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


At the dawn of the twenty-first century, we have become accustomed to medical breakthroughs and conditioned to assume that, regardless of illnesses, doctors almost certainly will be able to help—not just by diagnosing us and alleviating our pain, but by actually treating or even curing diseases, and significantly improving our lives. 

For most of human history, however, that was far from the case, as veteran medical historian Michael Bliss explains in The Making of Modern ...

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

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At the dawn of the twenty-first century, we have become accustomed to medical breakthroughs and conditioned to assume that, regardless of illnesses, doctors almost certainly will be able to help—not just by diagnosing us and alleviating our pain, but by actually treating or even curing diseases, and significantly improving our lives. 

For most of human history, however, that was far from the case, as veteran medical historian Michael Bliss explains in The Making of Modern Medicine. Focusing on a few key moments in the transformation of medical care, Bliss reveals the way that new discoveries and new approaches led doctors and patients alike to discard fatalism and their traditional religious acceptance of suffering in favor of a new faith in health care and in the capacity of doctors to treat disease. He takes readers in his account to three turning points—a devastating smallpox outbreak in Montreal in 1885, the founding of the Johns Hopkins Hospital and Medical School, and the discovery of insulin—and recounts the lives of three crucial figures—researcher Frederick Banting, surgeon Harvey Cushing, and physician William Osler—turning medical history into a fascinating story of dedication and discovery.

Compact and compelling, this searching history vividly depicts and explains the emergence of modern medicine—and, in a provocative epilogue, outlines the paradoxes and confusions underlying our contemporary understanding of disease, death, and life itself. 

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Editorial Reviews

Howard Markel
“The talented author and historian Michael Bliss has done it again. This concise, eloquent, and elegant volume is brimming with important insights and exciting ideas. It is the perfect introduction for anyone who hopes to understand the modern history of medical discovery and its impact on contemporary society.”
Nursing Management
"A book of 112 pages could not hope to cover the vast topic of modern medicine. However, Michael Bliss has managed to condense it to an overview that relates to current debates and discussions, particularly around the effect that religious beliefs can have on medical treatments. . . . The author's style of writing is open and accessible. A topic that could easily have been something reserve for the attention of medical researchers is made accessible to a wider audience. This is more than a historical text; it is a delight for all curious minds."
Howard Markel
“The talented author and historian Michael Bliss has done it again. This concise, eloquent, and elegant volume is brimming with important insights and exciting ideas. It is the perfect introduction for anyone who hopes to understand the modern history of medical discovery and its impact on contemporary society.”—Howard Markel, author of The Anatomy of Addiction: Sigmund Freud, William Halsted and the Miracle Drug, Cocaine
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Product Details

  • ISBN-13: 9780226059013
  • Publisher: University of Chicago Press
  • Publication date: 2/15/2011
  • Pages: 112
  • Sales rank: 651,725
  • Product dimensions: 5.80 (w) x 8.60 (h) x 0.60 (d)

Meet the Author

Michael Bliss is University Professor Emeritus at the University of Toronto, a recipient of the Order of Canada, and an honorary Fellow of the Royal College of Physicians and Surgeons of Canada. He is the award-winning author of many books, including The Discovery of Insulin, William Osler: A Life in Medicine, and Harvey Cushing: A Life in Surgery.

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Read an Excerpt


Turning Points in the Treatment of Disease


Copyright © 2011 Michael Bliss
All right reserved.

ISBN: 978-0-226-05901-3

Chapter One


We spend most of this chapter in late nineteenth-century Montreal, then the dominant city in the Dominion of Canada. It was a commercial, financial, and industrial center of about 165,000 people, surrounded by suburban villages, situated on the St. Lawrence River in the province of Quebec. Sixty percent of Montrealers were of French descent, 40 percent of British. The scene opens in 1874 as a young Montreal doctor, William Osler—the most recently appointed and probably best-trained professor at Canada's best medical school, McGill University's Faculty of Medicine—finds himself confronted with one of his first patients, an English visitor to the city. Osler realizes that the sick man has a case of hemorrhagic or black smallpox, what the French- Canadians call la picotte noir.

