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

In his work Six Memos for the Next Millennium, Italo Calvino urges consideration of brevity as a positive and welcome attribute in writing, but it is unlikely that he had in mind a book quite as thin as this one. The weighty title promises over-much for a slender volume of 100 pages or so, and a little modesty in that department might have made the book less disappointing. Its title suggests an analysis of decisive events in the history of medicine, but that is not what we have here. Of the varied topics discussed by Michael Bliss, only one - the discovery of insulin - can really be said to have been pivotal.

The book is derived from a lecture series Bliss delivered in 2008 at the University of Western Ontario, based on his interesting and useful books. They are summarised here in three chapters on a smallpox epidemic in Montreal in 1885, the development of Johns Hopkins Medical School, and the discovery of insulin. Bliss holds these very disparate threads together with the figure of William Osler, who survived the Montreal epidemic, was first physician-in-chief at Johns Hopkins, and who turned down the presidency of the University of Toronto, where the work on insulin was done.

A key theme Bliss does not address is the pre-eminent importance of laboratory research on animals. During the period he seems most interested in - between the 1880s and the 1920s - both the study of human physiology and the development of successful therapeutics leapt forward as a result of the clinical application of lab-based research. Bliss touches on this essential matter in several places: mentioning that animal work preceded successful brain surgery, efforts to isolate thyroid extract for cretinism, and famously underpinned the discovery of insulin - but nowhere does he adequately address or analyse its significance. Nor does he do more than allude to the vast contribution, not least to Osler's thinking, of the world outwith North America.

The structural problem with the book is that the author seems undecided as to whether it is primarily concerned with the journey of Canadian medicine from epidemic smallpox to the discovery of insulin (to which the chunk of the central chapter on Harvey Cushing's brain surgery is not relevant) or whether it is an examination of the Oslerian fusion of clinical and laboratory medicine, in which the smallpox epidemic is a false start.

Osler is well worth serious attention, and an important figure in medicine on many fronts, not least in his unique combination of the effective and humane clinician and the laboratory scientist. But the curiously meandering and adulatory treatment he receives from Bliss extends to trivia such as the fact that Osler's father, a minister, baptised the infant Frederick Banting, later awarded a Nobel prize for the discovery of insulin. At a stretch, such a coincidence might serve for a footnote in a book on Canadian medicine, but not for the text of one on the making of modern medicine.

This book's footnotes are wafer-thin - Bliss essentially refers readers to his own earlier works, and his offer of an email address for anyone remaining stumped suggests a lack of concern for future readers, for whom email may be obsolescent and the author inaccessible.