the tools of analysis and because of taboos on cadaver dissection, the Coans because of their avowal of the four-humors concept of disease. Thereafter, progress in biomedicine has largely been a tale of triumph for the reductionists: those who took human anatomy and physiology seriously, and who, by the end of the 19th century, could demonstrate unequivocally that specific causes (such as particular bacteria) gave rise to specific diseases. Nuland believes that we are witnessing the dawn of a new era in which reductionism is joined with a broader view of the patient as an individual whose state of health or disease reflects many factors, including lifestyle, personality, genetics--in short, a new form of holism (not to be confused with counterculture alternatives). Somewhat romantically, like a Victorian gentleman, Nuland attributes these new currents to the growing presence of women in medicine, a point he underscores in a glowing account of pediatrican Helen Taussig's work with surgeon Alfred Blaylock in the repair of congenital heart defects. Indeed, the prose at times takes on the rhythms and metaphors of that earlier age, a style that suits Nuland's detailed portraits of his medical notables very well.