It is a terrible disease, which Dr. Osler is helpless to cure. He can help his patient a little by prescribing morphine to relieve his suffering. Osler can also be very confident of both the accuracy of his diagnosis and, unfortunately, the accuracy of a prognosis that holds out little hope. As the victim worsens, Osler stays by his bedside, for hours on end, and at the patient's request he reads to him from the Bible. The man occasionally mutters prayers, and his doctor helps in one further way: "As the son of a clergyman ... I performed the last office of Christian friendship I could, & read the Commendatory Prayer at his departure"—an act of both priestly caring and medical resignation.

* * *

Smallpox was one of the most dramatic and loathsome contagions that physicians like Osler confronted in the nineteenth century. It was far from the only disease that highlighted their helplessness. They had no weapons against bubonic plague, cholera, diphtheria, typhus, typhoid fever, scarlet fever—indeed any kind of infection. They had no weapons to confront any kind of chronic disease, ranging from congenital conditions, such as the deficiency that caused cretinism in children, to systemic breakdowns, such as the onset of diabetes mellitus, the growth of tumors, the decay of the cardiovascular system, and many other afflictions. They were powerless to affect humanity's inevitable progress toward death, as powerless as King Canute was to control the tide, as powerless as we are today to improve our climate.

In such situations, with little to do other than try to make patients as comfortable as possible, it is not remarkable that both physician and patient would fall back on age-old religious rituals, such as the reading of Scripture and the saying of prayers. It is not remarkable that victims stalked by deadly diseases comforted themselves as best they could with fatalistic acceptance, variations on the theme that whatever could not be changed by human activity must be a product of divine will. For Christians, the overwhelming majority of the population of English-speaking countries throughout the nineteenth and twentieth centuries, the good news was that their faith included the prospect that physical suffering and death were followed by a glorious and eternal afterlife. You would meet your loved ones again on the other side of the grave. And so, in times of epidemic and grief, one could at least pray for the souls of the dead, that the God who had taken them would favor them with his grace.

Of course, one also prayed that God might stay his judgment and not inflict disease on his people. If disease had divine origin, and if it struck unevenly, surely there were elements of divine choice at work in the incidence of sickness. Perhaps God was striking down sinners by sending plagues—plagues on Egypt, plagues on his enemies, plagues on the sinful, plagues on the corrupt. Perhaps the coming of disease could be prevented by prayer, by faith, by devotion, by the intercession of the saints, by godliness, by avoiding sin, by taking what might be called religious precautions—always remembering that the ways of the Lord were ultimately unfathomable, so there could be no guarantee of exactly how prayers and devotions would be answered, if at all.

By the last quarter of the nineteenth century, the continuing development of humanist, secular, empirical, and scientific explanations for the onset of disease conditions mounted a powerful challenge to the predominantly or fundamentally religious worldview. That challenge was no more evident than in the view that sanitation, both public and private, could obviate the conditions of filth, odor, miasma, and pollution that seemed to give rise to so many diseases, the exact causality of which was usually unknown. For many people in the Western world, cleanliness had begun to rival godliness—even displace godliness—as a precondition of health. Beginning in England in the 1830s, public health through improved sanitation had become a great crusade in the age of progress. Sanitation did prove vitally important in helping prevent the spread of filth-and waterborne diseases, such as the greatly dreaded cholera.

It had also happened that one of the greatest breakthroughs in the history of health had occurred at the end of the eighteenth century in connection with the equally dreaded and possibly even more loathed epidemic disease, smallpox. One of our most familiar medical stories, broadly true in its essential details, is of how an English country doctor, Edward Jenner, discovered in the 1790s that if he inoculated people with the germs of cowpox—that is, if he gave them variolae vaccinae, smallpox of the cow—they would develop an immunity to human smallpox. Exactly how this happened would be a mystery for many years, but that it occurred offered marvelous possibilities. Prevention by vaccination almost immediately replaced the only other preventive procedure for smallpox, which had been inoculation with the human virus itself. At best this inoculation induced a mild case of smallpox and subsequent immunity. Too often it would ignite what could become a smallpox epidemic.

