The art and practice of medicine is built around lessening the suffering of our fellow man. The method of doing this however, has changed dramatically throughout human history. Western medicine had its beginnings in the restoring balance to the body that was not in sync with the environment. As scientific reasoning found its way into medical practice after the dark ages, the benefits of medicine quickly became a cornerstone of western civilization and a legitimizing factor in imperialism. In the early modern era, it was transformed into an industry that dedicated itself to the conquest of disease through science. The framework for better understanding disease changed throughout history from a narrow, western scientific perspective to a broader context that includes social, cultural, and economic factors.
The perceptions of western explorers in Africa greatly influenced the geographical theory of disease during the early colonial era. Although Europeans initially came to Africa to report on the indigenous population, their preconceptions of civilization along with their standards for medical practice warped their thoughts about the natives. James Lind, physician to the Royal Hospital, explored the West Indies, or as he describes it – the “unhealthy country”. Lind shows that the root of disease causing agents is the earth itself (Lind, 153). He says that all Europeans should avoid the tropics at all cost, “as nothing can be more inhuman than fending unseasoned Europeans high up from the mouths of rivers, into an uncultivated country, especially during the rainy season, and where there is no shelter from the pestiferous nocturnal air”. As the South Atlantic Trade started to take off for economic prosperity, Lind’s geographic medical theory was quickly replaced by a climatological theory of disease. Scientific investigations in Great Britain led by Priestley and later by Wilson showed that human respiration and combustion have the same basic chemistry, leading to the assumption that an element called “phlogistone, the material or principle of fire” can accumulate in places of dense human population, and can be absorbed by the water. These thoughts represented a shift in medical theory. They show that physicians identified the causative agents of disease to be climate rather than the geographical location. This quickly changes as European society embraces imperialist culture and begins to subordinate the indigenous African population.
As Africa became subservient to British and European rule, medical perceptions of the natives reflected the dehumanizing prejudice that physicians carried with them. David Livingstone, a missionary and physician, describes that he is inherently biologically different from the Bechuana tribesmen. After Livingstone was severely mauled by a lion, he describes: “my two companions in this affray have both suffered from peculiar pains, while I have escaped with only the inconvenience of a false joint in my limb”. Furthermore, Livingstone shows that his companion’s wounds would fester again in the following year. His descriptions reflect the widespread medical perspective that Europeans are biologically different than Africans. Although this represented a distinct break from the geographic and climatological theory of disease, this perspective of tropical medicine had a tremendous impact on imperial Europe. Physicians, a source of social authority for westerners, had in essence qualitative proof that Africans were less healthy than Europeans and, unbeknownst to them for lack of civilizing influences, desperately needed western biomedicine.
In the early 20th century, one of the most important concepts in western medicine began to develop: the idea that the body is not the source of disease, but rather a host for a wide variety of pathogens. This idea originated in work being done in European scientific establishments such as the Pasteur Institute in France and the Koch Institute in Germany. It identified “germs” as the casual agent in disease – not the human body itself. The incredible rate of recovery for patients who had undergone treatment using the germ theory made it gain ground in the medical community quickly. Medical students were learning that diseases like malaria were caused by germs that were spread by mosquitoes. The notion that malaria was spread by a miasma or phlogistone was publicly ridiculed by rising physicians eager to earn a voice of authority in this new exciting age of healing. In describing the precautionary measures that Europeans were taking in the tropics, Ronald Ross, a physician of the Liverpool School of Tropical Medicine, said that people “impelled by this old superstition – and it is nothing more – …do the most outrageous and unnatural things in the hope of escaping infection”. Similarly, Patrick Manson, a well-renowned physician who had established a school of tropical medicine, gave a series of lectures outlining the various ways that pathogens manipulate the hospitable environment of the human body. Although this perspective is increasingly accurate with regards to pathology, not to mention it lays the foundation for further scientific research on disease, it fails to address one key question in medicine: why are public policy initiatives failing to deliver medical cures to the people that need them?
A fundamental problem in modern medicine lies in the transition between scientific discoveries at the bench and their delivery at the bedside. The colossal amount of scientific discoveries made in the 20th and 21st centuries is a testament to the importance that society places on the virtues of science. For example, during the Ebola outbreak in the early 90’s, the media overemphasized the role of science in stopping the outbreak. Instead of focusing on the root cause of the outbreak, which include poorly trained medical staff, insufficiency of resources caused by economic disparity, the media’s spotlight on the heroic scientific effort to stop the outbreak “increase[s] the ignorance regarding our biological relationship with our world”. Weldon asserts that “in lieu of taking responsibility for cleaning up our own messes …the truth has been disguised as a stimulating story that has to do more with myth than with science”. While this is true, to what extent should medical endeavors intrude on affairs of foreign nations? Similar to Weldon’s assertion, Paul Farmer shows that medicine that is “focused on individual risk and short on critical contextualization will not reveal these deep transformations nor will it connect them to disease emergence”. He shows that “the problem is not ‘too much science’, but too narrow a view of science relevant to medicine”. He asserts that the way to prevent future medical catastrophes is to establish some level of economic equality and education on the grounds that global health relies on the well being of global societies.
While Farmer and Weldon show a radically different perspective on global health, they are in many ways reflective of Livingstone, Lind, Manson and Ross. In the case of Livingstone and Lind, colonial Europe cared less about the well being of the indigenous inhabitants than what Africa could offer their country’s economies. The provision of western medicine in Africa was an aftereffect of embracing civilization. Similarly, the assertions made by Farmer and Weldon show that while there is no economic benefit to stabilizing socioeconomic inequality in Africa, the tradeoff that western civilization receives is in better global health. Also, just as Manson and Ross asserted that the body is not the causal agent of disease, but rather a host, Farmer and Weldon assert that international politics is the cause of disease, and not a harmless host. Manson and Ross changed medical research by focusing attention on agents that were scarcely investigated: what kinds of germs, viruses, and parasites caused disease and why. Farmer and Weldon did exactly the same thing, asking the public: what public policy enactments directly led to disease and why.
The global socioeconomic perspective that Farmer and Weldon advocate is strikingly different than any preceding medical view. The act of suffering because of a disease was always an intimate, individualistic one. Although as humans we empathize with one another, the agony, frustration, powerlessness, and insurmountable loss that can come with disease are unique human experiences. Hence, the notion that another person’s suffering can lead to one’s own is difficult to show. Also, embarking on a crusade to conquer disease by establishing economic and social stability is a politically risky and expensive endeavor. Farmer was right in showing that politics and economic policy deserve investigation in how they contribute to disease, however it raises questions on how much influence medicine should have in the world.
Medicine is built around the idea of lessening the suffering of our fellow man. The perspective that healers had on how to alleviate suffering changed dramatically throughout time. Perspectives changed from the Hippocratic humoral theory, to one based on climate, then science, and finally it rests on a socioeconomic theory. Although the defining feature of medicine is simply the alleviation of human suffering, medicine has now become an industry that craves the obliteration of disease. As the agenda of medical practice bleeds into the social and political realms, society must come to a conclusion on how important human suffering is, and how important it is to incessantly try to eliminate disease from the human condition.
Pinak S. Joshi is a pre-medical student who blogs at his self-titled site, Pinak S Joshi.