Seeking the Cure: A History of Medicine in America Review

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(More customer reviews)I was rereading a wonderful old novel by H. G. Wells, "The History of Mr. Polly." Mr. Polly's father dies, and Wells says: "...the local practitioner still clung to his theory that it was imagination he suffered from, but compromised in the certificate with the appendicitis that was then so fashionable." Why was appendicitis "fashionable?"
If someone asked you to fill in the blank quickly in the sentence "The surgeon performed an _________" you would probably say "appendectomy." Yet it isn't such a terribly common operation today. Why is it the ur-operation, the one always used for purposes of hypothetical illustration. Why appendectomies?
I saw "Seeking the Cure" and dipped into it to see whether it had an answer. It did, or at least as close to an answer as you'd ever get. It was a confluence of events. I hadn't realized that abdominal surgery had once been a medical taboo, with a nearly 100% mortality rate. Antisepsis ("Listerism") and anesthesia made it safe. It had once been extremely difficult to diagnose. I hadn't really thought of centrifuges, microscopes and blood counts as being a breakthrough in modern technology, but of course they were, part of the medical technology revolution that emerged from World War I. And they made it possible to diagnose appendicitis reliably. And there was one influential surgeon who promoted the idea that it was a surgeon's disease, that appendicitis "belonged to" the surgeon. Hospitals and surgeons found appendectomies to be lucrative, and they became almost a fad; Rutkow cites a hospital in which 1/5th of all operations performed were appendectomies.
Well, I was hooked. The book fascinated me. For me, it had just the right amount of detail, just the right balance between popular storytelling and serious history, just the right blend of attention to personality, to technology, and to organizational dynamics. Rutkow interleaves the narrative with short profiles of historically important individuals--with glimpses of their personality.
I was fascinated by his description of the way hospitals in the 1920s were transformed into technology centers where patients were sent for diagnosis--to be "worked up"--as well as for treatment. Hospitals positioned labs centrally and put windows in their labs so visitors would be sure to see how up-to-date they were, much as businesses once showcased their computer facilities.
To give one example of how he illuminates history: Why did Medicare finally pass under Johnson? Because the AMA, which had doggedly opposed any form of national health insurance, was weakening. Why was the AMA weakening? Because it primarily represent generalists, and lost influence with the rise of the specialists after World War II. What did World War II have to do with the rise of the specialist? (In part) because the military decided to assign specialists to higher pay grades, thus putting a sort of institutional endorsement of specialization.
I don't know how the book would strike a serious medical historian, but as an introduction for the curious layperson like me it is first rate.

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