A Physician Reflects—Herman Boerhaave and other Essays

As doctors grow older and shed clinical responsibility, they become uneasily aware that the craft that they once practised is no longer relevant to the health problems of today. Perhaps the most satisfying way of demonstrating that the volcano is not extinct is to attempt an expertise in medical history. This tends to provoke a confrontation with the historians, who are skilled in analysing data but know little about medicine. Each side regards the other as a bunch of amateurs. The dual credentials of Sir Christopher Booth, however, are impeccable. As a physician, he has fulfilled numerous impressive chairmanships and presidencies, and his professional interest in medical history goes back nearly fifty years to when he was a young medical registrar. A Physician Reflects offers a collection of lectures and essays given over many years. The central theme is the transformation of British medicine from an art to a science, as illustrated by the superbly scholarly essay on Boerhaave, which is the best thing in the book—although Chapter 8, ‘From Art to Science’ is perhaps the one of which the author is most proud. Likewise, the pieces on the Fothergills (1980) and Samuel Gee (1993) are illuminating additions to medical history. On more recent events, Booth is on less sure ground. The chapter on ‘Gastroenterology in Britain, a Study of a Specialty’, which is largely a description of forgotten heroes of the 1970s, is of little general interest and would be best left undisturbed in the archives of some learned society. ‘The Royal College of Physicians Enters the Modern World Or “The Gold-Headed Cane”’ represents a valiant attempt to credit the denizens of Regent’s Park with the discovery of the cause of lung cancer, and will cause much innocent merriment among surgeons and others. Readers may also be troubled by his lapses into banality—for instance, ‘Medical journalism has been of vital importance for the international diffusion of knowledge and new ideas’ (p. 69), ‘Throughout the centuries, physicians have carefully studied the illnesses that they encountered’ (p. 100), ‘Computers have entered the clinic providing a useful adjunct to diagnosis’ (p. 143). But, there is much to enjoy here, not least the account of a professorship to tour Australia and New Zealand, described with elegance and vigour. Booth concludes: ‘Whatever the Jeremiads may say, there is little doubt that the pace of advance in medical science and technology will continue to accelerate’. Well, maybe. But first-world research has focused more and more on the expensive illnesses of affluent people, and isn’t it possible that, in the face of the huge political changes that threaten our ‘western civilization’, the poorer but more populous parts of the world will refuse to continue bankrolling these inequalities, and, using simple communication techniques that they have learned from us, will overturn the entire system? It’s worth a thought.