Erwin Ackerknecht. A Short Huto+y of Medicine. 3rd ed. rev. Baltimore: Johns Hopkins University Press, 1982. xx + 277 pp. $7.95 (paper) (Reviewed by Donald Fleming) Dr. Erwin Ackerknecht, trained at Leipzig and Baltimore by Henry E. Sigerist and

later Professor of the History of Medicine at the University of Wisconsin, Madison, before concluding his academic career as Director of the Institute of Medical History at the University of Zurich, is one of the leading medical historians of his generation. His principal works are the standard biography of the great nineteenth-century pathologist Rudolf Virchow and an admirable history of medicine as practiced at the Paris Hospital from 1795 to 1848.

The first edition of the present book appeared in 1955, with a revision in 1968. Though the current edition was published in 1982 and contains some updating in the brisk epilogue “Twentieth-Century Trends,” this remains essentially a book written from the perspective of about 1950. Organ transplants are barely mentioned, and molecular biology, genetic engineering, and test-tube babies are passed over in silence. The bibliographies are only occasionally, and it must be said rather arbitrarily, brought up to date. Sir Geoffrey Keynes’s life of William Harvey and Frank J. Sulloway’s major though controversial Freud: Biologist of the Mind are missing, and so are the classic multivolume works of Howard Adelmann on the pioneer microscopist Marcello Malpighi. But the most extraordinary omission is the great Dictionary of Scientific Biography (1970-1980), in which so many medical scientists are better portrayed and evaluated than ever before. I do not, of course, suggest that Professor Ackerknecht is un- acquainted with the DSB, to which he himself contributed. But no book on the history of medicine should fail to alert even the most elementary students to the existence of this in- comparable reference work.

If this volume cannot be said to pull abreast of current developments in medicine, it need not be any worse for that as a first entry into the history of the subject. The question then becomes the adequacy of Ackerknecht’s account as far down as it comes. The answer is important, for the book has been translated into other languages and almost certainly constitutes the single most widely read introduction to the history of their own calling for prospective physicians in more than one country. For those who hold, with Ackerknecht and the present reviewer, that something of the sort is an essential humaniz- ing element in the training of practitioners, this is a more significant work than its modest dimensions might suggest.

Judged by this admittedly high standard, the volume appears to deserve an equivocal though predominantly favorable verdict. The proportions are problematical, for almost half of the book is devoted to the period before 1600; and after allowing for the importance of Hippocrates and Galen, Paracelsus and Vesalius, this still seems ex- cessive. One result is to crowd the remainder of the author’s canvas with a good many names that he is reluctant to omit but of which he does not have time to say anything par- ticularly specific or memorable.

The true strength of the book lies in Ackerknecht’s summing up of the themes that he has made his own-the transformation of clinical medicine by the great Parisian observers at the bedside, followed by the reorientation of medicine toward the laboratory sciences, begun in Paris but definitively consummated in nineteenth-century Germany.

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The treatment of the twentieth century is less incisive. Perhaps this is inevitable; for with the arguable exception of an ever-increasing emphasis upon the prevention of illness, no changes as fundamental as those of the nineteenth century have occurred as yet, though they may be impending. With regard to the social context of medicine, Ackerknecht justifiably underscores the impact of peasants flooding into the big cities of western Europe in the nineteenth and twentieth centuries.

Ackerknecht is a man of prodigious learning, but on two fundamental points he seems to be in error. First, there is no warrant for stating (on pages 74-75) that in Galen’s system only a “small” portion of the blood reaching the right ventricle of the heart is dis- charged into the pulmonary artery (Galen’s “arterial vein”) as distinguished from the portion mistakenly conceived by him to be passing directly into the left ventricle through alleged pores in the interventricular septum. We simply do not know the relative propor- tions of the blood envisioned by Galen as passing through the alternative channels. The issue is historiographically momentous, for Ackerknecht embraces the traditional view of the modernization of medicine as entailing above all a liberation from Galenism, par- ticularly in the work of Harvey. But if Galen, despite his error about the pores in the sep- tum, said nothing to preclude a substantial pulmonary circulation as well, his authority can scarcely have been a major deterrent in Harvey’s eyes; and this view of the matter is borne out by a reading of Harvey himself.

Second, in his discussion of another famous crux in the history of science, Ackerknecht says on page 163 that Friedrich Wiihler’s synthesis of an organic com- pound, urea, was “of basic theoretical importance”-“It killed the romantic idea that ‘organic’ chemistry has its own laws.” But we now know that WGhler did not synthesize urea out of exclusively inorganic materials. Even if it is argued that since this was un- known until recently, the practical effect was the same as if he had done it, the fact is that few of his contemporaries seem to have paid any attention to the issue. Wohler’s work can scarcely have been a crucial episode in the downfall of vitalism.

With regard to matters for which Professor Ackerknecht may not be responsible, this book is gravely marred by errors that ought to have been caught by a great university press. Important names in the history of science or medicine, or of medical historiography, are misspelled: “Chevreuil” for Eugtne Chevreul, “Naunym” for Bern(h)ard Naunyn, “J. McAlpine” for Ida Macalpine, “H. J. Franklin” for K. J. Franklin. Theodor Schwann of the cell theory appears on one occasion as “Thomas.” The tail end of the list of Nobel laureates is scandalously inaccurate: “Conrad E. Block” for Konrad Bloch, “Howard Tenin” for Temin, “David H. Hubell” for Hubel. In the same list, Maurice Hugh Frederick Wilkins has been converted into two people by the in- sertion of a comma after “Hugh.” But the most egregious error consists in citing the Nobelist Charles Huggins in the text proper as “Hughes.” Editor’s Note: Professor Ackerknecht was offered an opportunity to respond to the review, but he declined to do so.