Vaccination was quickly heralded and adopted around the world. In 1798, the same year Jenner published his landmark pamphlet on vaccination, a teenage boy in far-off Newfoundland was vaccinated successfully by one of Jenner's former students. By the 1820s, millions of people had been vaccinated in Europe and America, the pope had endorsed vaccination as a gift from God, and humanity stood on the threshold of salvation from one of its most-feared scourges. As Osler knew in 1874, physicians were still as helpless to treat actual cases of smallpox as they were of most other diseases. But here was a disease that could fairly easily and usually reliably be prevented. In the first two-thirds of the nineteenth century, the incidence of smallpox outbreaks in Western countries decreased rapidly, becoming unusual occurrences controllable by quarantine and vaccination. Foresighted public health workers speculated, as had Jenner himself, that smallpox was a disease that in theory could be completely conquered, completely eradicated.

* * *

On February 28, 1885, George Longley, a conductor on a Grand Trunk Railway Pullman car that had arrived in Montreal from Chicago, felt he was coming down with something. A local doctor diagnosed a mild case of smallpox and, after various misadventures (relating to the fact that the conductor was a Protestant but the Montreal General Hospital would not treat cases of smallpox), had Longley admitted to the Roman Catholic Hôtel-Dieu Hospital. Perhaps because of some early confusion about whether or not Longley had smallpox or chicken pox, Hôtel-Dieu's procedures for isolating the highly contagious patient broke down. Although Longley fully recovered from his case, the disease spread to hospital workers, two of whom died.

A completely separate hospital building, the city's old smallpox hospital (it had been busy in the 1870s when smallpox was endemic in Montreal but had been closed for the past several years) was reopened so the contagious patients could be removed from Hôtel-Dieu. But this action came too late. As smallpox continued to spread in Hôtel-Dieu, it was decided in mid-April that the whole building had to be disinfected. All patients who were able to be relocated and did not seem to have smallpox were sent home. Almost immediately cases of smallpox outside of the hospital began to be reported. The civic Board of Health realized there was a serious epidemic of smallpox in the streets of Montreal.

The health authorities thought it could easily be contained and the disease stamped out. All patients were to be taken to the smallpox hospital, and their residences were then to be sealed and disinfected with sulfur fumes. In rare cases where patients could not be removed, their residences were to be isolated and the inhabitants quarantined. In the meantime, vaccination was to be made freely available. Montrealers who did not want the services of the public vaccinators could be vaccinated by their private physicians. By the end of April, it was thought that the mini-epidemic, which had taken only about six lives, was over.

In fact, everything was going wrong. Complaints began to pour in to the Board of Health about harmful effects of vaccination, notably the development of cases of erysipelas (skin inflammation and fever, sometimes acute) among the recently vaccinated. Parents claimed that vaccination was making their children desperately sick, perhaps even killing them. Realizing that its vaccine supply was contaminated, the Board of Health decided to suspend public vaccination, relying instead on private physicians for vaccination and on procedures for removal, isolation, and quarantine. The health officers almost immediately found, however, that in the poor neighborhoods of Montreal, where the flames of smallpox were concentrated, people did not take any preventive or control methods seriously.

They would not cooperate with the health authorities. They would not send their sick children to the smallpox hospital. They would not even isolate their children. When the sanitary police placarded their homes, they tore down the placards. Quarantine was ignored. Children and adults with freshly pockmarked faces were observed in the many crowds that gathered in Montreal that summer—crowds that massed to observe religious processions and a bishop's funeral, to welcome troops home from helping suppress Louis Riel's rebellion in Canada's Northwest Territories, and to attend Buffalo Bill's Wild West Show. Many Montrealers were vaccinated or re-vaccinated by their doctors, but many others ignored the preventive. At least two apparently qualified local doctors spoke out strongly against any kind of vaccination. They claimed that vaccinations were a foul injection of animal disease into human bodies, that they caused cases of smallpox as well as other infections, and that sanitary precautions—cleaning up the city, especially its slums—would be sufficient to defeat smallpox.

The outbreak of smallpox was not contained. The red death, as Edgar Allan Poe and others had called it, spread like fire. By mid-August 1885, 120 Montrealers had died from smallpox, and the disease seemed to be raging out of control. The city finally became alarmed, as did the outside world. Several newspapers began giving the epidemic front-page coverage. Many more Montrealers rushed to be vaccinated by their doctors. The Board of Health resumed free vaccination, using a new vaccine. It beefed up its containment efforts, enlarged the smallpox hospital, and considered laying charges against those who violated the sanitary bylaws.

