The Making of Modern Medicine: Turning Points in the Treatment of Disease.

Higgins, James E.

The Making of Modern Medicine: Turning Points in the Treatment of Disease, by Michael Bliss. Routledge Worlds series. Toronto, University of Toronto Press, 2011. vii, 104 pp. $21.95 Cdn (cloth).

The Making of Modern Medicine is a collection of three lectures by renowned historian and author Michael Bliss. Each of the chapters corresponds, albeit in greater detail, to lectures Bliss offered in 2008 at the University of Western Ontario. The purpose of the lectures, and thus the book, is to highlight the shift to modernity in medicine, a period traversing the scientific and social landscape between 1885 and 1922. Interestingly, Bliss pairs the rise of modern medicine with a decline in what he terms a belief in "the old gods" of supernatural relief from sickness and death, (p. 3). In this configuration, the applied practice of medicine replaced, literally, religion's hold on responses to disease, a point he stressed by examining the changing nomenclature the public used to describe physicians during the period.

The lectures are arranged chronologically according to their content with the result that this admirable little book sweeps the reader along a narrative of victory against microbes and physical malfunction. The first essay details a smallpox epidemic in Montreal in 1885. The outbreak, according to Bliss, was met by a fatalism defined by anti-vaccination crusaders and common belief that smallpox was an indication of God's displeasure. The competition between modern medicine and the folk beliefs of the poorest, worst-afflicted members of Montreal society becomes, in Bliss' skilled hands, a struggle between the medieval and the modern, a struggle which culminated in a combination of archaic and scientific responses that provoked the worst late-nineteenth century outbreak of smallpox in North America.

His middle lecture, a synopsis of the first twenty years of Johns Hopkins Medical School and Hospital, pays particular attention to William Osler's role in developing the institution into the finest medical centre in North America. The last word in medical science, Hopkins provided a transition between the world of the supernatural and the realm of science, both literally and in terms of Bliss's narrative. Bliss, however, does not deviate into the sort of hero worship that often characterizes discussion of Hopkins' early years. Indeed, he neatly summarizes the limits of Osler and his colleagues when he noted that for years, the men of Hopkins could seek to "diagnose, predict, and relieve pain," but could seldom effect a cure. Bliss emphasizes, however, that by 1910 Osler's keen mind and sometimes-unconventional oversight forged the greatest hope for relief from disease, disorder, and trauma in North America and perhaps the world.

The final chapter transports the reader from turn-of-the-century Maryland to early-twentieth century Toronto, and likewise serves to distance the reader from a focus on the dangers of ancient pathogens and the struggle between religion/folkways and modern medicine, to focus on research surrounding type I diabetes. At the centre of the lecture is the University of Toronto and a cadre of brilliant, often lucky, and sometimes contentious researchers who sought to come to grips with a disease whose lethality, at 100 percent, matched that of any pathogen with the exception of rabies. Bliss illustrate the extraordinary task of preserving life in the face of an autoimmune disease that demanded not quarantine from microbial threats beyond the body, but from an enemy--a malfunctioning pancreas--that lurked within. Bliss, in only twenty superb pages, manages to link the development of insulin treatment with a coming-of-age saga of Canadian laboratory and clinical medicine. So deft is his control of the narrative that one is hardly aware that he links three themes (laboratory investigation of the disease, emergence of University of Toronto School of Medicine and Hospital as a first-class institution, and the achievements of individual Canadian researchers) with no clumsy asides or transitions and in a manner accessible to scholar and casual reader, alike.

In his epilogue, Bliss contends with the inescapable fact that the whole of medical science--the centuries of questioning, experiments, discoveries, and application of that knowledge to the human body--has led to a reduction of pain and a lengthening of life, but whether by prayer, nostrum, or modern therapy, the final outcome is always the same; the body breaks down and life is extinguished. In the hands of another author, scientific advances--progress as defined by the modern, industrialized world--might shrink to mere illusion. But Bliss recognized the inherent righteousness of reduction in mortality, especially among children; in increase of life expectancy; in the alleviation of suffering.

The Making of Modern Medicine suffers from few flaws. Structurally sound and stylistically accessible to the general reading public, his lectures offer important vignettes for the academic. Perhaps the greatest oversight for a published work was the omission of citations in chapter one with respect to a religious interpretation of smallpox. The narrative Bliss offers hearkens back to the variolation versus religion fights of the eighteenth century but, though he provides illustrations of newspaper ads for quack medicines and therapies, he offers none to illustrate his point concerning the negative influence of religion during the fight against smallpox in Montreal. Beyond this small concern, Bliss has constructed a remarkable narrative of scientific achievement, religious decline, and inexorable dissipation by disease and time.

James E. Higgins

DeSales University