Reviews

Editors Helen and William Bynum have amassed a team of experts in their fields to provide a breathtaking journey through the story of human efforts to fight illness and disease from ancient Egypt to the modern day. The book is logically organised into seven sections exploring themes; within each section, academic experts offer snapshots on topics as diverse as bubonic plague and beta-blockers.

Inevitably, given the title, this compendium is chiefly – and unusually for some contemporary medical historians – a celebration of medical achievement, just as it should be. Here are all the familiar heroes and triumphs, like Harvey, Pasteur, Snow and Lister, and their extraordinary stories of dogged determination and maverick insights. Yet there are some extraordinary new stories too, along with welcome spotlights on insufficiently hymned figures.

Among the most fascinating of the less well-known innovations is the story of the incubator. Darwinist ideas discouraged doctors in Britain and the US from attempting to save premature babies, explains Jeffrey Baker. But French obstetrician Stéphane Tarnier (1828-1927) noticed chicken incubators on a trip to a Paris zoo and promptly installed similar devices in his hospital ward. Mortality for underweight babies fell by nearly half.

These expertly chosen and beautifully reproduced images offer us the best understanding of changing attitudes towards health and disease

Before long, ‘incubator baby’ shows were popping up as exhibits in shop windows and world fairs. The invention of the defibrillator is another vastly significant yet unfamiliar tale, although the book’s account inexplicably omits the first established case of reviving a patient with electric shocks, in London in 1774, when a three-year-old girl was reportedly resuscitated after falling from a window.

But the real stars in the sparkling firmament of this scintillating book are without doubt the illustrations. Ranging from exquisite anatomical drawings to public health posters, from Islamic tapestries to CT images, these expertly chosen and beautifully reproduced images offer us the best understanding of changing attitudes towards health and disease.

Together these wise words and stunning pictures offer a humbling story and a visual feast.

He considers that to attribute it to “evil”, as some do, is a cop-out, for it explains nothing. Why should some people, in otherwise just and caring societies, carry out aberrantly vicious acts? His hypothesis is that underlying such acts is a total inability to put yourself in another person’s shoes, to feel what they feel and act accordingly; a lack of what is called empathy – this he calls “zero degrees of empathy”.

Baron Cohen is a professor of developmental psychopathology at the University of Cambridge, and one of the foremost names in the study of autism and Asperger’s syndrome. He has blurred the boundaries between such extreme mental health conditions and the normal human brain, developing the concept of the autism spectrum and the “extreme male brain”.

He finds support for his hypothesis in neurology and psychology, and demonstrates, with studies using questionnaires, twins and functional magnetic resonance (FMR), that human beings fall along a spectrum in their capacity for empathy.

This empathy spectrum forms a normal distribution curve, where most people cluster in the middle and a few at the extreme ends. At one extreme are those who commit, or perhaps have the capacity to commit, extreme acts of thoughtlessness or cruelty (not necessarily physical), and at the other, those exceptional individuals who devote their lives to caring for others. In the middle are you, me and Joe Public; some are more empathic than others. Interestingly, more men than women fall into the low-average level and more women than men into the high-average group.

He has blurred the boundaries between such extreme mental health conditions and the normal human brain

Baron Cohen goes on to look at possible explanations for the empathy spectrum and he finds them in childhood experiences, eg, low levels of empathy are associated with childhood abuse, neglect or disturbance, characteristic electrical patterns in the brain and their effect on key neurotransmitters, like serotonin, and in distinct genetic variations, though not upon a single gene. The evidence he cites is inevitably drawn from studies of either mental health patients, or those in conflict with the law in either Europe or the United States.

Does he satisfactorily explain Nazi cruelty? I am not sure he does. I think he explains the behaviour of misfits – mental or penal – in essentially just, caring 21st century societies, but he ignores societal norms.

What is regarded as cruel depends on social context. Stoning was not considered cruel 2,000 years ago – such barbaric cruelty was the norm – a mere 100 years ago, callous, insensitive treatment of children was routine and it took exceptional free-thinkers to challenge it. But we still await an explanation for how, in the first half of the 20th century, Nazi doctors treated Jewish people no better than laboratory mice.