Tourists and business travelers began to shun what was starting to be seen as a plague-ridden community. Merchants across Canada and the United States began boycotting products made in Montreal factories. In the stricken city, a committee of concerned businessmen and public-spirited citizens began to advocate making vaccination compulsory. The death rate rose to seventy-five per week, then to one hundred per week, with no end in sight.

By the end of September, there were stories of smallpox sufferers literally dying in the streets of Montreal, even as more incidents of violent resistance to patient removals and placarding were reported. After a week when a further 238 Montrealers died from smallpox, the city council decided it had to make vaccination compulsory. As soon as that resolution was passed, crowds of angry Montrealers gathered and began stoning and trashing Board of Health offices. The mob ultimately laid siege to city hall, their protests and battles with police mounting to the level of a full-scale riot.

Montreal's mayor, Honoré Beaugrand, supported by the city council, formally requested that the militia be called out to come to the aid of the civil power. More than one thousand soldiers were mustered to protect civic buildings and civic officials, and especially to stand guard as a new smallpox hospital was constructed in buildings on the provincial exhibition grounds. Within a day or so, the violence was contained, but there was no attempt to implement compulsory vaccination. One soldier died in a gunshot accident while on guard at the smallpox hospital.

Through October 1885, a grim masque of red death raged in Montreal, with 250 to 300 deaths per week within the city and as many more in several poor villages on its outskirts. Black hearses trundled up and down the streets of the city, especially its east end. Authorities vaccinated where they could, removed patients to the smallpox hospital under armed guard, and laid charges against obstructors. The outside world, including American state governments and the government of Ontario, enforced its own quarantine against Montreal. Passengers on trains leaving the city were inspected at the Ontario-Quebec boundary and the Canada-U.S. border. They were required to show vaccination scars and/or vaccination certificates, or accept vaccination on the spot. A market immediately developed in fraudulent vaccination certificates.

In November and December, the death toll gradually declined, though New Year's Eve 1886 featured a pitched battle as Montreal police defended wooden barricades erected to block streets connecting the smallpox-ridden village of Sainte-Cunégonde with the rest of the city. On January 31, 1886, the epidemic was officially declared ended. Many churches held ceremonies thanking God for relieving the city. Embers of smallpox radiated into spring.

* * *

In the fifteen months from February 1885 to May 1886, Montreal recorded at least 9,600 cases of smallpox. There were a further 10,300 cases outside the city, mostly in its poor suburbs. In all, 3,164 Montrealers died of smallpox, about 2 percent of the city's population. There were a further 2,600 deaths in Quebec outside the city, mostly in nearby suburbs. These figures almost certainly understate the real tolls because many cases and deaths were unreported or mislabeled.

In the history of North America, there had never been a smallpox epidemic like this in any city. Montreal's smallpox epidemic of 1885 appears to have been the worst scourge of the disease in any industrial city anywhere since perhaps the beginning of the century, certainly in the last third of the century. While sparks of the smallpox virus did set off minor conflagrations in many cities and countries into the 1880s, they were everywhere else met with fierce resistance and preventive measures that stamped them out. In 1884, for example, an outbreak in a rural township in the province of Ontario was defeated by a state-ordered closing of schools and churches, a ban on all public gatherings, strict enforcement of quarantine, and house-to-house vaccination. In 1885 when travelers from Montreal threatened to set off epidemics outside Quebec, every jurisdiction responded forcefully and with success. The worst spin-off epidemic was in Charlottetown, Prince Edward Island, where in six weeks smallpox took fifty-three lives. Here, too, the virus was stopped by compulsory house-to-house vaccination, a closing of schools and churches, and a ban on all public meetings.


Excerpted from THE MAKING OF MODERN MEDICINE by MICHAEL BLISS Copyright © 2011 by Michael Bliss. Excerpted by permission of THE UNIVERSITY OF CHICAGO PRESS. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.

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Table of Contents



I Fatalism: Montreal, 1885

II The Secular Saints of Johns Hopkins

III Mastery: Toronto, 1922

Epilogue: The Collapse of Life Expectancy

Notes  Index

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