BMJ  2004;328:1443 (12 June), doi:10.1136/bmj.328.7453.1443-a

reviews

Book

Moments of Truth: Four Creators of Modern Medicine

None of the four 19th century medical personalities who are the subjects of this book won the Nobel prize, but all made important steps in the development of today's medicine. At a time when immediate auscultation and hippocratic succusion (holding patients by their shoulders and shaking them vigorously) were typical diagnostic procedures, the Frenchman René Laënnec invented the stethoscope and introduced it to clinical practice. Ignaz Semmelweis, a Hungarian obstetrician, proved that puerperal fever was a type of septicaemia and pioneered antiseptic obstetrics. The book's third part focuses on the more famous pioneer of antisepsis, Joseph Lister, and the fourth on Walter Reed, the US army pathologist who discovered that yellow fever was spread by mosquitoes.

The author, a retired consultant pathologist, describes the historical difficulties that the four men faced. Laënnec, born in 1781, lived through four decades of political turbulence in France. During the First Republic privileges and social distinctions were disregarded and "anybody could call himself a doctor and practise medicine," resulting in a dramatic rise in mortality and morbidity. However, later, under Napoleon, medical education was developed and governing bodies re-established, allowing Laënnec to pursue his scientifically based medical career. Semmelweis practised in Habsburg Vienna and as a Hungarian was criticised by his local colleagues. Lister's use of carbolic acid as an antiseptic brought derision from his fellow practitioners and students. Walter Reed had to pursue his career as an army doctor at a time of military conquest against Native Americans.

Dormandy skilfully interweaves the work of the four men with the academic, political, and medical intrigues of their time. Scientific fraud and competing political and financial interests were as much a part of the 19th century as they are of our own times. More generally, the book also beautifully describes life at peace and at war in revolutionary and Napoleonic France, imperial Austria, Victorian England, and late 19th and early 20th century America. However, despite a thorough notes section at the end of the book giving even more historical detail, Dormandy includes too many descriptive details, making it a little difficult to follow the lives of the main characters.

All four figures were crucial to the evolution of medicine from a practice of charlatans and skilled barbers to a profession based on science. Maybe in 100 years' time another author will write a similar book on the development of today's evidence based medicine. But are equivalent discoveries possible today? Would any famous medical journal publish the work of one clinician that wasn't a randomised controlled trial and that lacked enough participants to have statistical significance?

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Iasi, Romania ioanavlad{at}hotmail.com

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Rapid Responses:

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Politics of Noble prize!

Dr.Naseem A. Qureshi MD, IMAPA, LMIPS
bmj.com, 17 Jun 2004 [Full text]

Discoveries worthy of a Nobel

Akheel A Syed
bmj.com, 17 Jun 2004 [Full text]

Laennec misspelt

Mahender P. Chandie Shaw, et al.
bmj.com, 21 Jun 2004 [Full text]

Better a stethophone

john j picard
bmj.com, 12 Sep 2004 [Full text]